Glucose-Insulin-Potassium (GIK) for Acute Myocardial Infarction: A Negative Study with a Positive Value

Summary. Glucose-insulin-therapy for acute myocardial infarction (AMI) has had a long history, going back 37 years to the pioneering concepts of Sodi-Pallares. Although a recent meta-analysis of a number of smaller trials has suggested mortality benefit, it is only the South American trial, published in Circulation in 1998, that has been large enough to show a mortality benefit of GIK infusions when compared with controls in the same trial. In contrast, the Polish study published in this issue of this journal produced a negative result. The two chief differences between the studies are the much higher risk of mortality of the patients chosen for the positive trial, and the much higher dose of GIK that was used. Despite this positive trial information, and the very extensive experimental background (which is here reviewed), the present data are not firm nor extensive enough to support the routine use of GIK in patients with AMI. Thus more trials based on the concepts of metabolic therapy are required and are being organized. At present, a careful strategy of patient selection is advocated. In the case of diabetics with AMI, current evidence is already strong enough to recommend routine use of modified GIK for all such patients.     

急性心肌梗死常见并发症的防治进展

随着生活水平的提高,冠心病的发病率呈逐年上升趋势。急性心肌梗死（AMI）为冠心病的严重类型,具有发病急、病情凶险、病死率高等特点,可出现心力衰竭、心源性休克、心律失常及心脏破裂等多种并发症,这些并发症是导致心肌梗死死亡的主要原因。尽管溶栓、冠脉介入治疗的广泛应用使得AMI住院病死率显著降低,但AMI并发症严重影响着冠心病患者的远期预后及生活质量。因此通过早期预测因素风险评估,积极采取预防措施,尽早防治严重并发症是降低AMI病死率的关键。     

急性心肌梗死与高血糖

无论有无糖尿病病史,急性心肌梗死患者常伴有高血糖。急性血糖升高可对心血管造成许多有害影响,并可加重患者的不良转归。强化高血糖控制措施可改善急性心肌梗死患者的预后。因此,提高对急性心肌梗死与高血糖之间相关关系、产生机制及其防治的认识,具有重要的意义。     

Acute Myocardial Infarction During Transesophageal Echocardiography

We describe the occurrence of acute myocardial infarction during transesophageal echocardiography (TEE) in a patient with atrial fibrillation and underestimated angina. Such a case has not been previously reported in the literature. This case illustrates one of the possible complications of TEE, leading us to suggest systematic sedation in patients with angina in whom TEE is envisaged.     

国内外急性心肌梗死注册登记研究进展

近20年来,关于急性心肌梗死的基础研究及临床诊治方面已取得重要进展,而急性心肌梗死的注册登记研究在推动该领域进展中起了重要的作用,尤其是注册登记反映了真实世界急性心肌梗死患者从发病、诊断、救治及预后等,通过各国急性心肌梗死注册数据的分析结果大大优化了急性心肌梗死的防治策略,从而降低急性心肌梗死病死率.现对国内外急性心肌梗死的注册登记研究进行简要综述,以了解目前国内外急性心肌梗死注册登记研究的状况及这些研究给临床带来的启示和重要价值.     

急性心肌梗死院前延迟的研究进展

就诊延迟直接影响急性心肌梗死的预后,就诊延迟可分为院前延迟及院内延迟。与院内延迟相比院前延迟影响因素更多,时间往往更长,因此如何缩短院前延迟更具临床意义。在此就院前延迟的概念、意义、影响因素及可能缩短院前延迟的方法做一简要综述。     

体力活动对于急性心肌梗死的影响

急性心肌梗死及由此引起的死亡、缺血性冠状动脉病变、心力衰竭等,在我国心血管疾病的发生中占有很高的比例,造成急性心肌梗死发生的因素有很多,继吸烟、大量饮酒、血脂异常等因素之后,人们对体力活动水平的认识也在逐渐提高,很多研究表明有氧性质的体力活动对心血管疾病乃至急性心肌梗死的预防有积极效应,但是对于最佳活动的时间、频率及强度,目前尚缺乏充分的认识。     

Cardiac Dysrhythmias in Patients with Acute Myocardial Infarction

Abstract A series of 676 patients with acute myocardial infarction were evaluated with regard to initial serum potassium level, prior diuretic therapy and occurrence of cardiac dysrhythmias during their first 24 hours in a coronary care unit. Serious dysrhythmias (ventricular tachycardia, ventricular fibrillation, and asystole) were significantly more frequent in hypokalemic patients. In this regard no differences were observed between patients on or off prior diuretic therapy     

