药物涂层球囊在PCI术后再发急性心肌梗死患者中的应用效果

目的 探讨药物涂层球囊(DCB)在经皮冠脉介入术(PCI)后再发急性心肌梗死(AMI)患者中的应用效果.方法 选择2019年1月至2020年1月收治的36例曾行PCI术后再发AMI的患者进行回顾性分析,根据手术处理方式不同将其分为球囊扩张组(n=20)、药物球囊组(n=16).球囊扩张组采用顺应性球囊、切割球囊或非顺应...     

2型糖尿病合并急性心肌梗死患者冠状动脉介入治疗的临床评价

目的 探讨2型糖尿病(T2DM)合并急性心肌梗死(AMI)的特点及接受经皮冠状动脉介入治疗(PCI)的疗效和预后.方法 31例AMI伴T2DM患者和37例AMl不伴T2DM患者接受PCI治疗,对比观察其冠状动脉病变特点及PCI成功率和预后.结果 伴T2DM组患者多支血管病变、远端血管病变及弥漫性血管病变较单纯AMI组多见[20例(65%)与12例(32%)、22例(71%)与11例(30%)、19例(61%)与9例(24%),X~2值分别为7.75、13.82、10.80,P均＜0.05],伴T2DM组PCI成功率与单纯AMI组比较差异无统计学意义,但术后30 d内心血管不良事件发生率及病死率均明显高于单纯AMI组[19%(6/31)与3%(1/37)、13%(4/31)与O(0/37),X~2值分别为3.94、5.01,P均＜0.05].结论 T2DM合并AMI冠状动脉病变复杂,PCI术安全有效,但远期预后差.     

强化家庭随访的个案管理模式在急性心肌梗死病人中的应用

目的:评价强化家庭随访的个案管理模式在急性心肌梗死(acute myocardial infarction, AMI)病人中的应用效果。方法:采用随机数字表法将2019年1月—2020年8月经我院治疗出院的80例急性心肌梗死病人分为对照组与观察组,各40例。对照组给予常规随访干预;观察组给予强化家庭随访的个案管理模式干预,均持续干预3个月。比较两组的左心室射血分数及左心室舒张末期内径、生活质量、自我效能感及主要心血管事件。结果:干预3个月后,观察组左心室射血分数[(62.40±5.36)%]高于对照组[(59.28±4.91)%],左心室舒张末期内径[(49.22±4.41)mm]短于对照组[(52.11±4.83)mm],差异均有统计学意义(P<0.05);观察组生活质量评分[(85.66±7.36)分]及自我效能评分[(37.18±7.40)分]均高于对照组[(77.59±6.30)分,(29.51±5.11)分],差异均有统计学意义(P<0.05);观察组主要心血管事件发生率(2.50%)低于对照组(15.00%)。结论:强化家庭随访的个案管理模式能够明显改善急性心肌...     

达格列净对急性心肌梗死合并2型糖尿病经皮冠脉介入术患者心肾功能及不良心血管事件的影响

目的 探讨达格列净对急性心肌梗死合并2型糖尿病经皮冠脉介入术（PCI）患者心肾功能及主要不良心血管事件（MACE）发生率的影响。方法 选取2022年2—8月河北北方学院附属第二医院收治的80例急性心肌梗死合并2型糖尿病PCI术患者作为研究对象,在组间基线特征可比的基础上,采用随机数字表法分为对照组（40例）和观察组（40例）。对照组给予胰岛素,观察组在对照组基础上给予达格列净。两组均持续治疗6个月。比较两组术前、术后即刻、治疗6个月后的管腔狭窄程度,术前、治疗6个月后的心功能指标、肾功能指标、脂联素（ADP）、氨基末端脑钠肽前体（NT-proBNP）及胰岛素样生长因子-1(IGF-1),治疗期间的MACE发生情况及药物不良反应。结果 术后即刻两组患者管腔狭窄程度差异无统计学意义（P>0.05）;治疗6个月后,观察组患者管腔狭窄程度低于对照组,差异有统计学意义（P<0.05）。治疗6个月后,两组患者左心室舒张末期内径、收缩末期容积指数均降低,且观察组患者低于对照组（P<0.05）;两组患者左心室重量指数、左心室射血分数均升高,且观察组患者高于对照组（P<0.05）...     

