The role of inflammatory stress in acute coronary syndrome

Objective To summarize current understanding of the roles of anti-inflammatory and proinflammatory mechanisms in the development of atherosclerosis and acute coronary syndrome and to postulate the novel concept of inflammation stress as the most important factor triggering acute coronary syndrome. Moreover, markers of inflammation stress and ways ,to block involved pathways are elucidated.Data sources A literature search(MEDLINE 1997 to 2002) was performed using the key words “inflammation and cardiovascular disease”. Relevant book chapters were also reviewed.Study selection Well-controlled, prospective landmark studies and review articles on inflammation and acute coronary syndrome were selected.Data extraction Data and conclusions from the selected articles providing solid evidence to elucidate the mechanisms of inflammation and acute coronary syndrome were extracted and interpreted in the light of our own clinical and basic research.Data synthesis Inflammation is closely linked to atherosclerosis and acute coronary syndrome.Chronic and long-lasting inflammation stress, present both systemically or in the vascular walls, can trigger acute coronary syndrome.Conclusions Inflammation stress plays an important role in the process of acute coronary syndrome.Drugs which can modulate the balance of pro- and anti-inflammatory processes and attenuate inflammation stress, such as angiotensin-converting enzyme (ACE) inhibitors/angiotensin Ⅱ receptor blockers, statins, and cytokine antagonists may play active roles in the prevention and treatment of acute coronary syndrome when used in addition to conventional therapies (glycoprotein Ⅱ b/Ⅲ a receptor antagonists, mechanical intervention strategies, etc).     

Echocardiographic findings in patients with acute coronary syndrome and normal angiogram

Coronary angiograms performed at the time of an acute coronary syndrome typically present vessel occlusions, ruptured plaques or thrombotic lesions that require reperfusion therapy. However, occasionally, no coronary artery stenoses are detected. Myocardial ischemia frequently causes left ventricular wall motion abnormalities that can be seen easily by echocardiography. In our study we aimed to analyze echocardiographic findings in patients with acute coronary syndrome and normal angiogram. After standardized risk stratification, a total of 897 patients were classified as an acute coronary syndrome and underwent a coronary angiography immediately. In 76/897 patients angiography excluded coronary macroangiopathy. Routine echocardiographic assessment in patients with normal angiogram showed in 21.1% a reduced left ventricular systolic function and 32.9% presented with segmental wall motion abnormalities. In summary, by detection of segmental wall motion abnormalities in 1/3 of patients with suspected acute coronary syndrome and normal angiogram, obviously, an echocardiographic evaluation in this patient population is of clinical relevance. Recommendations for performing echocardiography in patients with suspected acute coronary syndromes independent of angiographic findings are strongly supported. Further analyses should implement echocardiographic techniques as contrast and tissue doppler imaging.     

Kounis syndrome: allergic acute coronary syndrome

Kounis syndrome is defined as a group of acute coronary syndromes that manifests as unstable vasospastic or nonvasospastic angina,and even as acute myocardial infarction triggered by the release of inflammatory mediators following an allergic insult.1 Kounis syndrome is a rare and complex syndrome.Instant treatment decisions need to be made once it happens.Here,we defined a case of severe Kounis syndrome,culminating in acute coronary syndrome,as a result of an acute allergic reaction,which was likely related to iodinated contrast media or dextran-40 use.     

急性冠脉综合征合并超重／肥胖者冠状动脉病变特点分析

目的探讨急性冠脉综合征合并超重／肥胖患者冠状动脉病变的特点。方法入选合并超重／肥胖的急性冠脉综合征患者55例,无肥胖的急性冠脉综合征患者38例。所有受试者均进行冠状动脉造影。结果超重／肥胖组冠脉病变以多支病变为主,占52．72％,高于非肥胖组,χ2=11．088,P〈0．01。超重／肥胖组冠脉重度病变及完全闭塞分别为27．03％和34．46％,高于非肥胖组,χ2=15．262,P=0．002。超重／肥胖组冠脉血管发生弥漫性病变为52．73％,高于非肥胖组（18．42％）,χ2=11．148,P=0．001。结论急性冠脉综合征合并超重／肥胖患者冠状动脉病变具有多支、弥漫性及狭窄严重的特点。     