Intravenous Thrombolytic Treatment for Acute Myocardial Infarction

Abstract. Intravenous thrombolytic treatment (streptokinase or anisoylated plasminogen streptokinase activator complex (APSAC) was given to 50 consecutive patients within 3 hours after onset of symptoms of acute myocardial infarction. Left heart catheterisation with coronary angiography and simultaneous double view left ventriculography were performed approximately 4 hours after start of thrombolytic treatment. This examination showed that the acute infarct-related coronary artery was open in 36 patients (72%) and closed in 14 patients (28%). A higher left ventricular ejection fraction was found among patients with open, than among patients with closed infarct-related artery (58.8% vs. 48.4%, p=0.05). The group with open artery also had a lower score of regional left ventricular dysfunction (1.7 vs. 2.4, p<0.05, on a scale from 0–3). Single, double and triple vessel coronary heart disease was found in 22, 14 and 13 patients respectively. Mean age was lower in the group with single vessel disease as compared to double and triple vessel disease (48.4 years vs. 53.4 and 55.4 years, p<0.05 and p<0.005). Independently of whether the infarct-related artery was open or closed, there tended to be an inverse correlation between number of diseased vessels and preservation of left ventricular function (statistical significance only for single vessel versus triple vessel disease with respect to score of regional left ventricular dysfunction, 1.8 vs. 2.4, p<0.05). These findings suggest that early thrombolytic treatment within 3 hours of onset of symptoms may preserve myocardial tissue during the evolution of acute infarction. Furthermore, a presumably better collateralisation from adjacent coronary arteries without stenoses may be important for myocardial preservation. Finally, early angiographic examination can be performed safely and is a good support for determination of further treatment, which in the actual patients was coronary bypass surgery in 8 cases, transluminal angioplasty, PTCA, in 20 cases, and medical treatment alone in 22 cases.     

Heparin After Acute Myocardial Infarction

Heparin is commonly, but by no means universally, used after acute myocardial infarction. When used the dose, route of administration, and duration of therapy varies considerably. The role of heparin is reviewed with particular reference to its use in conjunction with other commonly used therapies, such as aspirin and thrombolytic agents. Intravenous heparin after thrombolytic therapy remains untested in patients treated with aspirin. When used, benefit is seen in a narrow aPTT range, and there have been unexpected increases in mortality in patients with the greatest heparin effect. The addition of delayed subcutaneous heparin to aspirin and thrombolytic therapy does not provide a mortality benefit. In patients not treated with thrombolysis, there is no clear evidence that heparin confers significant mortality benefit if patients are treated with aspirin. Heparin therapy may reduce the incidence of intraventricular thrombus after anterior wall infarction, but there is no clear evidence that it reduces the clinically important sequelae of cerebral embolism and stroke. Given concerns about increased hemorrhagic rates with heparin and unknown benefit, it is reasonable to conclude that its role in the management of patients with acute myocardial infarction remains unclear.     

Efficacy of a New Accelerated Streptokinase Regime in Acute Myocardial Infarction: A Double Blind Randomized Clinical Trial

Background: Studies of thrombolysis in acute ST‐elevation myocardial infarction (STEMI) have focused on differences in outcome between groups receiving various regimes. Expedited treatment may influence the efficacy of nonfibrin specific thrombolytic agents in restoring early patency of the infarct‐related artery (IRA), which is a major determinant of survival after ST‐elevation myocardial infarction (STEMI). Methods: We performed a randomized double blind clinical trial comparing an accelerated infusion (1.5 MU/20 min; group A, n = 200) with the conventional infusion (1.5 MU/60 min; group B, n = 100) of streptokinase (SK) in 300 patients with their first episode of acute STEMI. Demographics, clinical reperfusion rates, angiographic study findings, left ventricular ejection fraction (LVEF), in‐hospital morbidity and mortality and one year mortality were compared between two groups. Results: Mean age was 59 ± 12 years (79% male). There were no differences in baseline data between groups. Clinical, electrocardiographic and physiologic reperfusion indices revealed significant faster and higher reperfusion rates and better preserved LVEF at discharge in group A. Sixty‐three percent of patients in either group underwent invasive coronary angiography at a mean of 5 days with comparable findings. Atrial fibrillation, malignant ventricular arrhythmias in the second day, in‐hospital and late mortalities rates occurred more frequently in group B patients. In multivariate analysis, accelerated SK infusion was the only independent predictor of higher electrocardiographic reperfusion (OR = 3.2, CI: 1.93–5.3, P < 0.001). Conclusions: The accelerated SK infusion regimen of 1.5 MU in 20 min is safe and well tolerated with significantly faster and higher clinical reperfusion rates, more preserved LV systolic function, less atrial and ventricular sustained arrhythmias, and less in‐hospital and 1 year mortality rates in acute STEMI.     

急性心肌梗死合并左心室血栓的研究现状

左心室血栓形成是急性心肌梗死严重的并发症之一,尤其在急性前壁心肌梗死中的发生率更高,栓子脱落后主要可使体循环动脉栓塞,可引起脑、脾和肾等重要脏器功能障碍及肢体功能障碍而产生严重后果.因此,如何预防、早期诊断左心室血栓形成及防治不良后果,在临床医疗有重要意义.现对急性心肌梗死合并左心室血栓形成的研究状况做一综述.     