急性心肌梗死合并2型糖尿病冠脉内支架置入术后的远期随访

目的 观察急性心肌梗死合并2型糖尿病(T2DM)患者的冠状动脉(冠脉)病变特点和冠脉内支架置入术后的远期疗效.方法 将2002年10月至2007年8月行冠脉内支架置入术的478例急性心肌梗死患者分为T2DM组(213例)和非DM组(265例).对2组的冠状动脉病变情况及干预后远期疗效情况作对比.结果 与非DM组比较,T2DM组冠脉病变数较多(3.11 ±1.32 vs2.74±1.18,P＜0.05),2支(40.84％ vs 33.58％,P＜0.05)和3支病变比例高(30.52％vs21.89％,P＜0.05),弥漫病变(35.21％ vs20.75％,P＜0.01)和慢性闭塞性病变(16.90％ vs 10.94％,P＜0.05)多见.随访6～71(38.50±5.70)个月,2组临床随访率均在93％以上;比较2组随访事件的累积发生率,T2DM组较非DM组支架内再狭窄人月发生率明显增高(56.11 ×10-4vs23.17×10-4,P＜0.01),再次血运重建人月发生率明显增高(77.14 × 10-4 vs 50.16×10-4,P＜0.01).结论 合并2型T2DM的急性心肌梗死患者冠脉病变重.T2DM是支架内再狭窄、再次血运重建和主要心血管事件的独立预测因子.     

乳酸检测在2型糖尿病合并急性心肌梗死患者中的临床意义

目的探讨乳酸检测在2型糖尿病合并急性心肌梗死患者中的临床意义。方法回顾性选择2016年1月至2016年10月在本院心内科收治入院的2型糖尿病合并急性心肌梗死患者58例(DM+AMI组),及非糖尿病急性心肌梗死患者53例(AMI组),评估两组患者临床指标、血乳酸水平及动脉血p H的差异。结果相较于AMI组,DM+AMI组平均住院时长、心衰发生率及严重程度、心律失常及肺部感染的几率均明显增高,差异有统计学意义(P均0.05)。与AMI组相比,DM+AMI组血乳酸水平显著升高,动脉血p H明显降低,差异有统计学意义(P均0.05)。对乳酸水平进行分级后,发现DM+AMI组患者发生高乳酸盐血症及乳酸性代谢性酸中毒的几率明显高于AMI组,差异有统计学意义(P0.05)。结论 2型糖尿病合并急性心肌梗死患者常伴随体内高乳酸盐水平状态,而这部分患者发生心衰、心律失常及肺部感染的几率较非糖尿病急性心肌梗死患者明显增高,因此严密监测患者血乳酸水平对改善患者预后、降低并发症的发生都有积极意义。     

急性心肌梗死PCI术后围术期心肌梗死影响因素分析及近期预后

目的:探讨急性心肌梗死患者行择期经皮冠状动脉介入治疗(PCI)术后发生围PCI术心肌梗死的影响因素及近期预后情况。方法:选择非ST段抬高型心肌梗死(NSTEMI)或ST段抬高型心肌梗死(STEMI)错过血运重建半个月以上仍有症状的患者132例。将患者分为围PCI术心肌梗死组(围PCI术心肌梗死组,n=63)和非围PCI术心肌梗死组(非围PCI术心肌梗死组,n=69)。比较两组患者的基本临床资料、血液生化检查结果,PCI术前服药情况、冠脉造影结果、冠状动脉(罪犯血管)的微循环阻力指数(IMR),PCI术后即刻及术后3个月的左心室舒张末期内径(LVEDd)、左室射血分数(LVEF)变化。对两组血糖、q-CRP、IMR进行二分类多元逐步Logistic分析。统计患者PCI术后3个月内主要不良心血管事件(MACE)的发生率。结果:两组患者IMR、q-CRP、血糖差异均有统计学意义(P0.05)。二分类多元逐步回归分析显示,IMR是围PCI术心肌梗死的影响因素。IMR与PCI术后心肌肌钙蛋白I(cTnI)水平及其增加值正相关(P0.05)。两组PCI术后3个月LVEDd及其增加值、LVEF及其增加值差异均有统计学意义(P0.05)。围PCI术心肌梗死组MACE事件发生率(28.6%)大于非围PCI术心肌梗死组(10.1%),差异有统计学意义(P0.05)。结论:IMR是急性心肌梗死患者是否发生围PCI术心肌梗死的影响因素;发生围PCI术心肌梗死的患者近期预后较差。     

