Angiographically evident thrombus following fibrinolytic therapy is associated with impaired myocardial perfusion in STEMI: a CLARITY-TIMI 28 substudy.

AIMS: The presence of residual thrombus following fibrinolytic therapy for ST-segment elevation myocardial infarction (STEMI) may predispose to greater embolization and microvascular dysfunction. METHODS AND RESULTS: We hypothesized that even in the presence of a patent epicardial artery, residual thrombus would be associated with worsened TIMI myocardial perfusion grades (TMPG), independent of epicardial flow. Data were analysed from the angiograms of 2684 patients enrolled in the CLARITY-TIMI 28 trial, with angiographically patent arteries (TIMI 2/3 flow) at a median of 88 h following fibrinolytic therapy. Thrombus in a patent epicardial artery was observed more frequently among patients with shorter times from randomization to angiography, among patients with non-left anterior descending infarctions, and among patients treated with placebo (vs. clopidogrel). Thrombus was associated with more frequent TIMI 2 flow (35.1 vs. 22.1%, P < 0.001), higher corrected TIMI frame counts (CTFC) (42 vs. 33 frames, P < 0.001), and a lower incidence of normal TMPG 3 (48.7 vs. 63.9%, P < 0.001), irrespective of treatment with clopidogrel or placebo. In multivariable analyses, thrombus remained associated with higher CTFC (P < 0.001) and worse TMPG (OR 1.6 for TMPG 0/1/2, P < 0.001) after adjustment for baseline covariates as well as known correlates of TMPG. The association between thrombus and impaired TMPG remained even after further adjustment for CTFC or TIMI flow grade. CONCLUSION: Residual angiographic thrombus following fibrinolytic therapy in STEMI patients is associated with impaired myocardial perfusion, independent of epicardial flow. This finding emphasizes the roles of platelet aggregation and distal embolization in the pathogenesis of microvascular dysfunction in STEMI.     

Dose escalation trial of the efficacy, safety, and pharmacokinetics of a novel fibrinolytic agent, BB-10153, in patients with ST elevation MI: Results of the TIMI 31 trial

Background: Currently available fibrinolytic agents are limited by their ability to restore normal blood flow in only half of patients, the risk of reocclusion, and the risk of intracranial hemorrhage. The genetically engineered agent BB-10153 is activated by thrombin, not plasminogen activator enzymes, which limits its activity to the site of thrombus which may in turn reduce the risk of systemic bleeding. BB-10153 also has a relatively long half-life of 3–4 hours, which may also limit the potential for early reocclusion [1, 2]. Methods: The study was a phase II, open-label, multi-center, dose escalation, single-dose administration study to determine the efficacy, safety, tolerability, pharmacokinetics and pharmacodynamics of BB-10153 in ST segment elevation MI (STEMI). STEMI patients (n = 50) received a single dose of BB-10153 at one of six dose levels (1.0, 2.0, 3.0, 5.0, 7.5 and 10 mg/kg). The primary endpoint was TIMI flow grade (TFG) 3 at 60 minutes following the intravenous bolus of BB-10153. Results: Mean area under the curve for drug concentration ranged from 48.0 μg⋅h/mL in the 1 mg/kg dose group to 788.6 μg⋅h/mL in the 10 mg/kg dose group. Likewise, mean C_max generally increased with dose over the entire dose range, from 4.9 μg/mL in the 1 mg/kg dose group to 139.6 μg/mL in the 10 mg/kg dose group. The mean apparent terminal half-life (t1/2) was 4.4 hours (range 2.2 to 7.6 hours). Few patients in the 1–3 mg/kg dosage groups achieved TFG 3 on the one-hour post-dose angiogram (4/20, 20%), and no patients achieved complete ST segment resolution. The 5, 7.5 and 10 mg/kg doses were associated with similar rates of TIMI grade 3 flow of approximately three per seven patients. Pooling TFG 3 data from the 5, 7.5 and 10 mg/kg groups yielded a TIMI grade 3 flow rate of 34% (n = 10/29; range 29–43%). No patients experienced 30-day death, recurrent acute MI, cardiogenic shock, stroke or anaphylaxis during the study. One patient experienced recurrent angina and developed recurrent myocardial ischemia requiring urgent revascularization. Three patients sustained TIMI major bleeding events (one in 1 mg/kg group, two in 7.5 mg/kg group), six patients sustained TIMI minor bleeds (one in the 2, 3, 7.5 and 10 mg/kg groups, two in the 5 mg/kg group), twp patients sustained TIMI minimal bleeds (one in each of the 2 and 10 mg/kg groups) and no patients sustained intracranial hemorrhage (ICH). Conclusion: In a dose escalation study of a single intravenous bolus, the novel fibrinolytic agent, BB-10153 was associated with a rise in the mean area under the curve and C_max for drug concentration over the dose range 1 to 10 mg/kg. Higher doses were associated with a range of TIMI grade 3 flow of 29–43%, and no patients experienced 30-day death, recurrent acute MI, cardiogenic shock, stroke or anaphylaxis during the study. Condensed abstract In a dose escalation study of a single intravenous bolus, the novel fibrinolytic agent, BB-10153 was associated with a rise in the mean area under the curve and C_max for drug concentration over the dose range 1 to 10 mg/kg. Higher doses were associated with a range of TIMI grade 3 flow of 29–43%, and no patients experienced 30-day death, recurrent acute MI, cardiogenic shock, stroke or anaphylaxis during the study.     

