基质金属蛋白酶9在心肌梗死患者外周血白细胞表达的研究

目的 探讨白细胞中基质金属蛋白酶9(MMP-9)在急性心肌梗死(AMI)病理生理机制中的作用.方法 用电化学发光法及比浊法检测30例AMI患者与30名正常人血浆肌钙蛋白(Tn)、循环白细胞培养上清液中超氧化物歧化酶(SOD)、丙二醛(MDA)的含量;用酶联免疫吸附试验(ELISA)测定血浆MMP-9的含量及逆转录-聚合酶链反应(RT-PCR)检测白细胞中MMP-9 mRNA的表达水平.结果 AMI患者SOD的含量在6 h[(23±5)ng/mL]及1周内[(71±11)ng/mL]较正常人[(124±8)ng/mL]显著降低(P＜0.001),Tn[6 h(173±24)μg/L,1周(126±13)μg/L]、MDA[6 h(523±87)μg/L,1周(341±78)μg/L]、MMP-9[6 h(697±143)μg/L,1周(597±102)μg/L]较正常人[Tn(45±8)μg/L,MDA(87±9)μg/L,MMP-9(342±165)μg/L]显著增高(P＜0.05).MMP-9与MDA的变化水平呈正相关(r=0.73,P＜0.05),与SOD的含量呈负相关(r=-0.79,P＜0.01).AMI患者循环白细胞MMP-9 mRNA表达显著增强.结论 AMI患者循环白细胞处于炎性状态,MMP-9 mRNA表达增强,并可能由此导致血浆MMP-9水平增高.监测血浆MMP-9的水平有可能成为了解AMI发生发展的一个重要诊断指标.     

基质金属蛋白酶9在心肌梗死患者外周血白细胞表达的研究

目的探讨白细胞中基质金属蛋白酶9(MMP-9)在急性心肌梗死(AMI)病理生理机制中的作用。方法用电化学发光法及比浊法检测30例AMI患者与30名正常人血浆肌钙蛋白(Tn)、循环白细胞培养上清液中超氧化物歧化酶(SOD)、丙二醛(MDA)的含量;用酶联免疫吸附试验(ELISA)测定血浆MMP-9的含量及逆转录-聚合酶链反应(RT-PCR)检测白细胞中MMP-9 mRNA的表达水平。结果AMI患者SOD的含量在6 h[(23±5)ng/mL]及1周内[(71±11)ng/mL]较正常人[(124±8)ng/mL]显著降低(P<0.001),Tn[6 h:(173±24)μg/L,1周:(126±13)μg/L]、MDA[6 h:(523±87)μg/L,1周:(341±78)μg/L]、MMP-9[6 h:(697±143)μg/L,1周:(597±102)μg/L]较正常人[Tn:(45±8)μg/L,MDA:(87±9)μg/L,MMP-9:(342±165)μg/L]显著增高(P<0.05)。MMP-9与MDA的变化水平呈正相关(r=0.73,P<0.05),与SOD的含量呈负相关(r=-0.79,P<0.01)。AMI患者循环白细胞MMP-9 mRNA表达显著增强。结论AMI患者循环白细胞处于炎性状态,MMP-9 mRNA表达增强,并可能由此导致血浆MMP-9水平增高。监测血浆MMP-9的水平有可能成为了解AMI发生发展的一个重要诊断指标。     

辛伐他汀对急性心肌梗死患者基质金属蛋白酶和高敏C反应蛋白的影响

目的：探讨辛伐他汀对急性心肌梗死患者血浆高敏C反应蛋白和基质金属蛋白酶-9的影响。方法：60例急性心肌梗死患者随机分为两组,常规治疗组和辛伐他汀治疗组,治疗前后分别测定血浆高敏C反应蛋白和基质金属蛋白酶-9的浓度,并与对照组比较。结果：急性心肌梗死患者血浆高敏C反应蛋白和基质金属蛋白酶-9的测定值高于健康对照组（P〈0.05）;辛伐他汀治疗组治疗后血浆高敏C反应蛋白和基质金属蛋白酶-9的测定值分别低于治疗前水平（P〈0.05）。结论：辛伐他汀通过抗炎等机制对防治急性心肌梗死患者早期动脉粥样硬化及稳定斑块起着重要的作用。     

