Myocardial Salvage after Reduced-Dose Thrombolysis Combined with Glycoprotein IIb/IIIa Blockade Versus Thrombolysis Alone in Patients with Acute Myocardial Infarction

Background: The aim of study was to examine the efficacy of reduced-dose alteplase plus abciximab versus alteplase alone by quantifying the amount of myocardium salvaged using myocardial scintigraphy. Methods: This study analyzed 150 patients with acute myocardial infarction who received alteplase (69 patients) or reduced-dose alteplase plus abciximab (81 patients) in the setting of the Stent versus Thrombolysis for Occluded Coronary Arteries in Patients with Acute Myocardial Infarction (STOPAMI) 1 and 2 trials. Salvage index (proportion of initial perfusion defect salvaged by reperfusion therapy), which was obtained by paired scintigraphic studies performed 7–14 days apart, was the primary endpoint of the study. One-year clinical follow-up was also done. Results: Salvage index did not differ significantly among patients treated with reduced-dose alteplase plus abciximab (median, 0.41 [25th; 75th percentiles: 0.13; 0.58]) compared to patients who received alteplase (0.26 [0.09; 0.61], p = 0.30). Final infarct size was 16.0% [4.0; 31.0] of the left ventricle in the group with reduced-dose alteplase plus abciximab and 19.4% [7.9; 34.2] of left ventricle in the group with alteplase (p = 0.44). Within a time-to-admission interval of <2 hours, there was a trend for higher values of salvage index in patients who received reduced-dose alteplase plus abciximab compared with patients who received alteplase (0.55 [0.35; 0.73] versus 0.29 [0.11; 0.69], p = 0.15). For time-to-admission intervals 2 hours, no such trend was observed between those who received reduced-dose alteplase plus abciximab or alteplase (0.25 [0.08; 0.48] versus 0.22 [0.08; 0.46], p = 0.79). Major bleeding occurred in 4 patients (5.0%) in the group with reduced-dose alteplase plus abciximab versus 2 patients (3.0%) in the group with alteplase alone (p = 0.58). Conclusion: When used as a general strategy in patients with acute myocardial infarction, adding abciximab to alteplase does not increase significantly the amount of salvaged myocardium as compared with alteplase alone. Combination therapy may offer advantages over thrombolytic agents alone if such therapy is applied within 2 hours from symptom onset; however these data need to be proven by studies of adequate power.     

疏血通注射液联合尿激酶对急性心肌梗死进行静脉溶栓的临床观察

目的观察疏血通注射液联合尿激酶在急性心肌梗死进行静脉溶栓的疗效。方法选择50例急性ST段抬高型心肌梗死患者,随机分为对照组与治疗组,各25例。两组据病情常规给予阿司匹林、氯吡格雷、美托洛尔、辛伐他汀、硝酸甘油、低分子肝素、胺碘酮等治疗。对照组在常规治疗基础上加用尿激酶,治疗组在对照组基础上加用疏血通注射液静脉溶栓治疗。观察两组冠状动脉再通率。结果治疗组冠状动脉再通率为80%,高于对照组的64%(P<0.05);凝血指标纤维蛋白原较对照组显著降低(P<0.05),出血率及病死率两组比较无统计学意义(P>0.05)。结论疏血通注射液联合尿激酶对急性心肌梗死的静脉溶栓治疗安全有效,能增加冠状动脉的再通率。     

替罗非班联合冠脉内血栓导管抽吸对急诊ST段抬高心肌梗死患者PCI术血运重建的影响

目的探讨替罗非班联合冠脉内血栓导管抽吸对急诊ST段抬高心肌梗死(STEMI)患者标准经皮冠状动脉介入治疗(PCI)术血运重建的影响。方法 98例STEMI患者随机分为PCI+血栓抽吸+替罗非班组(A组),PCI+替罗非班组(B组)。观察两组患者血管再通时即刻的血流血管心肌梗死溶栓(TIMI)分级、TIMI心肌灌注(TMPG)分级、术后2h心电图ST段回落大于50%的发生率、心肌磷酸激酶同工酶(CK-MB)峰值、CK-MB峰值时间,术后2h胸痛缓解率再灌注心律失常发生率。结果 A组心肌灌注明显增加,TIMI血流及TMPG血流明显改善,术后2h心电图ST段回落大于50%的发生率、CK-MB峰值、CK-MB峰值时间,术后2h内胸痛缓解率及再灌注心律失常发生率优于对照组。结论血栓抽吸与替罗非班联合治疗可改善急性ST段抬高性心肌梗死患者冠脉内血栓病变的血栓负荷、冠状动脉血流、心肌灌注,改善患者预后。     

The Assessment of the Platelet Function During the Acute Phase of ST-segment Elevation Myocardial Infarction in Essential Thrombocythemia

We encountered a case of ST-segment elevation myocardial infarction (STEMI) as the first clinical manifestation of essential thrombocythemia (ET). Platelet function tests revealed high thrombogenicity during primary percutaneous coronary intervention compared with general cardiovascular patients, whereas the platelet function two weeks after admission was effectively suppressed by dual antiplatelet therapy. The patient, who lacked cytoreduction, suffered from recurrent STEMI because of poor compliance with antiplatelet drugs. The risk of acute coronary occlusion may be high during the acute phase of STEMI in ET patients because of high thrombogenicity. Insufficient antiplatelet therapy and no cytoreduction are also risk factors for recurrent coronary events.     