Correlation between infarct-related coronary artery patency and predischarge electrocardiographic patterns in patients with first anterior myocardial infarction who received thrombolytic therapy

The aim of this study was to investigate the correlation between the ST-segment and T-wave patterns in predischarge electrocardiogram and patency of left anterior descending coronary artery in patients with a first anterior myocardial infarction (AMI). One hundred and fifty-six of 175 consecutive patients who were admitted to our clinic between January 2000 and September 2002 due to a first episode of transmural AMI and who received thrombolytic therapy were enrolled. Coronary angiography was performed by the Judkins method on the 6th–10th day after the acute infarction. The corrected TIMI frame count (CTFC) was estimated according to the previously described method. According to the combination of the ST-segment and T-wave morphology on the day (6–10) of cardiac catheterization, patients were classified into four groups: group A, ST elevation 0.1mV and negative T waves; group B, ST elevation 0.1mV and negative T waves; group C, ST elevation 0.1mV and positive T waves; and group D, ST elevation 0.1mV and positive T waves. Of the 99 patients with negative T waves, 47 (48%) had CTFC 27, 32 (32%) CTFC between 27 and 40, 15 (15%) CTFC 40–100, and 5 (5%) CTFC 100. Of the 57 patients with positive T waves, CTFC was 27 in 14 (25%), between 27 and 40 in 17 (30%), 40–100 in 11 (19%), and 100 in 15 (26%) (P 0.001). From the 76 patients with an isoelectric ST segment, 38 (50%) had CTFC 27, 29 (38%) CTFC between 27 and 40, 8 (11%) CTFC 40–100, and 1 (1%) CTFC 100. Of the 80 patients with an elevated ST segment, 23 (29%) had CTFC 27, 20 (25%) CTFC between 27 and 40, 18 (23%) CTFC 40–100, and 19 (23%) CTFC 100 (P 0.001). Use of the combination of two electrocardiographic parameters (ST segment and T waves) also indicated that there were significant differences between groups A and D, and groups B and D (P 0.001 and P 0.05, respectively). Development of an isoelectric ST segment with negative T waves may indicate a better degree of reperfusion after AMI. In contrast, patients in whom ST-segment elevation and positive T waves remain at discharge from the coronary care unit have a higher probability of a nonpatent left anterior descending artery.     

QT dispersion as a predictor for arrhythmias in patients with acute ST elevation myocardial infarction

Aims and Objectives

To study the effect of Heart Rate Variability (HRV) and QT dispersion (QTd) in patients presenting with Acute ST elevation myocardial infarction (STEMI).

Methods

This is a retrospective study conducted on patients admitted with the diagnosis of acute ST elevation myocardial infarction. In all 100 patients with acute myocardial infarction in one year were subjected to a complete evaluation in terms of history and examination. Besides routine investigations standard 12 lead ECG was evaluated in all cases on admission, after 4 hrs, 24 hrs, 48 hrs and on discharge.

Results

The most common presenting symptoms were chest pain (88%) and dyspnea (50%). Tachycardia was seen in 56% while congestive heart failure was present in 29% patients. Patients who died had a higher QTd in comparison to patients who survived.