急性脑梗死患者血清基质金属蛋白酶-9和同型半胱氨酸检测的临床价值

目的通过对急性脑梗死患者血清基质金属蛋白酶-9(MMP-9)和同型半胱氨酸(Hcy)浓度变化的分析,探讨其在脑梗死预测、诊断及预后评估中的临床价值。方法选取临床确诊的62例急性脑梗死的病例作为患者组,40例健康体检者作为健康对照组。分别应用酶联免疫吸附法(ELISA)和循环酶法测定血清MMP-9和Hcy的浓度。根据脑血管病学术会议规定的脑梗死患者临床神经功能缺损程度评分标准(CNFDS)对脑梗死患者于入院时及入院后3周的状态进行评分,且患者均进行CT检查确诊。应用SSPS11.5软件包进行统计学处理。结果急性脑梗死患者血清MMP-9水平明显高于健康对照组(P<0.01),且其水平与梗死灶体积及患者预后有显著相关性。患者组血清Hcy水平明显高于健康对照组,差异有统计学意义(P<0.01)。结论急性脑梗死患者血清MMP-9和Hcy水平明显升高,且MMP-9的增高程度可为中枢神经系统受损程度提供信息,作为预后评估及药物治疗的重要依据。而血清Hcy水平是导致脑动脉粥样硬化的一个独立的危险因素,可作为预测急性脑梗死的依据。     

急性心肌梗死后外周血单个核细胞表面CD147与基质金属蛋白酶-9 mRNA表达的相关性

目的：基质金属蛋白酶在急性心肌梗死后的心室重构中起着重要作用，但其调节机制目前尚未明确。实验拟通过动物模型的建立及体外细胞培养，观察急性心肌梗死后单个核细胞表面CD147与心肌成纤维细胞基质金属蛋白酶-9 mRNA表达的关系。 方法：实验于2006—08／2007-06在河北省人民医院临床实验中心完成。实验材料：SD大鼠及SD仔鼠（出生1～3d）购自河北医科大学试验动物中心。实验过程中对动物处置符合动物伦理学标准。实验方法：①将30只大鼠随机分为急性心肌梗死组（n=15）和假手术组（n=15），假手术组只过线不结扎。流式细胞分析法检测大鼠术后24h外周血单个核细胞表面CD147表达。②选择SD仔鼠制备心肌成纤维细胞。将单个核细胞与心肌成纤维细胞以细胞数0．5：1，1：1，2：1混合培养24h后，半定量反转录一聚合酶联反应法检测基质金属蛋白酶-9 mRNA表达。当单核细胞与心肌成纤维细胞2：1混合时，加入CD147单克隆抗体1，2，4μL/L，培养24h后检测基质金属蛋白酶-9 mRNA表达。 结果：①急性心肌梗死后外周血单个核细胞表面CD147表达明显增加。②单个核细胞与心肌成纤维细胞混合培养，随着单个核细胞比例的增加，心肌成纤维细胞基质金属蛋白酶-9 mRNA表达增加。③在单个核细胞与心肌成纤维细胞2：1混合培养体系中，随着加入CD147单克隆抗体浓度的增加，基质金属蛋白酶-9 mRNA生成减少。 结论：急性心肌梗死后单个核细胞表面CD147表达明显增加，对心肌成纤维细胞基质金属蛋白酶-9生成起上游调节作用。     

Serum matrix metalloproteinase-9 is elevated in men with a history of myocardial infarction

