Immunologic mechanisms and treatment of acute coronary syndromes

Acute coronary syndromes （ACS） consist of unstable angina pectoris, non-ST segment elevation myocardial infarction and ST segment elevation myocardial infarction. The pathogenic mechanism of ACS is most often based on thrombosis secondary to plaque rupture in atherosclerosis （AS）. Recent studies indicate that immune and inflammatory responses are associated with the plaque instability in AS.1 Here we review molecular and cellular immunologic processes linked to initiation and progression of ACS and discuss potential applications of immunosuppressant therapy and the possible beneficial immune effects of some cardiovascular medicines used commonly in ACS.     

The serum levels of MMP-9, slCAM-1, CRP and WBC increased in patients with acute coronary syndrome

Objective：To evaluate the association of the peripheral levels of the defined inflammatory markers with different types of acute coronary syndrome （ACS） and stable angina, and the role inflammation played in the pathogenesis of ACS. Methods ：For understanding the variation of serum concentrations of matrix metalloproteinase-9 （MMP-9）, soluble intercellular adhesion molecule-1 （sICAM-1） ,C-reactive protein （CRP）, and white blood cell count （WBC） and their association with ACS, 90 patients with coronary heart disease （CHD） and 30 healthy volunteers were recruited. The enrolled people were assigned into four equal groups, including acute myocardial infarction （AMI） group, unstable angina pectoris（UAP） group, stable angina pectoris（SAP） group and healthy control group. The serum levels of MMP-9 and sICAM-1 were measured with ELISA kits, CRP were measured with im munoturbidimetric assay, and WBC number were assessed all before any treatment was administrated. Results： （1）The serum levels of MMP-9 ,sICAM-1 ,CRP and WBC in the patients with ACS were significantly higher than those in the control group （P 〈 0.01 ）. （2）Compared with control group, patients with SAP only had higher serum level of sICAM-1 （P 〈 0.01 ）. While the levels of MMP-9, CRP, and WBC had no significant difference between them （P 〉 0.05 all）. （3）Significant positive correlation between the serum levels of MMP-9 and sICAM-1 and CRP and WBC all were observed in the patients with ACS （P 〈 0.05）. Conclusion： The elevation of serum concentrations of inflammatory markers including MMP-9, slCAM-1, CRP and WBC were associated with initiation and progression of ACS, and they may help predicting cardiovascular events.     

Gender differences in efficacy of primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction

Background The clinical outcome of percutaneous coronary intervention （PCI） is poorer in women than that in men. This study aimed at comparing the impact of gender difference on the strategy of primary PCI in patients with acute ST-segment elevation myocardial infarction （STEMI）.
Methods Two hundred and fifty-nine patients with STEMI who underwent primary PCI within 12 hours of symptom onset were enrolled. The male group consisted of 143 men aged 〉55 years, and a female group included 116 women without age limitation. Procedural success was defined as residual stenosis 〈20% with thrombolysis in myocardial infarction flow grade 〉2 and without death, emergency bypass surgery or disabling cerebral events during the hospitalization. The rate of major adverse cardiac events （MACE）, including death, nonfatal myocardial infarction and target vessel revascularization during follow-up, was recorded.
Results Female patients were more hypertensive and diabetic and with fewer cigarette smokers than male counterparts. The prevalence of angiographic 3-vessel disease was higher in the female group, but the procedural success rate was comparable between the two groups （94.4% vs 92.2%）. The occurrence rate of MACE did not differ during the hospitalization （4.2% vs 6.0%, P=0.50）, but was significantly higher in the female group during follow-up （mean （16.0±11.2） months） than that in the male group （5.4% vs 0.7%, P=0.02）.
Conclusion Despite a similar success rate of primary PCI and in-hospital outcomes in both genders, female patients with acute STEMI still have a worse prognosis during the long-term follow-up.     