Conclusions

Markers of autonomic regulation of heart like QTd provides valuable information about the future course of events in a patient following acute STEMI which can be utilized to plan the future course of management in patients especially predisposed to adverse and catastrophic outcomes.     

ST段抬高型急性心肌梗死患者入院时心电图表现的临床意义

目的:评价ST段抬高型急性心肌梗死(STEMI)患者入院时心电图缺血程度(ST段抬高和QRS波终末扭曲)对梗死范围和住院期间病死率判断的价值。方法:入选STEMI患者122例,发病时间均在12h以内,根据入院时心电图表现分为非QRS波终末扭曲组(n=73)和QRS波终末扭曲组(n=49),住院期间记录一般临床特征、动态监测肌酸激酶(CK)和肌酸激酶同工酶(CK-MB)水平,并记录住院期间死亡例数。结果:QRS波终末扭曲组发病年龄较大(P=0.001),ST段抬高导联数多(P=0.025)及入院时Killp分级>1者例数多(P=0.044),有较高的CK[(1526.5±1180.4)IUvs(2129.7±1414.1)IU,P=0.012]和CK-MB[(137.1±109.0)IUvs(184.9±117.0)IU,P=0.023]水平。2组住院期间病死率分别为6.8%vs20.4%,Logistic回归证实住院期间病死率与QRS波终末扭曲呈明显的相关性(OR值7.14,95%可信区间1.17～43.60,P=0.016)。结论:入院时心电图QRS波终末扭曲对STEMI患者梗死范围大小和住院期间病死率有独立的预测价值。     

PCI联合血栓抽吸术治疗急性ST段抬高型心肌梗死的效果

目的 探究经皮冠状动脉介入术（PCI）联合血栓抽吸术治疗急性ST段抬高型心肌梗死（STEMI）的效果。方法 选取2014年11月—2017年11月我院收治的86例STEMI患者作为对象,经随机数字表法将之均分为两组,单纯PCI组行PCI治疗,联合组行血栓抽吸+PCI治疗,此外,两组均予盐酸替罗非班治疗。比较两组术后TIMI血流分级情况、支架植入2h后一般情况及主要不良心血管事件（MACE）发生情况。结果 支架植入后,联合组TIMI血流分级Ⅱ级+Ⅲ级患者的比例95.3%（41/43）显著高于单纯PCI组76.7%（33/43）（P＜0.05）;支架植入2h后,观察组cTnT峰值及CK-MB峰值显著低于对照组,ST段回落＞50%的比例及术后10d的LVEF显著高于对照组（P＜0.05）;住院期间和术后5个月内,两组MACE发生率相比,差异无统计学意义（P＞0.05）。结论 PCI联合血栓抽吸术治疗STEM能够有效改善冠脉血流和左心室功能,促进梗死区域的心肌灌注,改善患者短期预后。     

急性ST段抬高心肌梗死的最佳支架植入时机:即刻与延迟植入比较的Meta分析

目的:收集比较有关发生急性ST段抬高心肌梗死(STEMI)时即刻植入支架(IS)和延迟植入支架(DS)的随机对照和队列研究,对其结果进行系统评价和Meta分析,比较IS和DS的安全性和有效性。方法:在PubMed、Cochrane Library、中国知网3大数据库检索2017年5月前关于比较IS和DS安全性和有效性的文章,将IS患者作为实验组(IS组),DS患者组作为对照组(DS组),以主要心脏不良事件(MACE)发生率、慢血流/无复流发生率、远端栓塞发生率、靶病变血管开通率(TIMI 3级)、靶血管再次血运重建(TVR)率、主要出血发生率、再次心肌梗死发生率作为观察指标,使用Review Manager 5.3软件进行Meta分析,计算对应的OR值和95%CI,并分析异质性及其来源。结果:最终有8篇文献纳入Meta分析,包括2 181例患者,其中IS组1 262例,DS组919例。与IS相比,DS能够显著降低慢血流/无复流发生率(OR=4.55,95%CI:2.14~9.68)、远端栓塞发生率(OR=9.14,95%CI:3.47~24.10),提高靶病变血管开通率(TIMI 3级)(OR=0.22,95%CI:0.12~0.43);然而两组在MACE发生率、TVR率、再次心肌梗死发生率、主要出血发生率方面相比无明显差异。结论:在STEMI患者中,DS与IS在MACE发生率、TVR、再次心肌梗死发生率与主要出血发生率方面无明显差异;DS慢血流/无复流发生率与远端栓塞发生率均较IS低,靶病变血管开通率(TIMI 3级)较IS高。     