Elevated serum inflammatory markers have been reported in coronary heart disease. Levels of serum matrix metalloproteinase-9 (MMP-9), C-reactive protein (CRP), C3-complement (C3) and autoantibodies against oxidized low-density lipoprotein (oxLDL) in 120 male subjects with a history of myocardial infarction (MI) were compared with those in 250 age-matched controls, both groups from a large cross-sectional population survey, the FINRISK study. The concentrations of serum MMP-9 and autoantibodies against oxLDL were measured by enzyme-linked immunosorbent assay, CRP and C3 by immunonephelometry. MMP-9, CRP and C3 concentrations were higher in the subjects with a history of MI than in the controls (p=0.037, p=0.004, and p=0.006, respectively). There was no difference between the groups in serum levels of autoantibodies against oxLDL. In other background characteristics, men in the MI group had higher body mass index (BMI) and serum triglyceride values and lower serum HDL cholesterol values compared to controls (p=0.009, p=0.001, and p<0.001, respectively). When analyzed by stepwise multiple logistic regression using BMI, HDL cholesterol, triglycerides, CRP, C3 and MMP-9 as independent variables, the significant predictors for MI were HDL cholesterol (p=0.002) and MMP-9 (p=0.015). These results suggest that increased serum MMP-9 may reflect inflammatory pathologic processes that are related to progression of atherosclerosis.     

急性脑梗死合并2型糖尿病患者微栓子与血清基质金属蛋白酶-9的关系

目的探讨急性脑梗死合并2型糖尿病患者脑动脉微栓子与血清基质金属蛋白酶-9含量的关系。方法前瞻性地纳入颈动脉系统急性脑梗死患者118例,分为糖尿病急性脑梗死组60例、非糖尿病急性脑梗死组58例。收集一般临床资料,采用EMS-9型经颅多普勒超声检测仪及酶联免疫吸附测定法(ELISA)分别检测所有入组患者大脑中动脉微栓子信号及血清基质金属蛋白酶-9浓度,并进行相关分析。结果糖尿病并急性脑梗死患者微栓子信号阳性率高于非糖尿病急性脑梗死患者(P<0.05);糖尿病并急性脑梗死患者的血清基质金属蛋白酶-9含量明显高于非糖尿病急性脑梗死患者(P<0.01);Logistic回归提示,血清基质金属蛋白酶-9是微栓子信号阳性的危险因素(OR=1.013,P<0.01)。结论糖尿病并急性脑梗死患者微栓子信号阳性率与血清基质金属蛋白酶-9含量更高,基质金属蛋白酶-9的高表达可能促进微栓子的产生。     

单纯超滤治疗急性心肌梗死后心衰疗效分析

目的 探讨单纯超滤对急性心肌梗死后心功能不全患者的疗效分析.方法 收集2010年8月至2014年8月在河南省人民医院急诊科住院的急性心肌梗死患者,其中102例在急诊介入治疗、开通罪犯血管后出现急性心功能不全.全部患者首先采用内科常规治疗,分为2组,1组标准药物治疗,另1组在标准药物治疗下行单纯超滤治疗.同组患者不同时间点间的比较采用重复测量方差分析;2组患者间同一时点的监测指标、监护时间和住院时间的比较采用成组t检验.2组患者病死率的比较采用x2检验.以P ＜0.05为差异有统计学意义.结果 51例常规药物治疗患者,急性左心衰竭发作次数逐渐减少,电解质逐渐维持于正常水平,但改善情况均较单纯超滤组缓慢.4例死于心源性猝死.随访至发病后1年,14.89％ (7/47)患者间断有左心衰竭症状.51例行单纯超滤患者中,2例因血小板进行性减少而中止单纯超滤.1例因收缩压低于90 mmHg(1mmHg =0.133 kpa)且有脏器灌注不足临床表现终止单纯超滤.48例行单纯超滤患者生命体征平稳,心力衰竭症状明显减轻.单纯超滤治疗后血电解质较治疗前显著改善,B型脑利钠肽(BNP)明显降低(P＜0.05),1周后复测左室射血分数LVEF有所改善(P＜0.05),2例死于心源性猝死,其余46例,均在住院20 ～ 39 d后出院,随访1年,无左心衰竭再次发作.2组患者1个月病死率、平均重症监护时间、平均住院时间差异均具有统计学意义(P＜0.05).结论 急性心肌梗死后心功能不全患者行单纯超滤是一种相对安全而有效的治疗方法.不仅能在较短时间内稳定内环境,而且能干预心肌梗死后左心衰竭的发展和预后,使平均重症监护时间、平均住院时间显著降低.     