急性冠脉综合征患者C反应蛋白含量测定及意义

目的 探讨急性冠脉综合征患者C反应蛋白(CRP)含量变化及其对预后的影响。方法 采用免疫透射比浊法测定50例不稳定型心绞痛患者(心绞痛组)和35例急性心肌梗死患者(心肌梗死组)的CRP水平，同时选择30例体检正常者为对照组。结果 3组披检者CRP含量间差别有显著性意义(P＜0．05)。3组心脏事件发生率间差别有显著性意义(P＜0．05)。结论CRP水平升高是急性冠脉综合征发生的危险因素并可作为急性冠脉综合征患者预测预后的指标。     

碎裂QRS波在急性冠脉综合征的关系分析

目的:研究心电图导联上碎裂QRS波(fQRS)与急性冠脉综合征变化的关系。方法:选取100例急性冠脉综合征患者,评估冠脉病变情况,根据是否存在fQRS进行分组,分析fQRS对冠脉病变范围、罪犯血管影响。结果:急性冠脉综合征患者中出现fQRS达82%,与相关的血管有关。结论:fQRS出现可作为预测冠脉病变的指标之一。     

Elevated cardiac troponins: their significance in acute coronary syndrome and noncardiac conditions

Elevated cardiac troponin I or T levels are caused by cardiac injury. Such elevations in patients with acute coronary syndrome are crucial in terms of diagnosis, risk stratification and guiding therapy. Cardiac troponins are also often elevated in patients with chronic renal failure and in a wide range of other medical conditions in which the pathophysiology of acute coronary syndrome (plaque rupture and thrombosis) is not present. This review discusses the differences between cardiac troponin and other cardiac markers and the importance of bedside testing. The literature on elevated cardiac troponins in patients with acute coronary syndrome, patients without acute coronary syndrome and patients with chronic renal failure is summarized. The significance of elevated cardiac troponins in each group as it relates to prognosis and guiding treatment options is discussed.     

急性冠脉综合征血清C-反应蛋白的临床研究

目的:研究急性冠脉综合征患者血清C反应蛋白(C reaction protein,CRP)在发病中的作用及临床意义.方法:采用免疫比浊法对73例急性冠脉综合征患者的血清CRP水平进行观察,并与78例健康人进行比较.结果:急性冠脉综合征患者血清CRP浓度均高于对照组(P＜0.01).结论:急性冠脉综合征患者CRP血浆浓度升高,其升高可促进动脉粥样斑块的不稳定,导致急性冠脉综合征的发生,参与急性冠脉综合征的发生、发展过程,并在评估CHD发生的危险性中具有重要地位.     

64层螺旋CT在急性冠脉综合征中的临床应用

目的探讨多层螺旋CT（MSCT）冠脉造影（CA）对急性冠脉综合征（ACS）的临床诊断价值。方法对33例因胸痛而疑诊为ACS的患者行64层螺旋CT冠脉造影检查,并进行选择性冠状动脉造影（SAG）、心电图（ECG）检查。以SAG结果为“金标准”,比较其对ACS诊断的准确性。结果7例MSCT与SAG均排除冠脉狭窄病变。64层螺旋CT、ECG诊断中重度冠脉狭窄的敏感度分别为96．0％、88．0％;特异度为87．5％、37．5％;阳性预测值为96．0％、81．5％;阴性预测值为87．5％、50．0％。18例含有斑块,其中11例含软斑块,并进行了经皮冠状动脉腔内成形和支架植入术。结论64层螺旋CT冠脉造影对急性冠脉综合征患者是一种安全、可靠的无创性检查方法,并对内科介入治疗有指导价值。     

Role of the vascular endothelium in patients with angina pectoris or acute myocardial infarction with normal coronary arteries