aVR导联ST段抬高对非ST段抬高型急性心肌梗死的意义

目的：探讨aVR导联ST段抬高（ ST segment elevation ,STSE）对于非STSE型急性心肌梗死（ acute myocardial infarction , AMI ）的预测价值。方法回顾性分析425例非STSE 型AMI患者的心电图资料,并观察各导联ST段压低情况及是否存在T波倒置。对所测定数据进行整理和统计学处理。结果 aVR导联STSE多见于完全性右束支阻滞、左心室肥厚以及V1导联STSE的患者,在其他导联广泛ST段压低的患者中也较为多见;此类情况在T波倒置患者中较少见。本研究中,22例在住院时死亡,其中5例死于心源性休克。患者住院死亡率的不断升高和aVR导联STSE的等级不断上升相关。多重变量分析表明,aVR导联STSE已经成为预测住院死亡的独立重要变量。 aVR导联STSE大都与住院患者的心肌缺血时间以及发生心力衰竭相关,但是与血清肌酸激酶或肌酸激酶同工酶 MB 的水平高低没有相关性。结论如果aVR导联STSE和严重冠状动脉病变之间的联系,能够在大样本非STSE型AMI患者群体中得到进一步验证,那么aVR导联STSE就可以成为选择早期介入治疗患者的一个较为有用的指标。     

Quantitative Comparison of Coronary Artery Flow and Myocardial Perfusion in Patients with Acute Myocardial Infarction in the Presence and Absence of Recent Cocaine Use

Background: Numerous factors have been implicated in the pathogenesis of cocaine associated myocardial infarction (CAMI). However, the relative contributions each of these mechanisms provide to the pathogenesis of CAMI have not been well defined. We hypothesized that significant angiographic differences exist between CAMI patients vs thrombotic AMI patients (TAMI) and normal controls. Methods: The TIMI Flow Grade, corrected TIMI Frame Count (CTFC), TIMI Myocardial Perfusion Grade (TMPG), presence of triple-vessel disease, stenosis severity, and presence of angiographically apparent thrombus were compared in patients who sustained CAMI to TAMI patients and normal controls. Results: 2,495 angiograms were analyzed (CAMI = 57, TAMI = 2,403, Controls = 35). Impairment in both epicardial and microvascular flow in patients with CAMI was intermediate between TAMI and controls. Compared to TAMI patients, CAMI patients were less likely to have 3 vessel disease (8.9% vs. 19.1%; p < 0.05), epicardial stenosis was less severe (14.9+/–30.2 vs. 72.6+/–18.6; p < 0.0001), less thrombus was present (6.5% vs. 33.1%; p < 0.001) and TIMI grade 3 flow was observed more frequently (76% vs. 59%). Normal TMPG 3 perfusion was significantly impaired in both CAMI and TAMI patients when compared to controls without AMI (TMPG 3 was 40% and 26.6% vs. 100% respectively; p < 0.001 for both). The majority of patients in both AMI groups had diminished or absent tissue level perfusion (TMPG 0 flow, CAMI 53.9 vs. TAMI 56.8%). Conclusions: Both epicardial and microvascular flow is impaired in CAMI. While epicardial flow among CAMI patients is slightly better than TAMI patients, the incidence of little or severely impaired tissue level perfusion is nearly identical.     

Dobutamine- vs exercise-induced ST segment elevation early after Q wave myocardial infarction. Prediction of functional recovery after revascularization.