入院时糖化血红蛋白和血糖水平对急性心肌梗死患者行PCI术的预后评估

目的探讨急性心肌梗死（AMI）患者入院时糖化血红蛋白（HbA1c）和血糖水平与接受经皮冠状动脉介入（PCI）治疗后心血管不良事件发生率的关系。方法将62例接受经皮冠状动脉介入（PCI）治疗的AMI患者按入院时HbA1c及血糖水平分为2组。对照组28例,HbA1c≤6.5%,血糖（7.82±1.61）mmol.L-1;研究组34例,HbA1c〉6.5%,血糖（12.91±1.24）mmol.L-1。观察2组患者术后住院期间主要心血管不良事件的发生情况及超声心动图监测左心室舒张期内径（LVDd）和左心射血分数（...     

院后护理干预在急性心肌梗死直接经皮冠状动脉介入治疗患者中的应用

目的分析院后护理对急性心肌梗死(AMI)直接经皮冠状动脉介入治疗(PCI)患者的遵医行为及远期疗效的影响。方法选取成都军区昆明总医院2011年6月至2012年12月收治的226例ST段抬高型AMI行直接PCI患者,其中失访34例。将随访1年的192例患者中长期进行院后护理干预的110例患者纳入干预组,未进行院后护理干预的82例患者纳入对照组,比较两组服药依从性、门诊随访依从性、再入院率及远期主要不良心血管事件的发生率。结果干预组患者的药物漏服率、门诊漏访率、再入院率和1年内心绞痛再发率均低于对照组,组间比较差异均有统计学意义(P0.05);两组1年内病死率比较差异无统计学意义(P0.05)。结论院外护理干预是改善AMI患者预后的有效方法,应对其进行不断的完善并在临床推广应用。     

以问题为导向沟通模式在急性心肌梗死患者护理中的效果评价

目的 探讨以问题为导向护理沟通模式在急性心肌梗死患者护理中的应用效果。方法 选取2016年10月至2017年5月在宿迁市第一人民医院行急诊经皮冠状动脉介入治疗（percutaneous transluminal coronary intervention,PCI）的101例患者为对照组，给予急性心肌梗死急救护理常规；2017年7月至2018年2月行急诊PCI的98例患者为观察组，在给予急性心肌梗死急救护理常规的基础上，运用以问题为导向模式进行护患沟通。比较两组患者的入门到球囊扩张（D-to-B）时间、（D-to-B）时间达标率及签署PCI手术同意书的时间。结果 观察组患者行急诊PCI的D-to-B时间、签署手术同意书时间显著缩短，D-to-B时间达标率显著提高，与对照组比较差异均有统计学意义（P＜0.05）。结论 将以问题为导向的护理沟通模式应用于急性心肌梗死患者入院至行PCI的护理过程中，有助于缩短抢救时间，可能提高抢救成功率。     

分级分区管理模式在急性心肌梗死病人分流干预中的应用

[目的]:探讨分级分区管理模式在急性心肌梗死病人分流干预中的应用价值。[方法]选择2013年5月—2014年8月我院收治的急性心肌梗死病人共100例,随机分为对照组和观察组,每组50例。对照组病人采用常规模式进行分流干预,观察组病人采用分级(Ⅰ级~Ⅳ级)分区(分为治疗区、观察区和抢救区3个区域)管理模式进行分流干预,比较两组病人的临床救治效果。[结果]观察组病人入院到救治时间、救治时间、胸痛缓解时间短于对照组,平均费用及并发症发生率少于对照组。[结论]分级分区管理模式可提高急性心肌梗死病人入院的救治效果。     

Effectiveness and safety of amlodipine in secondary prevention in patients with myocardial infarction

Amlodipin (norvask) effectiveness was studied in 18 patients who survived primary Q-myocardial infarction. The 2-year treatment produced a positive effect in 66.6% patients, a negative one--in 11.1%. One patient died, a repeat non-fatal MI developed in 2 patients. Complications were registered in 1 patient. The drug reduced the number of angina attacks, amount of nitroglycerin (by 46.6 and 45.5%, respectively), the tolerance increased by 26.7, cardiac performance by 59.9%. It also led to a fall of both systolic and diastolic blood pressure (by 14.0 and 9.9%, respectively). Heart rate remained unchanged. Left ventricle underwent adaptive remodeling, myocardial ischemia diminished in the number of episodes and their duration. Frequent atrial and rare ventricular extrasystole disappeared in 1 patient.     