Gender-specific issues in the management of patients with acute coronary syndrome

Acute coronary syndrome （ACS） represents a continuum of acute myocardial ischemia including non-ST-elevation myocardial angina, synonymous with infarction and unstable non-ST-elevation ACS （NSTE-ACS）, and ST-elevation myocardial infarction （STEMI）. A large body of clinical evidence has demonstrated the great impact of gender differences on the treatment of ACS and clinical outcomes of these patients.In general, women develop coronary artery disease about 10 years later than men though the reasons for this remain unclear.     

Prognostic efficacy of troponin T measurement in angina pectoris.

This study was designed to evaluate the efficacy of the newly developed Troponin T (TNT) enzyme immunoassay for predicting the prognosis of patients with angina pectoris. TNT, creatine kinase (CK) and MB isoenzyme of creatine kinase (CK-MB) were monitored in 134 patients with angina pectoris. There was no abnormality with any of these tests in 40 patients with stable angina pectoris and 30 patients with unstable angina pectoris of Class I and 2 according to Braunwald's criteria. None of them developed acute myocardial infarction or other cardiac events. Elevation of TNT concentration with normal level of CK and CK-MB was found in 34 of the 64 cases of unstable angina pectoris of Class 3. Among the 34 patients, 11 had acute myocardial infarction within 10 days during hospitalization. In contrast, only one of the patients with unstable angina pectoris of Class 3 with normal value of TNT developed acute myocardial infarction. As the incidence of angina pectoris is quite high clinically but only a small numb     

Evaluation on the Safety and Efficacy of Tirofiban in the Treatment of Acute Coronary Syndrome

To evaluate the safety and efficacy of tirofiban, a specific inhibitor of the platelet glyco- protein Ⅱb/Ⅲa receptor, in the treatment of unstable angina and myocardial infarction without per- sistent ST elevation (acute coronary syndrome, ACS), a total of 200 patients were randomly assigned to a heparin group and a tirofiban heparin group on double-blind basis and the treatment effects of the two protocols on ACS were compared when the patients of both groups were taking aspirin at the same time. The composite primary end-point events consisted of death, myocardial infarction, or re- fractory ischemia. Our results showed that the frequency of the composite primary end point events in 30 days was lower in tirofiban heparin group as compared with that of heparin group (13.9% vs 29.3 %, P=0.010). The rates of the other composite end point events in the tirofiban heparin group were also lower than those in the heparin group in 4.5 days and in 30 days. Bleeding complication occurred in 7.0% of the patients receiving heparin alone and in 12.7% of the patients receiving tirofiban and heparin in combination (P=0.1717). The study showed that the incidence of ischemic events in pa- tients with ACS receiving tirofiban heparin was lower when compared with that of patients who re- ceived only heparin and aspirin, suggesting that tirofiban might be of special value in the treatment of ACS.     

替格瑞洛对急性ST段抬高型心肌梗死患者行急诊介入治疗的中期随访

Objective： To evaluate the safety and efficacy of antiplatelet therapy of ticagrelor on patients suffering from acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.Methods: In the study, 96 patients suffering from acute ST segment elevation myocardial infarction onset within 12 h undergoing primary percutaneous coronary intervention from May to October in 2013 were randomly divided into ticagrelor group (n=48) and clopidogrel group (n=48) by using the method of random number table. Ticagrelor and clopidogrel antiplatelet treatment were used before and after operation. Their baseline data, coronary artery disease characteristics, platelet count, adenosine diphosphate(ADP)-induced platelet inhibition rate by thrombelastograph after 5 days of treatment, the major adverse cardiovascular events of the follow up for 6 months and bleeding complications were observed and compared in the two groups. Results: The differences between the two groups of patients with their baseline data, the features of coronary artery lesions, platelet count before and after 5 days of treatment had no statistical significance (P>0.05). ADP induced platelet inhibition rate ［(80.2±10.7)%］ after 5 days of treatment in ticagrelor group was significantly higher than that in clopidogrel group ［(75.3±12.1)%, P<0.05］. The two groups of patients were followed up for 6 months, 8 cases of major adverse cardiovascular events occurred in clopidogrel group, 2 cases of major adverse cardiovascular events occurred in ticagrelor group, and there was significant difference between the two groups (P<0.05). The two groups (7 cases of 48 patients in ticagrelor group vs. 3 cases of 48 patients in clopidogrel group) had no statistically significant difference in bleeding complications (P>0.05).Conclusion: Antiplatelet therapy of ticagrelor on patients suffering from acute ST segment elevation myocardial infarction undergoing emergency PCI has good efficacy and safety.     