急性非ST段抬高心肌梗死与ST段抬高心肌梗死冠状动脉病变特点的比较

目的 比较非ST段抬高心肌梗死（NSTEMI）与ST段抬高心肌梗死（STEMI）的冠状动脉病变特点。方法：NSTEMI与STEMI病人入院后10d内行冠状动脉造影术，分析病变类型、范围、狭窄程度及侧支循环。结果：NSTEMI组的多支病变、〉90％的严重狭窄及侧支循环比率高于STEMI组，而完全闭塞率低于STEMI组（P〈0．05）。结论 NSTEMI的多支病率高于STEMI，前者的远期预后有可能较后者差。     

Association of Fragmented QRS Complex with Myocardial Reperfusion in Acute ST‐Elevated Myocardial Infarction

In this study, we aimed to evaluate the relationship between TIMI myocardial perfusion (TMP) grade, as an indicator of myocardial reperfusion, and fragmented QRS (fQRS) in standard 12‐lead electrocardiogram. Also, we evaluate fQRS is an additional indicator of myocardial reperfusion. One hundred patients admitted with first STEMI to Coronary Intensive Care Unit and who were used thrombolytic therapy was included in this retrospective study. Standard 12‐lead electrocardiogram records of patients simultaneous with coronary angiography (second day) were assessed and analysed for the presence of fQRS. Also, coronary angiography images were analyzed to identify the infarct related artery, TIMI grade of infarct related artery and TMP grade of infarct related artery. The patients with fQRS demonstrated a significantly lower TMP grade, TIMI grade and ejection fraction compared with the non‐fQRS patients (P = 0.004, P = 0.003, P = 0.02 respectively). The patients with inadequate myocardial reperfusion demonstrated a significantly higher fQRS compared with the adequate myocardial reperfusion patients. (56.9% versus 23.5%, P = 0.002 respectively). On correlation analysis, there was a significant negative correlation between fQRS and left ventricular ejection fraction (r = ?232, P = 0.02) TMP grade and adequate myocardial reperfusion (TMP 3) showed significant negative correlation with fQRS (r = ?0.370, P = 0.000; r = ?0.318, P = 0.001 respectively). Presence of fragmented QRS in STEMI patients was associated with inadequate myocardial reperfusion and it can be used as a simple, noninvasive parameter to evaluate myocardial reperfusion.     

Temporal Trends in the Clinical Acuity of Patients with ST-Segment Elevation Myocardial Infarction

Background

Despite advances in ST-segment elevation myocardial infarction (STEMI) systems of care over the last decade, studies have shown no improvement in risk-adjusted mortality. It has been hypothesized that the population presenting to the catheterization laboratory has become sicker over time, in ways not accurately captured by current mortality models. The objective of this study was to examine changes in the clinical characteristics and in-hospital case fatality rate of the STEMI population treated with early percutaneous coronary intervention (PCI).

急性心肌梗死冠脉内超声溶栓

目的研究冠脉内低频（２０ｋＨｚ）、高强度（４０Ｗ）超声溶栓在急性心肌梗死梗塞相关血管中的应用。方法急性心肌梗死患者１１例（前壁心梗６例,下壁心梗５例）,梗塞相关血管前向血流均为ＴＩＭＩ０级和１级（左前降支６例,左回旋支２例,右冠状动脉３例）,超声溶栓后行急诊经皮腔内冠状动脉成形术（ＰｒｉｍａｒｙＰＴＣＡ）。结果冠脉内超声溶栓对梗塞相关血管的开通率为７３％（血流达ＴＩＭＩ３级）,残余狭窄为（７２±１４）％,１１例全部立即行ＰＴＣＡ,超声溶栓失败的３例经ＰＴＣＡ后血管全部开通,ＰＴＣＡ术后残余狭窄为（２４±１２）％。冠脉内超声溶栓时,因超声探头折断,血管再度闭塞１例,冠脉轻度撕裂１例;无血管痉挛,无远端血管栓塞等并发症,也无室速、室颤等恶性事件发生。结论本研究表明冠脉内低频、高强度超声溶栓是安全、有效的血管开通方式,可应用于临床。     