Beta-blocker underuse in secondary prevention of myocardial infarction

OBJECTIVE: To review the clinical benefits of beta-blockers as secondary prevention following a myocardial infarction (MI) and to address the reasons that clinicians are reluctant to use beta-blockers in specific patient populations. DATA SOURCES: MEDLINE was searched for articles published from January 1966 to October 2002. Relevant studies were identified by systematic searches of the literature for all reported studies of associations between beta-blocker underuse and secondary prevention of MI. Additional studies were identified by a hand search of references of original or review articles. STUDY SELECTION AND DATA EXTRACTION: English-language human studies were selected and analyzed. DATA SYNTHESIS: Associations were observed in studies of beta-blocker use as secondary prevention of MI. A lower rate of beta-blocker treatment occurred in older patients and in patients with comorbid conditions such as diabetes, heart failure, chronic obstructive pulmonary disease, asthma, and peripheral arterial disease. In addition, underuse was attributed to the perception of high rates of adverse events associated with beta-blockers. beta-Blocker use as secondary prevention of an MI can lead to a 19-48% decrease in mortality and up to a 28% decrease in reinfarction rates. Nonetheless, beta-blockers are significantly underused in many patient populations due to concomitant disease states. Due to their normal physiologic deterioration, the elderly are at an increased risk of low cardiac output and bradycardia when given a beta-blocker; therefore, they should be started on a low dose that is then slowly titrated. In diabetic patients, beta-blockers can impair glucose control leading to hypoglycemia; therefore, post-MI diabetic patients must routinely monitor their blood glucose levels. In patients with decompensated heart failure, beta-blocker use can lead to further cardiac depression, but lower oral starting doses with slow titration can reduce this risk. beta-Blockers can induce bronchospasm in patients with chronic obstructive pulmonary disease or asthma, but cardioselective beta-blockers and appropriate use of medications such as albuterol can minimize these effects. Finally, in patients with peripheral arterial disease, with the exception of hypertensive patients with Reynaud's phenomenon, beta-blockers can be used safely. The only absolute contraindications to beta-blockers are severe bradycardia, preexisting sick sinus syndrome, second- and third-degree atrioventricular block, severe left ventricular dysfunction, active peripheral vascular disease with rest ischemia, or reactive airway disease so severe that airway support is required. CONCLUSIONS: Overall, the cardiovascular benefits of beta-blockers as secondary prevention of MI significantly outweigh the risks associated with their use.     

Prevalence and mortality of acute myocardial infarction in patients with diabetes

The purpose of this study was to investigate if insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) predispose to the development of acute myocardial infarction (AMI) and modify the prognosis. The study includes 832 AMI patients consecutively hospitalized over a 3-yr period. The prevalence of diabetes mellitus among the AMI patients was 9.7% and is significantly higher than in an age-matched population, where it is 6.1% (P less than 0.001). The prevalence of diabetes was higher for women than for men (14.9% versus 7.6%). The risk of AMI was found to be twice as high among IDDM than among nondiabetic patients (P less than 0.001). Men with NIDDM were not found to have a significantly higher risk of AMI (P greater than 0.1), but the risk of AMI in women with NIDDM was approximately doubled (P less than 0.01). During the first month following AMI the mortality rate for nondiabetic patients was 20.2% compared with 42.0% for diabetic patients (P less than 0.001). Insulin treatment in NIDDM was associated with a reduced mortality rate compared with treatment with oral agents (P less than 0.05). The mortality rate was significantly higher in patients with poor metabolic control compared with patients in good control, whether before AMI or at the time of hospitalization. Diabetic patients had a higher risk of developing cardiogenic shock and conduction disorders than nondiabetic patients. We conclude that diabetes mellitus disposes to AMI and that the mortality rate of AMI is significantly increased among diabetic patients. Poor metabolic regulation of the diabetes may aggravate the prognosis for AMI.     