Chest pain with normal coronary angiograms is a relatively common syndrome. The mode of presentation of this syndrome includes patients with syndrome X and patients with an acute myocardial infarction and angiographically normal coronary arteries. Different mechanisms have been proposed to elucidate the exact cause and to explain the various clinical presentations in these patients. Abnormalities of pain perception and the presence of oesophageal dysmotility have all been reported in patients with syndrome X. In situ thrombosis or embolization with subsequent clot lysis and recanalization, coronary artery spasm, cocaine abuse, and viral myocarditis have been described as potential mechanisms responsible for an acute myocardial infarction in patients with angiographically normal coronary arteries. Recent data suggest that both microvascular and epicardial endothelial dysfunction may play an important role in the pathophysiological mechanism of the syndrome of stable angina or acute myocardial infarction with normal coronary arteries.     

冠脉支架术后长期联用阿司匹林和氯吡格雷的有效性与安全性研究

目的观察急性冠脉综合征冠脉支架术后联合应用阿司匹林和氯吡格雷的疗效及安全性。方法将行冠脉支架术的611例冠心病患者按病情分为急性冠脉综合征组（ACS,72=424）和稳定性心绞痛组（SAP,n=187）。两组在冠脉支架术后长期联合应用（最短1个月,31．8％超过12个月）阿司匹林和氯吡格雷至随访结束。比较两组联合应用抗血小板的情况,观察两组患者主要心血管事件（心血管性死亡、心肌梗死、心肌缺血复发进行靶血管再通治疗）及抗血小板副作用（消化道出血、血小板减少、白细胞减少）的发生率。结果急性冠脉综合征组发生76例心血管事件（死亡15例,心肌梗死10例、靶血管再通治疗45例,卒中6例）;稳定性心绞痛组发生25例心血管事件（心血管性死亡8例,心肌梗死1例,靶血管再通治疗14例,卒中2例）,组间差异无显著性（P〉0．05）;阿司匹林及氯吡格雷负荷量差异有显著性,联合应用超过12个月例数差异无显著性意义;两组抗血小板副作用（消化道出血、血小板减少、白细胞减少）的发生率间差异无显著性（P〉0．05）。结论急性冠脉综合征组冠脉支架术后长期联合应用阿司匹林和氯吡格雷安全、有效,可减少冠脉支架术后心血管事件的发生,出血、血小板减少、白细胞减少等抗血小板药物并发症无明显增加。     

急性冠状动脉综合征患者血清超敏C-反应蛋白及尿酸的改变及其与动脉狭窄程度的关系

目的探讨急性冠状动脉综合征患者血清超敏C反应蛋白（hs-CRP）、尿酸的改变及二者与冠状动脉狭窄的关系。方法选择经冠状动脉造影证实为急性冠状动脉综合征的80例患者为研究对象,其中不稳定型心绞痛患者45例,急性心肌梗死患者35例。选择同期体检的30例健康者为对照组,比较三组血清hs-CRP及尿酸水平并探讨二者与急性冠状动脉综合征患者动脉狭窄的关系。结果不稳定型心绞痛及急性心肌梗死患者血清hs-CRP、尿酸水平显著高于对照组（P〈0.05）,但二者之间差异无统计学意义（P〉0.05）;随着急性冠状动脉综合征患者冠状动脉病变支数的增加,患者血清hs-CRP及尿酸水平显著增高（P〈0.05）;Pearson相关分析结果显示：血清hs-CRP及尿酸水平显著相关（r=0.387,P〈0.05）。结论 hs-CRP及尿酸可能通过炎症反应促进急性冠状动脉综合征的发生,二者与冠状动脉狭窄程度有关,可作为评估患者病情的指标。     

尿酸与急性冠脉综合征关系的临床研究

目的探讨尿酸与急性冠脉综合征患者预后的关系。方法选择急性冠脉综合征患者520例,依据尿酸水平分为尿酸增高组和正常组,对患者进行临床随访,观察患者临床预后。采用生存分析分析尿酸与急性冠脉综合征患者预后的关系。结果随访1年后,共66例达到随访终点,尿酸正常组的无终点事件生存率为91．0％,尿酸增高组的无终点事件生存率为82．0％（P〈0．05）。结论急性冠脉综合征患者尿酸增高与其不良预后有关,临床工作中应加以重视控制尿酸水平。     