Effects of patency of infarct-related coronary artery on acute outcome in acute myocardial infarction patients undergoing urokinase therapy. Collaborative Research Group on Thrombolysis.

OBJECTIVE To study the effects of patency of infarct-related coronary artery on acute outcome in cases of acute myocardial infarction undergoing urokinase therapy.

METHODS One thousand one hundred and thirty-eight cases of acute myocardial infarction admitted in 37 collaborative hospitals were given urokinase intravenously with a standard program. Patency of infarct-related coronary artery assessed by uniform criteria occurred in 757 patients (66.5%) and non-patency in 381 patients (33.5%). Four-week mortality and frequency of various severe complications were compared between patency patients and non-patency patients.

RESULTS The 4-week mortality in patients with patency was 3.4% versus 21.8% in those without patency (P < 0.001). Frequencies of various severe complications, such as heart failure, shock, ventricular fibrillation, bundle branch blocks and mechanical complications (P < 0.01), and complete atrioventricular block (P < 0.05) were much higher in patients without than in those with patency. In large sized infarcts such as high lateral plus anterior wall infarction the difference in 4 week mortality was even more obvious between patients with and without patency (2.6% vs 32.7%, P < 0.001). Using Cox proportional hazards regression model analysis, patency of infarct-related coronary artery was defined as the most important independent predictor of 4-week mortality. The risk ratio for occluded versus patent infarct-related coronary artery was 6.69.

CONCLUSIONS On univariate and multivariate analyses, patency of the infarct-related coronary artery was the most important prognostic factor for acute outcome in acute myocardial infarction.

     

Primary percutaneous coronary intervention on older patients with acute ST-segment elevation myocardial infarction: analysis of its risk factors

Objective： The aim of the present study was to assess the early clinical outcome and risk factors in old patients with acute ST elevation myocardial infarction （STEMI） following primary percutaneous coronary intervention （PCI）. Methods： A total of 136 patients older than 60 years with STEMI who received successful PCI were included in this study. The patients were classified in 2 age groups： patients 〉75 years and 〈75 years of age. The extent of coronary artery lesions was measured by quantitative coronary artery angiography （QCA）. Subjects were tracked for subsequent cardiovascular events： cardiac death, myocardial infarction, heart failure, percutaneous coronary intervention, coronary artery bypass and stroke. Results： Though the older group had a higher prevalence of adverse baseline characteristics and lower final TIMI flow than patients〈75y （P〈0.05）, the procedural success did not make difference between the two groups. In 12 months follow-up of 136 study participants, there occurred 39 CV events ： cardiac death （five patients）, heart failure （nineteen patients）, and stroke （six patients）. Three patients received coronary bypass grafts and six patients underwent PCI. Heart failure and overall cardiovascular event rates were higher in older patients compared with those in patients〈75y. The main adverse clinical events （MACE） for the old group were a little higher comparing with the younger in 12-month follow-up （P=-0.029 6 and P=-0.043 4）. Multivariate cox analysis identified that a diagnosis of diabetes （HR 2.495, 95%CI 1.224 to 5.083, P= 0.011 8） and time from symptom（HR 1.450, 95%CI 1.143 to 1.841, P= 0.008 2） to PCI as independent predictors of CV events after adjustment of all entered baseline variables. Conclusion： Our study suggests that drug-eluting stent implantation in older patients with acute ST elevation myocardial infarction has high initial procedural success rates despite having more severe baseline risk characteristics, and to shorten the time from symptom onset to PCI may decrease cardiovascular events in old patients following PCI.     

