Effect of cigarette smoking on clinical outcomes of hospitalized Chinese male smokers with acute myocardial infarction

Background Smoking is known to be a strong risk factor for premature atherosclerosis, acute myocardial infarction （AMI） and sudden cardiac death. According to a cross-sectional survey conducted in 2000-2001 in China, the prevalence of smoking among the Chinese men was 60.2%, the highest prevalence in the world. Up to date, the relationship between smoking and AMI in Chinese male smokers is still unclear. This study analyzed the baseline characteristics for male smokers hospitalized with AMI and investigated the effect of cigarette smoking on their clinical outcomes.Methods A total of 890 men aged 18 years or over with AMI were prospectively recruited from 1 January 2007 to 31 December 2009 from Shanxi Provincial People＇s Hospital. Patients were grouped into smokers and nonsmokers. The relationships between baseline characteristics and clinical outcomes were tested using either the chi-square test for trend for discrete variables or analysis of variance for continuous variables.Results Smokers accounted for 66.7% （594）, more than twice of nonsmokers （296 （33.3%））, and were averaged 7 years younger （（56.61±11.44） vs. （63.61±11.62） years, P 〈0.001）. Smokers had the higher rate of TIMI flow grade 2 or 3 after thrombolytic therapy （42.4 % vs. 24.5%, P=0.002）, 1 vessel disease （25.5% vs. 14.5%, P=0.003） than nonsmokers.Smokers had better in-hospital outcome with lower in-hospital mortality rate than nonsmokers （6.2% vs. 10.8%,P=0.023）.Conclusions Male smokers suffered from AMI in this study presented an average of 7 years earlier than nonsmokers and were more than twice as likely to have AMI as nonsmokers in China. Smoking appeared to result in earlier infarction,especially ST elevated myocardial infarction in otherwise healthier patients who are likely to survive.     

114例急性心肌梗死住院患者心电图分析

目的:分析急性心肌梗死患者的心电图变化,探讨心电图的临床应用价值。方法:按照ST段抬高与非ST段进行分组,抽取我院2005年1月～2009年8月114名急性心肌梗死住院患者,对其体表心电图进行回顾性分析。结果:114例急性心肌梗死患者中,72例为ST抬高性心肌梗死,其中22例发生室性心律失常,死亡12例;42例为非ST段抬高性心肌梗死,其中3例发生室性心律失常,2例死亡。ST段抬高和非ST段抬高组室性心律失常的发生率有统计学意义(P<0.05),两组病死率无统计学意义(P>0.05)。结论:心电图表现为急性ST段抬高性心肌梗死患者合并室性心律失常的发生率高于非ST段抬高的患者。     

年龄和性别对急性心肌梗死住院患者预后的影响

目的：探讨年龄和性别对急性心肌梗死（AMI）住院患者预后的影响。方法:回顾性研究1994年1月至2004年12月期间在我院住院且未行再灌注治疗的全部AMI病例，对比不同年龄和性别AMI患者住院期间缺血复发（包括心绞痛和再梗死）、心力衰竭和死亡发生率的差异。结果:共有1?315例患者入选，男性897例，女性418例。在≤60岁, 61～80岁和≥81岁三个不同的年龄组，女性患者比例随年龄的增长而增加（分别为18.4%、 37.8%和53.8%,P均＜0.05）；心力衰竭和死亡的发生率随年龄的增长而增加（分别为16.0％、30.0%、49.2%和4.1％、10.0%、32.3%, P均＜0.05）；缺血复发率无统计学意义。女性患者住院期间心力衰竭和死亡的发生率高于男性患者（分别为34.4％　vs　22.1%,　P＜0.001；11.7％　vs　7.8%, P＜0.05）,排除年龄因素后，性别对死亡率的影响无统计学意义。结论:AMI患者住院期间心力衰竭和死亡的发生率随年龄增长而增加；女性患者心力衰竭发生率显著高于男性，死亡率也高于男性，但排除年龄因素后，不同性别死亡率的差异未达统计学意义。     

急性心肌梗死溶栓治疗的疗效观察

目的：观察急性心肌梗死（AMI）溶栓治疗的临床疗效.方法：52例AMI患者均进行心肌梗死常规治疗,根据是否行尿激酶溶栓治疗分为治疗组（43例）和对照组（9例）.观察2组患者的治疗效果,包括病死率、冠状动脉再通情况、不良反应和并发症.结果：使用尿激酶溶栓治疗后7 d,治疗组43例冠状动脉再通率为67.4%（29/43）,病死率为7.0%（3/43）,未发生溶栓治疗相关的消化道出血及颅内出血等严重并发症.对照组9例冠状动脉再通率为33.3%（3/9）,病死率为22.2%（2/9）.结论：在不能行急诊经皮冠状动脉介入治疗及无溶栓禁忌症情况下,溶栓治疗是AMI的首选治疗方法.     