老年急性冠脉综合症急诊介入治疗的研究

目的研究老年急性冠脉综合征急诊介入治疗的疗效。方法对13例接受急诊介入治疗的老年急性冠脉综合征患者以及常规药物治疗的对照组10例进行疗效及血凝指标的研究。结果 PTCA组和常规治疗组在有可比性的前提下进行比较,PTCA组的死亡率、冠状动脉残余狭窄、并发症的情况优于对照组,且差异具有统计学意义（P〈0.05）。通过急诊科的治疗,24h后PTCA组和常规治疗组之间血凝指标的差异具有统计学意义（P〈0.05）。结论 PTCA组的治疗急诊老年急性冠脉综合征的疗效优于常规治疗组,值得急诊科推广。     

急性冠状动脉综合征患者血清C-反应蛋白水平的变化及辛伐他汀对其影响

目的　观察急性冠状动脉综合征 (ACS)患者血清C -反应蛋白 (CRP)水平的变化及辛伐他汀对其影响。方法　 60例ACS患者随机分成两组 ,常规治疗组 (n =3 0例 ) ,辛伐他汀治疗组 (n =3 0 ) ,分别采用免疫单扩散法测定ACS患者治疗前后和 5 6名稳定型心绞痛 (SAP)患者及健康体检者 (对照组 ,n =5 6)外周血清中CRP水平。结果　ACS患者血清中CRP水平较对照组明显升高 ,治疗后辛伐他汀组血清中CRP水平较常规治疗组下降明显。结论　他汀类降脂药可以显著降低ACS患者血清CRP水平 ,起到稳定斑块的作用。     

MCP-1与急性冠脉综合征患者冠状动脉侧支循环的相关性研究

目的观察急性冠状动脉综合征（ACS）患者血清中单核细胞趋化蛋白-1（MCP一1）的水平与侧支形成的关系探讨其产生的可能机制。方法入选2010年6月-2011年8月间于太原市中心医院心内科行冠脉造影术的患者153例,所有患者行冠脉造影前抽动脉血标本。患者分为急性冠脉综合征组、稳定型心绞痛（SAP）组和正常对照组,急性冠脉综合征组按Rentrop’s分级法分为有侧枝组和无侧枝组,以ELISA法测定血清MCP-1浓度。结果MCP-1浓度在急性冠脉综合征组较稳定型心绞痛组及正常对照组高（P〈0．01）,稳定型心绞痛组与对照组血清MCP-1浓度比较差异无统计学意义（P〉0．05）,急性冠脉综合征组中有侧支组的MCP-1浓度较无侧支组高,且MCP-1浓度与Rentrop’s分级存在正相关（r=0．591,P〈O．01）。结论MCP-1可预测急性冠脉综合征的发生,MCP-1对冠脉侧支形成可能起促进作用。     

血浆氨基末端脑钠肽前体水平对急性冠脉综合征患者冠脉病变危险性和心功能水平的预测价值

目的:通过测定急性冠脉综合征(ACS)患者血浆氨基末端脑钠肽前体(NT-proBNP)水平探讨NT-proBNP水平对ACS患者冠脉介入危险性和治疗反应的预测价值。方法:选择急性冠脉综合征患者42例,其中不稳定性心绞痛组25例,急性心肌梗死组17例;选取无冠心病史健康查体者12例作为正常对照组。通过电化学发光法测定血NT-proBNP浓度,对急性冠脉综合征患者通过冠脉造影检查得出冠脉病变积分,比较各组NT-proBNP水平,并对冠脉病变积分、心功能分级与NT-proBNP水平作相关性分析。结果:急性心肌梗死组血NT-proBNP水平显著高于不稳定性心绞痛组及正常对照组(P<0.05;P<0.01),与冠脉病变积分和心功能Killip分级有明显正相关性(r=0.612,P=0.015;r=0.575,P=0.016);不稳定性心绞痛组血浆NT-proBNP水平显著高于正常对照组(P<0.05),与心功能NYHA分级有明显正相关性(r=0.719,P=0.000);急性冠脉综合征患者冠脉介入治疗后血浆NT-proBNP水平有明显下降(P<0.05),与心功能改变有一致性(r=0.351,P=0.018)。结论:血NT-proBNP水平可以作为急性冠脉综合征患者冠脉介入危险评估的预测指标,并可监测急性冠脉综合征患者介入治疗的效果,并可能提示治疗的预后。     