Serum calcium,albumin, globulin and matrix metalloproteinase-9 levels in acute cerebral infarction patients

BACKGROUNDHemorrhagic transformation (HT) is a common complication in patients with cerebral infarction. However, its pathogenesis is poorly understood. The knowledge of factors that may increase risk for HT may help in improving the safety of thrombolytic therapy.AIMTo investigate the predictive value of serum calcium, albumin, globulin and matrix metalloproteinase-9 (MMP-9) levels for HT after intravenous thrombolysis (IVT) in patients with acute cerebral infarction. METHODSFive hundred patients with acute cerebral infarction who received IVT with alteplase within 4.5 h after the onset of disease between January 2018 and January 2021 at our hospital were selected as the study subjects. They were divided into groups based on computed tomography scan results of the brain made within 36 h after thrombolysis. Forty patients with HT were enrolled in an observation group and 460 patients without HT were enrolled in a control group. Serum calcium, albumin, globulin and MMP-9 levels were compared between the two groups. Regression analysis was used to discuss the relationship between these indices and HT. RESULTSThe previous history of hypertension, diabetes, atrial fibrillation, cerebrovascular diseases, smoking and alcohol intake were not associated with HT after IVT in patients with acute cerebral infarction (all P > 0.05). The National Institutes of Health stroke scale (NHISS) score was associated with HT after IVT in patients with acute cerebral infarction (P < 0.05). The serum calcium and albumin levels were lower in the observation group than in the control group (all P < 0.05). The levels of globulin and MMP-9 were significantly higher in the observation group than in the control group (all P < 0.05). Logistic regression analysis showed that NHISS score, serum calcium, albumin, globulins and MMP-9 were independent factors influencing the occurrence of HT following IVT in patients with cerebral infarction (P < 0.05). CONCLUSIONSerum calcium, albumin, globulin and MMP-9 levels are risk factors for HT after IVT in patients with acute cerebral infarction. Moreover, NHISS score can be used as a predictor of post-thrombolytic HT.     