AIMS: The association between stress-induced ST elevation and functional recovery following revascularization after myocardial infarction remains unclear. We assessed the relative accuracy of dobutamine- and exercise-induced ST elevation in Q wave leads in predicting functional recovery following revascularization, and we investigated the relationship of ST elevation to different wall motion responses to dobutamine. METHODS AND RESULTS: Thirty-nine patients underwent dobutamine stress echo and exercise test 8+/-2 days after Q wave myocardial infarction. All patients underwent angiography and subsequent revascularization. Follow-up echocardiograms were obtained 7+/-4 weeks after revascularization. Functional recovery was assessed by the difference between the baseline and the follow-up asynergy index. Nineteen patients (48%) developed dobutamine- and exercise-induced ST elevation. There was significant agreement between the tests (k=0.58, P<0.001). We found a significant correlation between dobutamine and exercise-induced ST elevation with functional recovery following revascularization (r=0. 45, P<0.005 and r=0.7, P<0.001, respectively). The parameters with the highest predictive value for functional recovery were: (a) the biphasic response during dobutamine infusion, (b) the development of ST elevation in both tests, and (c) the development of exercise-induced ST elevation in more than three leads. CONCLUSION: There is a strong association between dobutamine- and exercise-induced ST elevation with functional recovery following revascularization. Exercise-induced ST elevation in more than three leads and a biphasic response during dobutamine infusion accurately predict functional recovery.     

aVR导联ST段抬高对急性心肌梗死预后的价值

目的探讨心电图aVR导联ST段抬高对急性前壁心肌梗死患者预后的价值。方法首次入院急性前壁心肌梗死患者57例，对其心电图和冠状动脉造影及临床资料进行对比分析。根据心电图aVR导联ST段变化分为抬高组、无偏移组。结果梗死相关血管为左主干病变的ST段抬高组、ST段无偏移组分别为5例（21．7％）、1例（2．9％），两组统计有显著性差异（p〈0．01）；病变范围为多支病变ST段抬高组、ST段无偏移组分别为10例（43．4％）、8例（23．5％），两组统计有显著性差异（p〈0．05）；发生心脏事件ST段抬高组、ST段无偏移组分别为8例（34.8％）、3例（8．8％），两组有显著性差异（p〈0．01）。结论aVR导联ST段抬高对预测急性前壁心肌梗死患者的预后有重要的价值，应高度重视。     

高龄急性ST段抬高型心肌梗死患者临床特征及冠脉造影分析

【摘要】 目的 探讨高龄急性ST段抬高型心肌梗死( STEMI) 患者的临床特征及冠状动脉造影特点。方法 将临床确诊为STEMI年龄≥75 岁的97例患者( 高龄组) 与＜75岁的92例患者( 非高龄组) 进行对照研究,分析其临床特征和冠状动脉造影特点。结果 高龄组的STEMI 危险因素中合并高血压、糖尿病、高血脂、陈旧性心肌梗死、脑卒中史及肺功能减退的比例高于非高龄组,而吸烟史和AMI 阳性家族史低,但差异无统计学意义。高龄患者既往经皮冠状动脉介入治疗（PCI）、肾功能减退（肾小球滤过率降低）较对照组多, 分别是(24.7% VS 10.9%;52.1 4.2 VS 63.7 2.3ml/min.1.73 m2,P<0.05 )。高龄组不典型胸痛更多见,约占34.1%,主要表现为呼吸困难（16.5% VS 6.5%,P<0.05）。其他症状,如消化道症状及晕厥,未达到统计学差异 （13.4% VS 5.4%, P>0.05;5.2% VS 5.4%, P>0.05）。心功能KillipⅠ级在高龄组低于对照组(51.5% VS 71.7%,P<0.01),而KillipⅡ-Ⅲ级则高于对照组(38.2% VS 22.9%,P<0.05),均具有统计学意义。高龄组冠脉多支病变、侧支建立、复杂病变明显高于对照组,分别是（81.4% VS 65.2%,P<0.05;82.5% VS 68.5%,P<0.01;61.1% VS 47.8%,P<0.05）,差别具有统计学意义。结论 高龄STEMI患者既往PCI、肾功能减退、不典型胸痛更多见,冠状动脉多支病变、侧支建立、复杂病变的发生率显著增高。     

T wave inversions in leads with ST elevations in patients with acute anterior ST elevation myocardial infarction is associated with patency of the infarct related artery

Objectives

Following reperfusion therapy, early T wave inversions (TWI) have been shown to be a marker of successful reperfusion. We aimed to evaluate the relationship of TWI on the presenting ECG with spontaneous reperfusion as assessed by coronary angiography in patients with ST elevation (STE) myocardial infarction (STEMI).

Methods

Data of 146 consecutive patients presenting to the St. Luke's Episcopal Hospital Emergency Department with acute STEMI undergoing primary percutaneous coronary intervention (p-PCI) between January, 2007 and October, 2010 were retrospectively analyzed. Clinical data, ECG and angiographic data were reviewed. Patients were dichotomized based on T wave morphology on the presenting ECG into 2 groups – those with TWI and those with positive T waves (PTW).