缺血预适应对急性心肌梗死预后的影响

目的通过对急性心肌梗死患者一些临床指标的观察，评价缺血预适应对急性心肌梗死患者预后的影响。方法296例急性心肌梗死患者依发病前24h内有无心绞痛分为缺血预适应组（IP组）和无缺血预适应组（NIP组）。观察两组间ST段抬高程度、心肌酶峰值、心电图积分、左室射血分数（EF）、室壁瘤、右束支阻滞、休克、心衰的差异。结果IP组ST段抬高的程度（P〈0．05）、心肌酶峰值（P〈0．05）、心电图积分（P=0．01）、室壁瘤（P〈0．05）、右束支阻滞（P〈0．05）、休克（P〈0．05）、心衰（P=0．01）的发生机会均低于NIP组。EF（P=0．02）则高于NIP组。结论IP现象可明显改善急性心肌梗死患者的预后。     

急性心肌梗死患者院内并发心室颤动的危险因素分析

目的 探讨影响急性心肌梗死(AMI)患者院内并发心室颤动(VF)的危险因素.方法 885例AMI患者根据住院期间是否发生VF分成两组:VF组(n=28)和非VF组(n =857),回顾性分析两组患者的临床资料,并对相关危险因素进行单因素及多因素分析,探讨AMI患者院内发生VF的独立危险因素.结果 885例AMI患者中,28例发生VF(3.1％).单因素分析表明,VF组患者的入院时收缩压和左室射血分数(EF)明显低于非VF组(P＜0.05);而慢性肾功能不全病史、前壁心肌梗死、心房颤动、Killip分级＞Ⅱ级和心源性休克患者的比例,以及心率、呼吸频率、空腹血糖、血清肌酐(Cr)、血清肌酸激酶MB同工酶(CK-MB)和血清肌钙蛋白Ⅰ(cTNI)等指标均明显高于非室颤组,差异有显著性意义(P＜0.05).多因素Logistic回归分析表明,慢性肾功能不全(OR=2.313)、心源性休克(OR =4.193)、心房纤颤(OR=2.823)、Killip分级＞Ⅱ级(OR=3.674)是AMI患者住院期间并发VF的独立危险因素.结论 慢性肾功能不全、心源性休克、心房纤颤、Killip分级＞Ⅱ级是急性心肌梗死患者住院期间并发室颤的独立危险因素.     

血浆脂蛋白相关磷脂酶A2对急性心肌梗死患者住院预后的影响

Objective: To determine the prognostic utility of lipoprotein -associated phospholipase A2 (Lp-PLA2) for in-hospital major adverse cardiovascular events （MACE） in patients with acute myocardial infarction(AMI); Methods: A total of 167 patients referred for AMI participated, including 86 patients who were diagnosed as ST-segment elevation Acute Myocardial Infarction (STEMI) and 81 patients without ST-elevation (non-STEMI)) ,while 80 patients without AMI were selected as the control group; The following in-hospital MACE were recorded: death , remyocardial infarction , angina pectoris after MI , acute heart failure, and life threatening arrhythmias. The Lp-PLA2 levels among each group were compared, and the correlation between in-hospital MACE and Lp-PLA2 levels was explored. Results: (1)The plasma concentration of Lp-PLA2 was higher in patients with AMI than those of the control group, and the（加上） STEMI group was the highest, P<0.05; （2）The occurrence rate of in-hospital MACE rose was elevated significantly with the increased level of Lp-PLA2, P<0.05;(3) Levels of Lp-PLA2 were significantly higher in patients suffered from an event than those event -free subjects [（288.732±124.873） ng/ mL vs (231.537±92.059) ng/ mL],P<0.05;(4)Lp-PLA2 was found to be an independent risk factor in AMI patients for the in-hospital MACE in the regression analysis . Conclusions:Lp-PLA2 is positively correlated with the in-hospital adverse cardiovascular events in patients with AMI,and it’s an important biomarker in the risk stratification for in-hospital AMI patients.     