洛沙坦对大鼠心肌梗死后心肌间质基质金属蛋白酶2和金属蛋白酶组织抑制因子2表达的干预作用

目的:观察大鼠心肌梗死后心肌间质基质金属蛋白酶2及金属蛋白酶组织抑制因子2的表达和心室重塑、心功能变化的关系及洛沙坦干预的影响。方法:实验于2004-09/2005-08在华中科技大学协和医院心血管研究所实验室进行。①取180只SD大鼠,随机取8只为假手术组(不结扎冠状动脉),其余172只大鼠结扎冠状动脉前降支复制急性心肌梗死模型。②将造模成功的67只大鼠随机分成洛沙坦组[灌胃洛沙坦30mg/(kg·d),1次/d]和模型组(灌胃等量生理盐水),两组分为术后1,7,14,28d4个亚组。③应用反转录-聚合酶链反应法及免疫组化方法检测基质金属蛋白酶2,金属蛋白酶组织抑制因子2及Ⅰ/Ⅲ胶原的表达,超声心动图评价大鼠心功能变化和心室重塑的过程。结果:75只大鼠进入结果分析。①基质金属蛋白酶2及金属蛋白酶组织抑制因子2蛋白表达:模型组除术后1d基质金属蛋白酶2表达与假手术组无差异外,其他各时间点表达均高于假手术组(P<0.05);洛沙坦组术后7,14,28d金属蛋白酶2表达均低于模型组(P<0.05)。②基质金属蛋白酶2及金属蛋白酶组织抑制因子2mRNA表达:模型组各时间点均高于假手术组(P<0.05),洛沙坦组术后1,14,28d基质金属蛋白酶2mRNA表达均低于模型组(P<0.05)。③心肌Ⅰ/Ⅲ胶原比例:术后14,28d,模型组显著高于假手术组(P<0.05),洛沙坦组低于模型组(P<0.05)。④超声心动图显示模型组大鼠在术后7,14,28d时心功能明显低于假手术组(P<0.01),洛沙坦组14,28d时心功能指标均较模型组明显改善(P<0.05)。结论:大鼠心肌梗死后心肌间质金属蛋白酶2、金属蛋白酶组织抑制因子2表达增高,非梗死区Ⅰ/Ⅲ胶原比例升高可能是心室重塑和心力衰竭发生发展的原因之一。洛沙坦可通过抑制金属蛋白酶2表达,逆转Ⅰ/Ⅲ胶原比例改善心肌梗死后心室重塑及心力衰竭。     

9-1-1: Rapid identification and treatment of acute myocardial infarction

The sooner a person who is experiencing symptoms and signs of an acute myocardial infarction (AMI) (including out-of-hospital cardiac arrest) receives medical treatment, the greater his or her chances of survival and limitation of infarct size. A universal 9-1-1 emergency telephone system makes it possible for AMI patients or those around them to easily and quickly call for help and for emergency medical services (EMS) personnel to rapidly and accurately locate the patient. This article by the Access to Care Subcommittee of the National Heart Attack Alert Program (NHAAP) Coordinating Committee describes the history of 9-1-1, its key elements, its current implementation status, and existing State legislation and standards. Currently, approximately 78% of the United States population, mainly in urban areas, has access to a 9-1-1 system. Approximately 195 United States cities with a population of greater than 100,000 people have access to enhanced 9-1-1. It is the contention of the NHAAP that 9-1-1 services should be universally available to all Americans to ensure seamless access to EMS and, potentially, early detection, evaluation, and treatment for AMI. This article reports several key recommendations for achieving this goal.     

中西医结合治疗对急性心肌梗死患者心功能的影响

目的：观察中西医结合治疗对急性心肌梗死（ＡＭＩ）患者心功能的影响。方法：ＡＭＩ患者５６例，在发病的前２周均按常规治疗，从第３周开始将患者随机分成中西医结合组２９例和西医组２７例，西医组治疗同前，中西医结合组每日加服中药１剂。采用二维超声心动图分别记录２组患者治疗前后心功能各项指标。结果：中西医结合组治疗后每搏输出量〔（７３．５±６．０）ｍｌ〕、每分输出量〔（５．４３±０．３４）Ｌ／ｍｉｎ〕、射血分数（０．５３±０．０９）均明显增高，舒张末期容积〔（７４．６±２３．８）ｍｌ〕和收缩末期容积〔ＥＳＶ，（３６．６±１６．８）ｍｌ〕均明显降低，与治疗前〔分别为（３９．９±５．８）ｍｌ，（３．２１±０．２８）Ｌ／ｍｉｎ，０．４６±０．０９，（８２．８±２８．２）ｍｌ和（４４．６±１８．９）ｍｌ〕比较，Ｐ均＜０．０１，与西医组治疗后〔分别为（６４．８±６．１）ｍｌ，（４．６３±０．４０）Ｌ／ｍｉｎ，０．４６±０．０９，（８８．３±２４．９）ｍｌ和（４９．６±１５．８）ｍｌ〕比较，Ｐ均＜０．０５。结论：益气活血中药在抑制左心室的进一步扩张，减少ＥＳＶ，减轻心脏变形，改善局部和整体室壁运动以及左心室收缩功能方面有明显疗效。     