Results

Thirty-one patients (21.2%) had TWI, while 115 (78.8%) had PTW. Sixty-four (43.8%) patients had anterior STE and 75 (51.3%) had inferior STE. Anterior STE was more likely to have TWI than non-anterior (29.7% vs. 14.6; p = 0.014). By angiography, infarct related artery (IRA) patency (TIMI 2–3 flow) was seen in 45 (30.8%). TWI was more likely to be associated with IRA patency compared to PTW (51.6% vs. 25.2%; p = 0.008). In patients with anterior STEMI and TWI, patent IRA was seen more frequently compared to those with PTW (68.4% vs. 20%; p < 0.001). There was no association of T wave morphology and TIMI flow in patients with non-anterior STEMI. Patients presenting with stuttering symptoms were more likely to have TWI (70.4% vs. 10.2%; p < 0.001) suggesting recurrent episodes of reperfusion and ischemia.

Conclusions

In anterior STEMI patients, TWI on the presenting ECG is associated with spontaneous reperfusion. This relationship was not found among patients with non-anterior STEMI.     

心电图 Ⅱ,Ⅲ导联ST段抬高比值在判定下壁心肌梗死病变血管中的作用

目的 :通过心电图早期识别下壁心肌梗死的病变血管是右冠状动脉 （RCA）还是左回旋支 （L CCA） ,为临床处理和预防并发症提供帮助。方法 :对 2 73例下壁心肌梗死患者的心电图 , 导联 ST段比值 （ST / ）和冠脉造影结果进行分析。结果 :ST / =1检测 L CCA的特异度、敏感度、阳性预测值和阴性预测值分别为 81% ,97% ,86%和96% ;ST / <1对检测 RCA的敏感度、特异度、阳性预测值和阴性预测值分别为 97% ,91% ,98%和 89% ;而 ST →检测 LCCA的敏感度、特异度、阳性预测值和阴性预测值分别为 75 % ,96% ,82 %和 94% ;ST ↓检测 RCA的敏感度、特异度、阳性预测值和阴性预测值分别为 96% ,81% ,96%和 84%。结论 :这 4种新方法对判断下壁心肌梗死相关血管的敏感度和特异度均较高 ,且简便实用     

Feasibility and applicability of computer‐assisted myocardial blush quantification after primary percutaneous coronary intervention for ST‐segment elevation myocardial infarction

Objectives : The aim of the study was to evaluate whether the “Quantitative Blush Evaluator” (QuBE) score is associated with measures of myocardial reperfusion in patients with ST‐segment elevation myocardial infarction (STEMI) treated in two hospitals with 24/7 coronary intervention facilities. Background : QuBE is an open source computer program to quantify myocardial perfusion. Although QuBE has shown to be practical and feasible in the patients enrolled in the Thrombus Aspiration during Percutaneous Coronary Intervention in Acute Myocardial Infarction Study (TAPAS), QuBE has not yet been verified on reperfusion outcomes of primary percutaneous coronary intervention (PCI) patients treated in other catheterization laboratories. Methods : Core lab adjudicated angiographic outcomes and QuBE values were assessed on angiograms of patients who were enrolled in the PRoximal Embolic Protection in Acute myocardial infarction and Resolution of ST‐Elevation (PREPARE) trial. ST‐segment resolution immediately after PCI measured by continuous ST Holter monitoring was calculated by a blinded core lab. Results : The QuBE score could be assessed on 229 of the 284 angiograms (81%) and was significantly associated with visually assessed myocardial blush grade (P < 0.0001). Patients with improved postprocedural Thrombolysis in Myocardial Infarction‐graded flow, myocardial blush grade, ST‐segment resolution immediately after PCI, or a small infarct size measured by peak CK‐MB had a significant better QuBE score. Conclusions : QuBE is feasible and applicable at angiograms of patients with STEMI recorded at other catheterization laboratories and is associated with measures of myocardial reperfusion. © 2010 Wiley‐Liss, Inc.     

The prognostic role of serum uric acid level in patients with acute ST elevation myocardial infarction

Objectives

The role of uric acid as a prognostic factor in patients with acute ST elevation myocardial infarction is controversial. The purpose of this study was to demonstrate the relationship between serum uric acid level and mortality during admission period and 30-day period after admission.