急性ST段抬高型心肌梗死患者VDBP水平与Syntax评分相关性研究

【目的】探讨血清维生素D结合蛋白水平（vitamin D binding protein,VDBP）与急性ST段抬高型心肌梗死（acute ST-segment elevation myocardial infarction,STEMI）发生风险的相关性;通过分析VDBP与Syntax评分的相关关系,探讨其与冠状动脉病变严重程度的关系。【方法】选取74例STEMI患者,另选取同期在本院进行健康体检的50例健康志愿者作为对照组。采用酶联免疫吸附实验（enzyme-linked immunosorbent assay,ELISA）检测上述研究对象的血清VDBP水平,收集研究对象的临床资料,并进行Syntax评分。根据Syntax评分将试验组分为高危组（Syntax≥33,n=21）、中危组（23≤Syntax≤32,n=25）及低危组（Syntax≤22,n=28）,比较组间VDBP水平差异,并分析VDBP水平与Syntax评分的相关性。【结果】STEMI患者血清VDBP水平明显高于对照组[（3.43±1.11）μg/mL vs （2.28±1.15）μg/mL,p＜0.05]。STEMI患者各组间VDBP水平差异无统计学意义（F=1.020,P=0.366）。VDBP水平与Syntax评分无显著相关关系（r=0.143,p=0.223）。【结论】STEMI患者的血清VDBP水平较正常人明显升高,可能成为临床STEMI诊断的重要指标,但不能提示冠脉病变严重程度。     

Relationship of Hospital Teaching Status with In-Hospital Outcomes for ST-Segment Elevation Myocardial Infarction

Background

Prior analyses have largely shown a survival advantage with admission to a teaching hospital for acute myocardial infarction. However, most prior studies report data on patients hospitalized over a decade ago. It is important to re-examine the association of hospital teaching status with outcomes of acute myocardial infarction in the current era.

血浆和肽素对ST段抬高型急性心肌梗死患者住院期间发生主要不良心脏事件的评估价值

目的：探讨血浆和肽素水平对ST段抬高型急性心肌梗死（STEAMI）患者住院期间主要不良心脏事件（MACE）的临床评估价值。
　　方法：2012-06至2014-06采用酶联免疫吸附法（ELISA）测定80例STEAMI（STEAMI组）患者及80例稳定性冠心病（对照组）患者血浆和肽素水平,观察STEAMI患者住院期间MACE发生情况。
　　结果：STEAMI组患者血浆和肽素水平为（523.26±142.69）pg/ml,对照组血浆和肽素水平为（345.25±89.36）pg/ml,差异有统计学意义（P<0.05）。STEAMI组院内发生MACE者共有28例（35.00％）,与（未发生）非MACE者相比,MACE者血浆和肽素、血心肌肌钙蛋白I（cTnI）、肌酸激酶MB同工酶（CK-MB）、左心室射血分数（LVEF）水平显著升高,差异有统计学意义（P<0.05）。经Logistic多因素分析显示,血浆和肽素、心肌肌钙蛋白I、左心室射血分数是STEAMI住院期间发生MACE的独立危险因素。经接受者操作特性曲线下面积显示,血浆和肽素水平对STEAMI住院期间发生MACE的接受者操作特性曲线下面积、阳性预测值、阴性预测值、灵敏性及特异性显著高于心肌肌钙蛋白I、肌酸激酶MB同工酶浓度,差异有统计学意义（P<0.05）。
　　结论：血浆和肽素能有效预测STEAMI患者住院期间MACE的发生,对STEAMI患者预后判断具有一定的预测价值。     

急性ST段抬高型心肌梗死患者PCI后血清EREG水平及其与预后的关系

目的探究急性ST段抬高型心肌梗死(STEMI)患者经皮冠脉介入术后血清表皮调节素(epiregulin,EREG)水平及其与预后的关系。方法前瞻性选取2017年6月—2018年4月接受救治的182例STEMI患者作为研究对象。根据STEMI患者预后情况将其分为预后良好组(n=157)和预后不良组(n=25)。采用双抗体夹心酶联免疫吸附法检测STEMI患者血清EREG水平,并分析其与预后的关系。结果预后不良组血清EREG水平高于预后良好组,差异有统计学意义(P <0. 05)。血清EREG评估STEMI患者1年预后的ROC曲线下面积、敏感性和特异性分别为0. 931、100. 00%和84. 71%。EREG高水平组平均生存时间低于EREG低水平组,差异有统计学意义(P <0. 05)。Cox单因素和多因素分析结果显示年龄、舒张压、低密度脂蛋白胆固醇和EREG与STEMI患者预后关系密切。结论 STEMI患者血清EREG水平与预后关系密切,血清EREG水平较高提示其预后不良。     

The Analgesic Effect of Oxygen in Suspected Acute Myocardial Infarction: A Substudy of the DETO2X-AMI Trial

Objectives

In this substudy of the DETO2X-AMI (An Efficacy and Outcome Study of Supplemental Oxygen Treatment in Patients With Suspected Myocardial Infarction) trial, the authors aimed to assess the analgesic effect of moderate-flow oxygen supplementation in patients with suspected acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI) and to study the effect of oxygen supplementation on the use of opiates and sedatives during PCI.

Pharmacologic Reperfusion Therapy for Acute Myocardial Infarction

Acute myocardial infarction (MI) remains a significant problem in terms of morbidity, mortality and healthcare costs. Pharmacologic reperfusion therapies for MI are becoming increasingly complex. This review therefore places contemporary pharmacologic MI developments into perspective. An historical overview of pharmacologic reperfusion therapy for MI is provided, followed by an analysis of current limitations, treatment options, and present and likely future pharmacologic therapies. Adjunctive percutaneous and other treatments are also discussed, to clarify what is becoming a rapidly changing field.