洛沙坦对大鼠心肌梗死后心肌间质基质金属蛋白酶2和金属蛋白酶组织抑制因子2表达的干预作用

目的：观察大鼠心肌梗死后心肌间质基质金属蛋白酶2及金属蛋白酶组织抑制因子2的表达和心室重塑、心功能变化的关系及洛沙坦干预的影响。 方法：实验于2004-09／2005-08在华中科技大学协和医院心血管研究所实验室进行。①取180只SD大鼠，随机取8只为假手术组（不结扎冠状动脉），其余172只大鼠结扎冠状动脉前降支复制急性心肌梗死模型。②将造模成功的67只大鼠随机分成洛沙坦组[灌胃洛沙坦30mg／（kg&;#183;d），1次／d]和模型组（灌胃等量生理盐水），两组分为术后1，7，14，28d4个亚组。③应用反转录-聚合酶链反应法及免疫组化方法检测基质金属蛋白酶2，金属蛋白酶组织抑制因子2及Ⅰ/Ⅲ胶原的表达，超声心动图评价大鼠心功能变化和心室重塑的过程。 结果：75只大鼠进入结果分析。①基质金属蛋白酶2及金属蛋白酶组织抑制因子2蛋白表达：模型组除术后1d基质金属蛋白酶2表达与假手术组无差异外，其他各时间点表达均高于假手术组（P〈0．05）；洛沙坦组术后7，14，28d金属蛋白酶2表达均低于模型组（P〈0．05）。②基质金属蛋白酶2及金属蛋白酶组织抑制因子2mRNA表达：模型组各时间点均高于假手术组（P〈0.05），洛沙坦组术后1，14，28d基质金属蛋白酶2mRNA表达均低于模型组（P〈0．05）。③心肌Ⅰ/Ⅲ胶原比例：术后14，28d，模型组显著高于假手术组（P〈0．05），洛沙坦组低于模型组（P〈0．05）。④超声心动图显示模型组大鼠在术后7，14，28d时心功能明显低于假手术组（P〈0．01），洛沙坦组14，28d时心功能指标均较模型组明显改善（P〈0．05）。 结论：大鼠心肌梗死后心肌间质金属蛋白酶2、金属蛋白酶组织抑制因子2表达增高，非梗死区Ⅰ／Ⅲ胶原比例升高可能是心室重塑和心力衰竭发生发展的原因之一。洛沙坦可通过抑制金属蛋白酶2表达，逆转Ⅰ／Ⅲ胶原比例改善心肌梗死后心室重塑及心力衰竭。     

Factors associated with cardiac arrhythmias in patients with type 2 diabetes mellitus and myocardial infarction

An analysis of some features of heart arrhythmias in patients with myocardial infarction (MI) and type 2 diabetes mellitus (DM2) was performed. The study revealed that arrhythmias (usually extrasystoles or atrial fibrillation) were more common in patients with DM type 2 (42.1% in DM2, and 30.4% in non-DM patients, p = 0.0041) and demonstrated a direct correlation with coronary and myocardial dysfunction. In patients with DM2, arrhythmias were associated with the duration of DM and HbA1c level. In severe metabolic decompensation (HbA1c > 8.5%) and in cases with a relatively low HbA1c level (< 7%) arrhythmias were more frequent than in patients with an HbA1c level between 7.0% and 8.5%. In patients with an HbA1c level < 7.0%, the threat of hypoglycemia is increased, often due to insulinotherapy, as a possible arrhythmogenic factor associated with a relative elevation of immunoreactive insulin and C-peptide and diabetic nephropathy (DN). Severe DM decompensation (HbA1c > 8.5%) was associated with metabolic disturbances and toxic effect of hyperglycemia. Cardiac arrhythmias, systolic dysfunction, and DN are prognostically unfavorable factors influencing the survival rate in patients with MI and DM2.     