Methods

We assessed the relation between serum uric acid level and in-hospital and short-term mortality rates in 184 patients admitted with acute ST elevation myocardial infarction. We divided the patients according to their gender and uric acid level measured on admission into four groups: group A₁: men with uric acid ⩽7 mg/dl versus group B₁: men with uric acid >7 mg/dl and group A₂: women with uric acid ⩽5.6 mg/dl versus group B₂: women with uric acid >5.6 mg/dl. The patients were followed for 30 days after admission.

Results

In-hospital mortality rate in group B₁ was higher than group A₁ [P value: 0.011, Relative risk: 13.33 (95% confidence interval: 1.55–114.7)]. Short-term all-cause mortality was significantly higher in group B₁ patients [P value: 0.037, Relative risk: 3.3 (95% confidence interval: 1.02–10.64)]. Multivariate logistic regression analysis of data showed an odds ratio of 15.23 for in-hospital mortality and odds ratio of 3.76 for short-term mortality in male hyperuricemic patients.

Conclusions

Our data suggest that in the acute phase of ST elevation myocardial infarction, uric acid has a prognostic role for in-hospital and short-term (30-day) mortality in men.     

ST段抬高型急性心肌梗死溶栓后心电图改变的临床意义

目的通过分析急性心肌梗死抬高的ST段下降幅度,评价溶栓治疗过程中ST段改变对患者心功能的预测价值。方法96例ST段抬高型急性心肌梗死患者,入院后行溶栓治疗,并计算溶栓后2h内ST段抬高振幅总和(ΣSTE)的下降幅度。结果溶栓治疗2h后,ΣSTE较溶栓治疗前下降大于50%时,病人自觉胸痛症状消失,心功能得到较好保护。而ΣSTE较治疗前下降小于50%时,患者心功能不同程度受损。结论ST段抬高型急性心肌梗死的患者经早期溶栓治疗后,其抬高的ST段下降幅度可作为心肌血供能否恢复的间接预测指标,从而能较准确地反映心肌再灌注情况及预测心功能状态。     

ST段抬高型急性心肌梗死溶栓后心电图改变的临床意义

目的通过分析急性ST段抬高型心肌梗死（STEMI）患者治疗后抬高的ST段下降的幅度，评价溶栓治疗过程中ST段改变对STEMI患者心功能的预测价值。方法105例急性STEMI患者，入院后行溶栓治疗，并计算溶栓后2h内ST段抬高总和的下降幅度。结果溶栓治疗2h后，ST段抬高振幅总和较溶栓治疗前下降大于50％时，病人自觉胸痛症状消失，心功能得到较好的保护。而ST段抬高振幅总和较治疗前小于50％时，患者心功能不同程度受损。结论急性STEMI患者经早期溶栓治疗后，抬高的ST段下降幅度可作为心肌血供能否恢复的间接预测指标，从而能较准确地反映心肌再灌注情况及预测心功能状态。     

血栓弹力图评价替格瑞洛和氯吡格雷在急性ST段抬高型心肌梗死中抗血小板的疗效

目的:通过血栓弹力图评价替格瑞洛和氯吡格雷在急性ST段抬高型心肌梗死(STEMI)中抗血小板的疗效。方法:60例STEMI患者分为两组,阿司匹林+氯吡格雷组(Ⅰ组,n=30)和阿司匹林+替格瑞洛组(Ⅱ组,n=30),于抗血小板药物负荷剂量给药2 h后和维持治疗3个月后,使用血栓弹力图检测花生四烯酸(AA)途径和二磷酸腺苷(ADP)受体途径诱导的血小板抑制率。结果:抗血小板药物负荷剂量给药2 h后和维持治疗3个月后,Ⅱ组ADP受体途径诱导的血小板抑制率均明显高于Ⅰ组[(54.67±5.83)%对(45.75±16.72)%,P0.05;(59.53±12.18)%对(45.10±16.26)%,P0.05],AA途径诱导的血小板抑制率两组间无明显差异,患者的出血和缺血事件发生率两组间无明显差异。结论:替格瑞洛较氯吡格雷在STEMI治疗中能更快速充分地抑制血小板,血栓弹力图可用于指导STEMI患者抗血小板治疗。