冠状动脉支架植入术治疗急性心肌梗塞39例

目的：小结采用直接冠状动脉支架植入术治疗39例急性心肌梗塞患者的中期效果。方法：接受介入治疗距胸痛发作的平均时间为4．2h。经股劝脉采用Judkins技术完成冠状动脉造影及支架植入术,在38例患者42支血管共植入55个支架,1例患者仅行右冠状动脉球囊成形术。结果：术后即刻TIMI血流3级者36例（92．3％）,TIMI血流2级者3例（7．7％）。术中6例（15．4％）在便塞相关动脉开通后出现心室颤动,1例（2．6％）死于继发性心室颤动。术后平均随访8．1个月,除1例死于术后2周非梗塞相关动脉择期支架植入术外,无心肌梗塞、做外科冠状动脉搭桥术和再次做梗塞相关动脉介入治疗的病例。结论：直接冠状动脉支架术可以迅速获得便塞相关动脉TIMI3级血流,中期效果良好。     

代谢综合征对急性心肌梗死患者预后的影响

目的 探讨代谢综合征(MS)对急性心肌梗死(AMI)预后的影响。方法 将94例初发AMI患者分为AMI+MS组(43例)和AMI+非MS组(51例),比较2组患者心功能、左心室重构、心肌梗死后的心绞痛发作率和心性病死率。结果 AMI+MS组左心室舒张末期容积、左心室收缩末期容积和左心室舒张末期内径均较非MS组明显增加,左心室射血分数较AMI+非MS组明显减少。AMI+非MS组心肌梗死后的心绞痛发作率和心源性死亡率分别为17.6％和9.8％,AMI+MS组分别为34.8％和30.2％,两者比较差异有显著性。结论AMI并有MS的患者左心室重构和心功能损害更明显,心肌梗死后的心绞痛发作率和心源性死亡的危险性增加。     

Clinical profile and outcomes of atrial fibrillation in elderly patients with acute myocardial infarction

Background Atrial fibrillation （AF） occurs commonly in patients with acute myocardial infarction （MI） and is associated with an increased long-term mortality. This study aimed to investigate the clinical characteristics and outcomes of AF in in-hospital elderly Chinese patients with acute MI.
Methods A total of 967 patients with acute MI, aged 〉65 years, were categorized on the basis of the absence or presence of AF. Patients with documented AF were classified into two subgroups： the ongoing AF group and the new-onset AF group. We retrospectively evaluated the clinical profile, in-hospital outcomes, and effects of revascularization on the incidence of AF in elderly patients with acute MI.
Results AF was documented in 100 （11.53%） patients and the incidence of new-onset AF was 6.51% during hospitalization. History of old MI and cerebrovascular events were more common in patients with AF than in those without AF （P 〈0.001, P 〈0.01, respectively）. The incidence of AF was higher in patients with non-ST elevated MI （P=0.014）, inferior wall MI （P=0.004） and cardiac function of Killip class Ⅲ or Ⅳ （P=-0.008）. Patients with AF had more complication of pneumonia （P=0.003） and longer hospital stay. Left circumflex coronary artery involvement was more common in patients with AF （compared with patients without AF, P 〈0.001）. Percutaneous coronary intervention or coronary artery bypass grafting significantly decreased the incidence of new-onset AF from 7.97% to 3.82% （P=0.017）. AF depended to heart failure, increased the in-hospital mortality.
Conclusions AF is common in elderly patients with acute MI and is associated with poorer clinical outcomes. Revascularization reduces the incidence of AF and thus improves the clinical outcomes in these patients.     

西藏地区不同血红蛋白水平与院内急性ST段抬高型心肌梗死患者转归分析

目的 探讨西藏高原地区不同血红蛋白(Hb)水平对急性ST段抬高型心肌梗死(STEMI)近期院内主要心脏不良事件(MACE)的影响.方法 回顾性分析2013年10月—2018年10月西藏自治区人民医院高原病心血管内科收治的STEMI患者的临床资料,根据Hb水平分为正常组110例(男性:120 g/L≤Hb≤160 g/L...     