Antiplatelet therapy in non-ST-segment elevation acute coronary syndromes

Acute coronary syndromes are a frequent cause of hospital admission for patients with coronary artery disease. The pathophysiology of acute coronary syndromes often involves plaque rupture or fissure with platelet aggregation. Recognition of the importance of platelet aggregation resulted in several large randomized trials testing 3 types of platelet antagonists, aspirin, glycoprotein IIb/IIIa inhibitors, and adenosine diphosphate inhibitors. A thorough understanding of the data, risks, and benefits of these therapies is important to optimize treatment of the patient with an acute coronary syndrome. Recognition that there is a great deal of interpatient variability in response to these antiplatelet therapies highlights the need for future research in this area.     

非ST段抬高急性冠脉综合征患者cTnI与冠状动脉病变的关系

目的:探讨非ST段抬高急性冠脉综合征患者的心肌肌钙蛋白(ICardiacTroponinI,cTnI)水平与心电图ST段移位和冠脉病变的关系。方法:对92例非ST段抬高急性冠脉综合征患者于入院后12h内取静脉血用酶联免疫法测血清cTnI浓度,同时做12～18导联心电图,计算ST段缺血性下移程度,92例患者按Judkins法行冠脉造影术。依据cTnI>0.04ng/ml为阳性分为cTnI阳性组和cTnI阴性组。分析cTnI水平与ST段移位及冠状动脉病变之间的关系。结果:非ST段抬高的急性冠脉综合征患者的肌钙蛋白I阳性组ST段压低程度较阴性组明显(P<0.005)。血清cTnI阳性组的复杂病变和重度病变多于cTnI阴性组(P<0.01)。结论:非ST段抬高急性冠脉综合征患者的血TnI水平与ST段压低程度、冠脉病变稳定性及程度相关,血TnI水平的升高可作为识别冠状动脉不稳定病变评价的参考指标。     

瑞舒伐他汀钙联合曲美他嗪治疗急性冠脉综合征的临床疗效观察

目的观察瑞舒伐他汀钙联合曲美他嗪治疗急性冠脉综合征的临床疗效。方法将79例急性冠脉综合征患者随机分为对照组和治疗组。对照组给予常规治疗和曲美他嗪治疗,治疗组在此治疗基础上加用瑞舒伐他汀钙,总治疗疗程12周。比较两组患者血脂、超敏C-反应蛋白（high sensitivity C-reactive protein,hs-CRP）及冠心病缓解有效率。结果①治疗组患者经12周上述药物治疗,甘油三酯（triglyceride,TG）、总胆固醇（total cholesterol,TC）、低密度胆固醇脂蛋白（low density lipoprotein cholesterol,LDL-C）较治疗前减低,差异具有统计学意义（P〈0.05）;治疗12周后,治疗组较对照组患者TC、TG、LDL-C低。差异具有统计学意义（P〈0.05）;②治疗组患者经12周上述药物治疗,CRP值较治疗前减低,差异具有统计学意义（P〈0.05）;治疗12周后,治疗组患者CRP值较对照组低,差异具有统计学意义（P〈0.05）;③治疗组总有效率（87.5%）明显高于对照组（76.9%）（P〈0.05）,差异具有统计学意义（P〈0.05）。结论瑞舒伐他汀钙联合曲美他嗪治疗急性冠脉综合征疗效较好,不良反应轻微。