急性ST段抬高心肌梗死急诊介入术中再灌注心律失常的临床特点分析

目的分析急性ST段抬高心肌梗死（STEMI）患者急诊经皮冠状动脉介入术中（PCI）再灌注心律失常的临床特点。方法回顾性分析我院收治的经急诊PCI治疗的STEMI患者112例,分析再灌注心律失常的种类、再灌注心律失常与梗死相关动脉的关系以及与发病至冠脉再通时间之间的关系。结果STEMI急诊PCI中再灌注心律失常发生率为48．21％。前降支闭塞引起的再灌注心律失常以快速型心律失常为主,右冠状动脉及回旋支闭塞以缓慢型心律失常为主。梗死后6h内开通冠状动脉者再灌注心律失常发生率高于6h以上开通者（P〈0．05）。结论再灌注心律失常是STEMI患者行急诊PCI的常见并发症,其类型与梗死相关动脉及冠脉再通时间有关。     

易化的经皮冠脉介入治疗——急性心肌梗死治疗新策略

急性心肌梗死再灌注治疗的方法主要包括溶栓和紧急经皮冠脉介入治疗,其中溶栓治疗简单易行,但再灌注不充分,并且再闭塞率高;而直接经皮冠脉介入治疗,可以恢复心外膜血管的血流,血管的开通率高,但是只有在有条件的医院才能进行,而对于急性心肌梗死来讲,血管开通的时间是最重要的,因此,人们试图通过将溶栓治疗和经皮冠脉介入治疗联合应用来发挥各自的优势,尽量减少缺陷来尽快恢复心脏血流供给,也就是采用易化经皮冠脉介入治疗的方法来治疗急性ST段抬高心肌梗死,从而获得梗死相关动脉更早的开通和更高的开通率。     

Percutaneous Coronary Intervention for Acute Myocardial Infarction in a Single Coronary Artery Anomaly

We report on a case of an adult male patient with previously unknown coronary anomaly and acute myocardial infarction in the territory of the left anterior descending artery (LAD). The coronary angiography showed a single coronary artery with intertruncal course, arising from the right coronary sinus, and thrombotic occlusion of the LAD. Successful transradial percutaneous coronary intervention was done with implantation of an intracoronary stent in the occluded artery. The postprocedural course was complicated by ventricular tachycardia, congestive heart failure, and mild transient renal failure. In conclusion, transradial percutaneous coronary intervention is safe and feasible in rare coronary artery anomalies even in an emergent setting. The finding of an anomalous coronary artery should not be a reason to decline performing coronary intervention. Copyright © 2009 Wiley Periodicals, Inc.     

Clinical Characteristics and Outcomes in Young Patients With ST-Segment Elevation Myocardial Infarction After Primary Percutaneous Coronary Intervention

Background

There are few published studies of ST-segment elevation myocardial infarction (STEMI) in younger individuals. The differences between these “younger” and “older” individuals may not be fully appreciated by clinicians. The aim of this study was to determine the reasons for the earlier presentation and help to identify strategies for prevention of recurrent myocardial infarction (MI) in younger patients.

急性心肌梗死经皮冠状动脉介入治疗研究进展

急性心肌梗死的治疗主要涉及药物和介入治疗两个方面。及时有效的经皮冠状动脉介入治疗能迅速开通阻塞的冠状动脉、挽救濒死心肌,降低急性心肌梗死病人的病死率和病残率。现就有关急性心肌梗死的经皮冠状动脉介入治疗研究进展作一综述。     

Unusual Evolution of ST Elevation Acute Myocardial Infarction

We report a case of acute ST‐segment elevation myocardial infarction with an unusual evolution of ST‐segment elevation. Several possible explanations of this progression are discussed with supportive evidence for each explaination. The clinical, electrocardiographic, and angiographic features of this case are also illustrated.     

Incidence,Predictors and Outcomes of Contrast Induced Nephropathy in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Background:Contrast induced nephropathy (CIN) is considered one of the most common causes of hospital acquired renal failure and severely affects morbidity and mortality. Our objective was to investigate incidence, predictors and outcomes of CIN in patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI).Methods:The study was conducted on 550 patients with STEMI subjected to PPCI. Patients were classified into two groups according to the occurrence of CIN; group I (Patients without CIN) and group II (Patients with CIN). The two groups were assessed for the clinical outcomes including mortality and major adverse cardiac events (MACE).Results:Incidence of CIN was 10.6%, multivariate regression analysis identified the independent predictors of CIN including; age > 60 years OR 6.083 (CI95% 3.143–11.77, P = 0.001), presence of diabetes mellitus OR 2.491 (CI95% 1.327–4.675, P = 0.005), non-steroidal anti-inflammatory drugs (NSAIDs) use OR 2.708 (CI95% 1.393–5.263, P = 0.003), the volume of contrast agent >200 ml OR 6.543 (CI95% 3.382–12.65, P = 0.001) and cardiogenic shock OR 4.514 (CI95% 1.738–11.72, P = 0.002). Mortality was higher in group II than group I (11.9% vs. 4.4% respectively, P = 0.015). The incidence of MACE were higher in group II than group I (heart failure; 18.6% vs. 7.3%, cardiac arrest; 8.5% vs. 2.8% and cardiogenic shock; 16.9% vs. 6.9% with P. value = 0.003, 0.024, 0.007 respectively).Conclusion:Contrast induced nephropathy was associated with increased morbidity and mortality. The independent predictors of CIN were advanced age, diabetes mellitus, NSAIDs use, the volume of contrast agent >200 ml and cardiogenic shock.     