急性心肌梗死生化标志物的研究进展

急性心肌梗死是临床常见的危重疾病,血液中生化标志物的测定是反映心肌损伤的重要手段之一。生化标志物凭其高度的敏感性及特异性,在急性心肌梗死的诊断、危险分层及评估预后中发挥了非常重要的作用。目前已有越来越多的心肌梗死生化标志物在临床中得到应用。现就急性心肌梗死损伤生化标志物的最新研究进展做一综述。     

Manual Aspiration Thrombectomy in Acute Myocardial Infarction: A Clinical Experience

Multiple clinical studies have failed to establish the role of routine use of thrombectomy in ST-elevation myocardial infarction (STEMI) patients. There is a paucity of data on the impact of thrombectomy in unselected STEMI patients outside clinical trials. We sought to evaluate the clinical variables and outcomes associated with the performance of thrombectomy in STEMI patients. We retrospectively examined the clinical outcomes in all STEMI patients who underwent successful percutaneous intervention (PCI) at our center. Patients were divided into two groups, one with patients who underwent conventional PCI and another with patients who had thrombus aspiration in addition to conventional PCI. We compared the baseline clinical characteristics, laboratory investigations, re-infarction rates, and all-cause mortality. Total 477 consecutive STEMI patients were identified. Overall, 29% (139) of the patients underwent conventional PCI and 71% (338) of the patients were treated with aspiration thrombectomy and PCI. In addition to the presence of thrombus, patients with nonanterior infarction, and patients with hemodynamic instability requiring intra-aortic balloon pump support were more likely to undergo thrombectomy. Thrombectomy was associated with higher enzymatic infarction (creatine kinase: 2,796 [2,575] vs. 1,716 [1,662]; p < 0.0001; CK-MB: 210.6 [156.0] vs. 142.0 [121.9], p < 0.0001). However, thrombectomy was not associated with any difference in 30 day reinfarction rate (3.3 vs. 2.9%, p = 0.83), mortality (5.0 vs. 7.2%, p = 0.35), or composite of death and 30 day reinfarction (7.7 vs. 9.4%, p = 0.55). We observed that STEMI patients with anterior infarction and hemodynamic instability were more likely to undergo thrombectomy during primary PCI.     

26例急性心肌梗死临床护理策略

目的：通过收集、分析急性心肌梗死病例的治疗及护理方法,总结和探讨急性心肌梗死的临床护理策略.方法：回顾性分析2005年1月至2009年12月本院收治的26例急性心肌梗死患者的临床资料,了解急性心肌梗死发生发展过程中伴随的患者心理状况及导致的一些并发症.结果：本组26例患者中除3例死亡（11 5%）,2例放弃治疗（7.8%）,另21例（80.8%）患者均能贯彻和执行本院心血管内科的临床护理策略,通过积极救治、护理,安全渡过急性期,顺利康复出院.     

Papillary Muscle Rupture as a First Event in Acute Myocardial Infarction

Abstract. Cardiogenic shock caused by papillary muscle rupture in acute myocardial infarction is potentially reversible by surgical treatment. A case of inferior myocardial infarction in a 56-year-old previously healthy man is reported, in which the first event was papillary muscle rupture. The patient was in shock and had a mitral insufficiency murmur. The diagnosis was made by echocardiography and ventriculography. A St. Jude valve was implanted, and the patient was discharged in good health. It is suggested that routine echocardiography be carried out on patients with sudden cardiogenic shock, when a mitral murmur is present.     

Prophylactic Furosemide Treatment in Acute Myocardial Infarction

ABSTRACT. Prophylactic diuretic theraphy in acute myocardial infarction (AMI) was evaluated in 83 consecutive patients without severe left ventricular failure (LVF) on admission. A high dose group (HDG) received 120–160 mg and a low dose group (LDG) 20–40 mg furosemide daily for six weeks. Mortality and reinfarction rates did not differ between the groups. One HDG patient and five LDG patients developed severe LVF. Four HDG patients developed severe dehydration. Serum enzyme activities and electrolytes were similar in both groups. The increased diuresis in the HDG was accompanied by a 4 % hemoconcentration, smaller radiological heart volumes, higher heart rates, a higher demand for nitroglycerin and higher ratings of thirst. Exercise tests yielded similar results in both groups. Later blood volumes and transthoracic electrical impedance were similar in both groups. It is concluded that liberal prophylactic furosemide treatment in AMI offers no major clinical advantage.     

急性心肌梗死药物治疗研究进展

急性心肌梗死的治疗主要涉及药物和介入两个方面。及时有效的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。与介入治疗相比,强化的药物治疗方案不仅价格便宜,而且更容易推广实施。现就有关的药物治疗现状及进展作一综述。     

急性心肌梗死对左心房的影响

急性心肌梗死后心脏收缩和舒张功能受损,直接影响到患者的预后.既往对心室收缩功能研究较多,对急性心肌梗死时左心房结构及功能变化的研究相对较少,而左心房结构及功能的变化又直接影响到心室的舒张功能及患者的预后.现就急性心肌梗死时左心房结构及功能的变化及其意义做一总结.