老年急性心肌梗塞溶栓治疗临床研究

目的探讨老年急性心肌梗塞静脉内溶栓治疗的安全性及有效性。方法符合急性心肌梗塞溶栓条件者８６例进行分组研究。共分３组：老年组随机分为溶栓治疗组及未溶栓对照组；＜６０岁组均溶栓作为溶栓对照组。基础治疗均相民溶栓治疗患者加用尿激酶静脉滴入。监测溶栓前、后患者的胸痛程度、心电图、血清ＣＫ－ＭＢ值。统计患者的血管再通车、出血率、５ｗｋ病死率。结果急性心肌梗塞溶栓治疗后，再通率、出血发生率及５ｗｋ病死率，老年组与＜６０岁组比较，均无明显差异（Ｐ＞０．０５）。老年溶栓组与未溶栓组比较，未溶栓组严重心律失常发生率稍高，溶栓组出血发生率稍高，但均无明显差异（Ｐ＞０．０５）；心衰竭发生率及病死率溶栓组均有明显下降（Ｐ＜０．０５）。结论静脉溶栓治疗老年急性心肌梗塞可降低病死率，且出血率无明显增加．     

空腹血糖水平对初发急性心肌梗死患者预后的影响

目的 探讨空腹血糖(FBG)水平与初发急性心肌梗死患者近期和远期预后的关系及临床意义.方法 668例初发急性心肌梗死患者根据有无糖尿病病史和人院次日FBG浓度分为糖尿病组(n=177)、高FBG组(n=351)和正常FBG组(n=140).分别记录各组患者近期心血管事件发生情况和随访期间死亡情况,并对相关因素进行统计学分析.结果 Logistic和Cox回归分析表明,FBG是初发急性心肌梗死患者近期发生恶性心律失常(比值比OR=1.106,P=0.001)、充血性心力衰竭(OR=1.060,P=0.037)、心源性休克(0R=1.084,P=0.018)和心源性死亡(OR=1.068,P=0.028)的独立危险因子和远期死亡的独立预测因子(OR=1.043,P=0.004).Cox回归分析显示,高FBG组FBG>8.52 mmol/L和糖尿病组FBG>10.65 mmoL/L患者的死亡风险是正常FBG组患者的3倍(风险比值HR=3.087,P=0.007;HR=3.456,P=0.002).结论 FBG是初发急性心肌梗死患者近期心血管事件和远期死亡的独立影响因素.     

空腹血糖水平对初发急性心肌梗死患者预后的影响

目的 探讨空腹血糖（FBG）水平与初发急性心肌梗死患者近期和远期预后的关系及临床意义.方法 668例初发急性心肌梗死患者根据有无糖尿病病史和人院次日FBG浓度分为糖尿病组（n=177）、高FBG组（n=351）和正常FBG组（n=140）.分别记录各组患者近期心血管事件发生情况和随访期间死亡情况,并对相关因素进行统计学分析.结果 Logistic和Cox回归分析表明,FBG是初发急性心肌梗死患者近期发生恶性心律失常（比值比OR=1.106,P=0.001）、充血性心力衰竭（OR=1.060,P=0.037）、心源性休克（0R=1.084,P=0.018）和心源性死亡（OR=1.068,P=0.028）的独立危险因子和远期死亡的独立预测因子（OR=1.043,P=0.004）.Cox回归分析显示,高FBG组FBG〉8.52 mmol/L和糖尿病组FBG〉10.65 mmoL/L患者的死亡风险是正常FBG组患者的3倍（风险比值HR=3.087,P=0.007;HR=3.456,P=0.002）.结论 FBG是初发急性心肌梗死患者近期心血管事件和远期死亡的独立影响因素.     