心肌梗死患者的康复治疗

心肌梗死患者的康复治疗包括循序渐进和按部就班的康复运动训练、对患者及家属的医学康复指导和对患者心脏功能及身体状况的定期评定 ,其目的是尽可能使患者恢复正常生活。实际上 ,心肌梗死的康复治疗始于发病当日 ,并且 ,由于冠心病是一个慢性和逐渐发展的过程 ,因此 ,这种康复治疗是终生的 ,大致可分为住院阶段、出院后阶段和维持阶段。1住院阶段以往认为 ,急性心肌梗死患者应强制卧床休息3— 6周 ,但这样处理常可引起长期卧床的不良后果 ,有时比心肌梗死疾病本身对患者的危害还要大。长期卧床的常见不良后果有 :1卧床 3周体力可下降2 0 %…     

急性冠状动脉综合征患者血清基质金属蛋白酶-9及其抑制物水平变化

目的:观察不同类型冠心病患者血清基质金属蛋白酶-9、组织金属蛋白酶抑制物-1水平的变化,进一步了解血清基质金属蛋白酶-9及组织金属蛋白酶抑制物-1在冠状动脉粥样硬化发生发展中的作用及临床意义.方法:采用酶联免疫吸附法测定60例冠心病患者(急性冠状动脉综合征患者30例、稳定性心绞痛患者30例)、30例非冠心病患者(对照组)血清基质金属蛋白酶-9,组织金属蛋白酶抑制物-1的水平.结果:急性冠状动脉综合征组血清基质金属蛋白酶-9水平高于稳定性心绞痛组及对照组(P<0.01),而血清组织金属蛋白酶抑制物-1水平低于稳定性心绞痛组及对照组(P<0.01).稳定性心绞痛组血清基质金属蛋白酶-9水平高于对照组(P<0.01),血清组织金属蛋白酶抑制物-1水平低于对照组(P<0.01).急性冠状动脉综合征患者治疗后血清基质金属蛋白酶-9水平低于治疗前,组织金属蛋白酶抑制物-1高于治疗前(P<0.01).结论:血清基质金属蛋白酶-9水平增高及组织金属蛋白酶抑制物-1水平降低与粥样斑块破裂相关,可作为判断粥样斑块不稳定的血清学指标.血清基质金属蛋白酶-9水平增高及组织金属蛋白酶抑制物-1水平降低有助于评价冠状动脉病变的程度及冠心痛患者的预后.     

Results of treatment of patients with acute myocardial infarction and high risk of cardiac complications

The authors compare the results of the treatment of 883 patients with acute myocardial infarction (AMI) referred to the group with high risk of cardiac complications based on the TIMI, GRACE, and TIMI Il assessment stratification scales. 487 patients were treated by conservative therapy using anticoagulative (n = 414) or thrombolytic (n = 73)) agents. 396 underwent surgical treatment (coronary artery bypass surgery (101) or percutaneous coronary angioplasty (295)). The mortality rate in the group treated by percutaneous coronary angioplasty was 13.6 (p < 0.001), 7.2 (p < < 0.01) and 3.5 (p < 0.05) times lower than after anticoagulation therapy, thrombolysis and coronary bypass surgery respectively. It is concluded that percutaneous coronary angioplasty has advantages over other modalities for the treatment of patients with acute myocardial infarction and high risk of cardiac complications.     

Plasma catecholamines in patients with acute myocardial infarction and in cardiac arrest

Plasma catecholamine concentrations in cardiac arrest (ventricular fibrillation and asystole) are significantly higher than after myocardial infarction. The levels reached are well above those normally required to stimulate cardiac activity. Possible reasons for the failure of the myocardium to respond to the catecholamines are discussed and the rationale for giving more catecholamines is questioned.