Myocardial infarction: contemporary management strategies

Myocardial infarction (MI) is a common clinical diagnosis, associated with significant morbidity and mortality, not only in the short term, but also years following the index event. A more complete understanding of the pathophysiology of MI has ushered the era of multipronged treatment approach, with a combination of goal-directed revascularization, a broad adjunctive pharmacological therapy and aggressive secondary prevention measures. The goals of this article are to review the basic pathophysiological processes, which lead up to a clinical diagnosis of MI, to highlight the essential elements of clinical presentation and to summarize the evidence for comprehensive therapy. Emphasis has been placed on the choice of primary reperfusion therapy for ST-elevation MI, on risk-stratification of patients with non-ST elevation MI, and on rationale behind the selection of anti-ischaemic and antithrombotic therapy. Finally, evidence-based approach to secondary prevention is outlined.     

Acute Myocardial Infarction with Severe ST Segment Elevation Treated with Percutaneous Coronary Intervention More than Two Days after Onset: A Case with Remarkable Recovery

The patient was a 65-year-old man with marked ST-elevation myocardial infarction. Cardiac catheterization revealed an occluded middle portion of the left anterior descending artery and no collateral circulation. Percutaneous coronary intervention (PCI) was performed, and ST elevation improved 5 days after PCI. Almost all electrocardiogram (ECG) findings were normal 6 months later. Echocardiographic findings were also normal. This case was very successful and unusual in that no ventricular aneurysm formed despite ST elevation continuing for a few days and that ECG and left ventricular function were nearly normal after PCI performed days after the onset in a case without collateral circulation.     

Serial Doppler Echocardiographic Assessment of Diastolic Dysfunction during Acute Myocardial Infarction

Objectives: We performed serial Doppler echocardiography in patients with ST‐elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) to describe the temporal changes in Doppler parameters following STEMI. Background: Data on comprehensive Doppler assessment of diastolic dysfunction following STEMI, incorporating tissue Doppler imaging (TDI), are lacking. Severe diastolic dysfunction in stable patients usually manifests as a restrictive mitral filling pattern (RFP), reduced TDI‐derived annular velocities (E'), and elevated E/E' ratios >15. Methods: Twenty‐eight patients (19 males, mean age 60 ± 10 years) with a first‐ever STEMI who underwent PCI were prospectively assessed with echocardiography and invasive left ventricular end‐diastolic pressure (LVEDP) measurements prior to PCI. Repeat echocardiograms were performed at day 3 and 12 months. Results: During STEMI: (i) LVEDP was significantly elevated but decreased post revascularization (26.1 ± 6.2 vs. 20.8 ± 5.2 mmHg, P = 0.002); (ii) the predominant mitral inflow pattern was an abnormal relaxation pattern (n = 14 [50%]), whereas restrictive filling pattern was only observed in seven (25%) patients; (iii) E' velocities were only modestly reduced (septal E' 7.4 ± 2.2 cm/sec, lateral E' 9.6 ± 2.2 cm/sec), and (iv) a septal E/E'ratio >15 seen in only one patient, whereas all other patients had an E/E' ratio of 8–15. Serial TDI showed that E'velocity decreased at day 3 (septal E' 7.4 ± 2.1 cm/sec vs. 5.9 ± 1.6 cm/sec, P = 0.002) and remained reduced at 1 year follow‐up, suggesting persistence of diastolic dysfunction. Conclusions: During STEMI, contrary to findings in stable patients, the predominant Doppler manifestation of the severe diastolic dysfunction and elevated LVEDP was an abnormal relaxation mitral inflow pattern accompanied by E/E' ratios of 8–15. Serial Doppler assessment suggests incomplete diastolic recovery following STEMI.     

经皮冠状动脉介入治疗相关性心肌梗死研究进展

经皮冠状动脉介入治疗（PCI）目前在全世界普遍开展,已成为冠心病治疗过程中的一个重要手段,PCI相关的心肌梗死是PCI术后影响患者预后的一个并发症。对PCI相关性心肌梗死的研究是当前冠状动脉介入研究的热点,其定义、发生机制、以及与自发性心肌梗死的区别等仍存在许多争议。现综合近几年围手术期心肌梗死的研究结果,总结了围手术期心肌梗死研究的最新进展。