2007-2018年住院ST段抬高型心肌梗死和非ST段抬高型心肌梗死患者比例及院内死亡率变化趋势

目的　探讨住院ST段抬高型心肌梗死（STEMI）和非ST段抬高型心肌梗死（NSTEMI）构成比及院内死亡率逐年变化趋势。方法　回顾性分析2007年1月1日至2018年12月31日于海军军医大学（第二军医大学）长海医院心血管内科住院治疗且出院诊断为急性心肌梗死（AMI）的4 868例患者资料,通过年度变化百分比法（APC）分析STEMI和NSTEMI构成比和院内死亡率的变化趋势。结果　4 868例AMI患者中STEMI 患者3 064例（62.9%）,NSTEMI患者1 804例（37.1%）。NSTEMI的比例在12年内呈上升趋势（APC值为14.0%,P＜0.01）,由2007年的15.7%上升至2018年的45.2%;STEMI患者的比例呈下降趋势（APC值为－5.5%,P＜0.01）,由2007年的84.3%下降至2018年的54.8%。2007－2018年,AMI院内死亡率呈下降趋势（APC值为－6.6%,P＜0.05）,由2007年的7.0%下降至2018年的4.3%;NSTEMI院内死亡率呈下降趋势（APC值为－11.9%,P＜0.05）,由2007年的13.9%下降至2018年的1.9%;而STEMI的院内死亡率并无明显变化（APC值为－3.8%,P=0.225）。结论　2007－2018年我院住院AMI患者中,NSTEMI患者比例呈上升趋势。NSTEMI院内死亡率在12年内呈下降趋势,而STEMI的院内死亡率并无明显下降。     

急性ST段抬高型心肌梗死患者预后的危险因素分析

目的 分析影响急性ST段抬高型心肌梗死(STEMI)患者住院期间预后的危险因素.方法 回顾性分析我院急诊科确诊STEMI患者的临床资料,根据住院期间是否发生主要不良心血管事件将患者分为住院期间不良预后组和住院期间无不良预后组,通过logistic回归分析寻找影响STEMI患者住院期间预后的独立危险因素.结果 共有436例患者纳入研究.其中住院期间不良预后组185例,无不良预后组251例.单因素分析发现:与无不良顸后组比较,不良预后组患者年龄更大,男性、吸烟者比例更低,体重更轻,心率更快,收缩压和舒张压更低,心肌酶、肌酐和血糖更高,血红蛋白、LVEF更低,前壁梗死、Killip 2 ～4级、既往患糖尿病比例更高(P＜0.05).logistic回归分析显示Killip 2～4级、既往患糖尿病是STEMI患者住院期间不良预后的危险因素,LVEF升高则是住院期间不良预后的保护因素,三者比值比分别为3.1090、2.552 0和0.960 8(P ＜0.05).结论 心功能差、既往患糖尿病患者发生住院期间不良预后风险大.     

院前急救与住院救治过程中使用尿激酶溶栓治疗急性心肌梗死的效果研究

目的探讨使用尿激酶院前急救与住院溶栓治疗急性心肌梗死（AMI）的不同疗效,并探讨院外溶栓治疗AMI的可行性。方法选择本院救治的90例AMI患者,先期确诊行院前溶栓组44例,入院后溶栓组46例。院外救治组诊断AMI后立即给尿激酶150万U静脉点滴,同期住院后确诊的46例按上述方法立即溶栓。结果确诊后溶栓时间：院外急救组为（1.40±0.35）h,院内溶栓组为（2.51±1.55）h。治疗后冠状动脉总再通率：院前溶栓组80.9%（33/42）,2例死亡;住院溶栓组70.5%（31/44）,2例死亡（P〈0.05）。结论入院前早期溶栓治疗AMI患者可以增加冠状动脉的再通率,安全可行,值得提倡。     

Impact of patients’ symptom interpretation on care-seeking behaviors of patients with acute myocardial infarction