Screening for undiagnosed diabetes in patients with acute myocardial infarction

Background  Screening for undiagnosed diabetes in patients with acute myocardial infarction is recommended (ESC and EASD Task Force 2007). Glucose tolerance testing in the peri-infarct period may not be valid because of confounding, e.g. by the acute stress reaction. The aim was to evaluate undiagnosed diabetes (DM) and impaired glucose regulation (IGR) in AMI during hospital stay and 3 months after discharge. Materials and methods  In 96 consecutively admitted AMI patients (Heart Center Wuppertal, Germany) OGTT were performed, of whom in 62 OGTT were also carried out 3 months later. Results  Before discharge 32% of the patients had newly diagnosed diabetes and 47% patients had prediabetes (IGR). Glucose tolerance was normal in 20 (21%) patients only. After 3 months, 74% with newly diagnosed DM at baseline still had disturbed glucose metabolism (58% DM, 16% IGT). No patient with normal OGTT became diabetic after 3 months. In multivariate regression, the odds of having diabetes (3 months) was about sixfold higher when having diabetes before discharge (OGTT). Admission glucose, infarction size CK_MAX, and inflammation (CRP) were not significantly related to OGTT results. Conclusions  This prospective study confirms a high prevalence of undiagnosed DM in patients with AMI. In about 60% of AMI patients, newly diagnosed DM persisted after 3 months. For the first time we could show that there is no correlation between infarction size and undiagnosed diabetes. Thus, an OGTT performed before discharge may provide a reliable measure of disturbed glucose regulation but needs to be repeated. M. Lankisch and R. Füth equally contributed to this work.     

The influence of treatment modality on illness perception and secondary prevention outcomes among patients with acute myocardial infarction

ObjectivesThis study aims to determine if patients with acute myocardial infarction differ in illness perception and secondary prevention outcomes depending on the treatment they received.MethodsA repeated measures design was used to compare patients with acute myocardial infarction receiving three different treatment modalities: ST-elevation myocardial infarction treated by primary percutaneous coronary intervention, ST-elevation myocardial infarction treated by thrombolytic therapy, and non ST-elevation myocardial infarction treated by medication. A convenient sampling technique was used to recruit 206 patients with acute myocardial infarction who agreed to participate in the current study. Patients' illness perception, physical activity, and demographical and clinical data were collected during hospital admission and again at 6 months.ResultsA total of 186 patients completed the study. Results showed that the primary percutaneous coronary intervention group perceived their illness as acute rather than chronic (P = 0.034) and has lower personal control (P = 0.032), higher treatment control (P = 0.025), and higher perception of illness coherence (P = 0.022) compared with patients receiving thrombolytic therapy and treated after non-ST segment infarction. Moreover, they report low control of their blood pressure (P = 0.013) and less physical activity (P = 0.001).ConclusionThe results of this study revealed that patients' treated with primary percutaneous coronary intervention had negative illness perception and limited behavioral changes 6 months after hospitalization in comparison with other treatment modalities such as percutaneous coronary intervention and thrombolytic treatment. Further research is recommended to confirm this association with longer follow-up study and among different cultures.     

缺血预适应对急性心肌梗死合并糖尿病患者预后的影响

目的　探讨心肌缺血预适应对急性心肌梗死合并糖尿病患者临床状况及近期预后的影响。方法　 6 7例确诊为急性心肌梗死同时合并有糖尿病的患者 ,根据心肌梗死发病前 1周内有无心绞痛发作分为缺血预适应组 (2 8例 )和对照组 (39例 ) ,两组基础临床情况类似。观察心肌梗死范围、心肌酶学改变、左室射血分数及住院期间泵衰竭、心源性休克、严重心律失常等心脏事件的发生率和病死率。结果　缺血预适应组患者临床状况及近期预后较好 ,与对照组相比 ,梗死面积小 ,≥ 2个梗死面的检出率低 (32 .1%与 5 6 .4 % ,P <0 .0 5 ) ,血浆CPK、CK MB、cTnT峰值均显著降低 (P <0 .0 1或P <0 .0 5 ) ,且住院期间的泵衰竭发生率(17.9%与 4 1.0 % ,P <0 .0 5 )、心源性休克 (10 .7%与 33.3% ,P <0 .0 5 )、严重心律失常 (14 .3%与 4 6 .2 % ,P<0 .0 1)及住院病死率 (3.6 %与 2 0 .5 % ,P <0 .0 5 )均降低。结论　缺血预适应对急性心肌梗死合并糖尿病的患者有保护作用 ,可以减少心肌梗死面积 ,降低临床并发症的发生率 ,但不能改善左室射血分数与促进心功能的恢复