Background Delay in seeking medical care in patients with acute myocardial infarction （AMI） is receiving increasing attention. This study aimed to examine the association between expected symptoms and experienced symptoms of AMI and its effects on care-seeking behaviors of patients with AMI. Methods Between November 1, 2005 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 19 hospitals in Beijing and included 799 patients with ST-elevation myocardial infarction （STEMI） admitted within 24 hours after onset of symptoms. Data were collected by structured interviews and medical record review. Results The median （25%, 75%） prehospital delay was 140 （75, 300） minutes. Only 264 （33.0%） arrived at the hospital by ambulance. The most common symptoms expected by patients with STEMI were central or left chest pain （71.4%）, radiating arm or shoulder pain （68.7%）, shortness of breath or dyspnea （65.5%）, and loss of consciousness （52.1%）. The most common symptoms experienced were central or left chest pain （82.1%）, sweats （71.8%）, shortness of breath or dyspnea （43.7%）, nausea or vomiting （32.3%）, and radiating pain （29.4%）. A mismatch between symptoms experienced and those expected occurred in 41.8% of patients. Patients who interpreted their symptoms as noncardiac in origin were more likely to arrive at the hospital by self-transport （86.5% vs. 52.9%, P 〈0.001） and had longer prehospital delays （medians, 180 vs. 120 minutes, P 〈0.001） compared to those who interpreted their symptoms as cardiac in origin. Conclusions Symptom interpretation influenced the care-seeking behaviors of patients with STEMI in Beijing. A mismatch between expectation and actual symptoms was associated with longer prehospital delay and decreased use of emerqency medical service （EMS）.     

Twenty-year trends in major cardiovascular risk factors in hospitalized patients with acute myocardial infarction in Beijing

Background Hypertension, diabetes mellitus, hypercholesterolaemia and current smoking are the strongest modifiable cardiovascular risk factors for acute myocardial infarction （AMI）. We examined their changing trends over the last 20 years. Methods The clinical data of 3498 patients hospitalized in Peking University People＇s Hospital with AMI from 1991 to 2010 were used. Information was collected regarding to patients＇ demographic data, cardiovascular risk factors （hypertension, diabetes mellitus, hypercholesterolemia and current smoking）. To assess trends over time in the prevalence of risk factors, we categorized patients into four groups （1991 to 1995, 1996 to 2000, 2001 to 2005 and 2006 to 2010）. Results Highly significant increases were observed in the prevalence of hypertension from 40.8% to 55.6% for males and from 58.0% to 69.0% for females; and diabetes mellitus from 12.9% to 30.8% for males and from 23.0% to 42.3% for females. Similarly, the prevalence of hypercholesterolaemia decreased from 53.1% to 30.7% for males and from 57.0% to 44.0% for females. The prevalence of current smoking decreased in females from 29.0% to 11.1%, but remained unchanged in males. In addition, the proportion of patients with more than three modifiable risk factors increased from 19.0% to 27.1% and the age at onset of AMI extended to younger as well as older individuals. Conclusions The prevalence of hypertension and diabetes mellitus are still increasing in patients with AMI in Beijing and although the prevalence of hypercholesterolaemia and current smoking decreased, high clustering of risk factors were commonly present. These adverse trends show a compelling need for more effective management of cardiovascular risk factors.     

Outcomes of primary percutaneous coronary intervention for acute ST-elevation myocardial infarction in patients aged over 75 years

Background The optimal reperfusion strategy in elderly patients with ST-elevation myocardial infarction （STEMI） remains unclear. The purpose of this study was to evaluate the safety, in-hospital and one-year clinical outcomes for patients 〉75 years of age with STEMI receiving primary percutaneous coronary intervention （PCI）, compared with those treated by conservative approach. Methods One hundred and two patients 〉75 years of age with STEMI presented 〈12 hours were randomly allocated to primary PCI （n=50） or conservative therapy only （n=52）. The baseline characteristics, in-hospital outcome and major adverse cardiac events （MACE）, including death, non-fatal myocardial infarction and target vessel revascularization at one-year clinical follow-up were compared between the two groups. Results Age, gender distribution, risk factors for coronary artery disease, infarct site and clinical functional status were similar between the two groups, but the patients in primary PCI group received less low-molecular- weight heparin during hospitalization. Compared with conservative group, the patients in primary PCI group had significantly lower occurrence rate of re-infarction and death and shortened hospital stay. The composite endpoint for in-hospital survivals at 30-day follow-up was similar between the two groups, but one-year MACE rate was significantly lower in the primary PCI group （21.3% and 45.2%, P=0.029）. Left ventricular ejection fraction was not significantly changed in both groups during follow-up. Multivariate analysis revealed that primary PCI （OR=0.34, 95% CI： 0.21-0.69, P =0.03） improved MACE-free survival rate for STEMI patients aged 〉 75 years. Conclusion Our results indicated that primary PCI was safe and effective in reducing in-hospital mortality and one-year MACE rate for elderly patients with STEMI.