Comparison of efficacy and safety of native eptifibatide vs. tirofiban in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Objective: To compare clinical outcomes and safety of eptifibatide or tirofiban in patients with acute coronary syndrome(ACS) undergoing percutaneous coronary intervention(PCI). Methods:Thirty-six patients with ACS(unstable angina/non-ST-segment elevation myocardial infarction, UA/NSTEMI) who underwent PCI were randomly divided into two groups to receive eptifibatide or tirofiban treatment. Eptifibatide or tirofiban was predominantly initiated in the catheter laboratory before the intervention. In-hospital and 30-day MACE outcomes; bleeding as well as platelet counting were investigated in those two groups. Results:No in-hospital and 30-day MACE event occurred in the two groups. The number of ischemia leads after treatment reduced compared to that before PCI in the two groups. There was improvement in the number of ischemia leads for 24 h after administration in the tirofiban group than those in eptifibatide group(4.21±2.46 vs. 3.89±3.31, P =0.03). The two groups showed no incidence of massive bleeding. Minor bleeding rates were 16.7% and 22.2% in the two groups respectively. Conclusion:Eptifibatide as an adjunct to PCI may further decrease the incidence of ischemia event in patients with ACS and improve the safety, but its long-term efficacy and side effects need further observation.     

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.     

急性冠状动脉综合征介入治疗4670例近期疗效的评价

目的分析过去15年经皮冠状动脉介入(PCI)治疗急性冠状动脉综合征(ACS)患者的近期临床疗效。方法1989年8月至2004年10月沈阳军区总医院心血管内科对4670例住院的ACS患者行PCI治疗,其中发病30d内的急性心肌梗死(AMI)患者1750例(37.5%),不稳定心绞痛患者2920例(62.5%)。评价PCI的成功率、合并症及住院期间近期临床疗效。结果PCI总的病例成功率为98.1%(4579/4670),AMI行急诊PCI者梗死相关动脉开通率98.2%(825/840)。住院期间共死亡52例(总病死率1.1%),其中术中死亡2例(术中病死率0.04%)。总的PCI相关并发症发生率为6.5%(304/4670)。从入院至PCI时间为3.5d±2.1d,平均住院12d±8d。结论PCI治疗ACS成功率高,术中、术后死亡率和手术相关并发症发生率低,近期疗效好。     

急性心肌梗死患者行经皮冠状动脉介入术后住院期间死亡的危险因素分析

目的 探讨影响急性心肌梗死(AMI)患者行经皮冠状动脉介入术(PCI)后住院期间死亡的危险因素.方法 回顾性分析2009年1月至2011年9月因AMI入住我院并行PCI的275例患者的一般情况、既往史、入院情况、术中及术后情况、并发症等资料,对可能影响术后死亡的危险因素通过logistic回归模型进行分析.结果 多因素logistic回归分析表明,女性( P=0.047,OR=2.91)、广泛前壁心肌梗死(P=0.044,OR=3.07)、肾功能不全史(P=0.021,OR=7.98)、发生心源性休克(P=0.008,OR=15.71)、术后心肌梗死溶栓(TIMI)血流＜3级(P=0.016,OR=5.61)、置入主动脉内球囊反搏(IABP;P=0.043,OR=3.49).结论 影响AMI患者行PCI术后院内死亡的危险因素为女性、广泛前壁心肌梗死、置入IABP、术后TIMI血流＜3级、肾功能不全史和发生心源性休克.     

梗塞前心绞痛对老年急性心肌梗塞预后的影响

目的：为了研究梗塞前心绞痛（ＡＰ）对老年急性心肌梗塞（ＡＭＩ）预后的影响。方法：作者对１８６例ＡＭＩ患者（老年人１１８例,老年前期６８例）,观察ＡＭＩ前４８ｈ有无ＡＰ发作,分为ＡＰ（＋）和ＡＰ（－）组,分析两组病人的预后。结果：在〈６０岁的ＡＭＩ患者中,梗塞前ＡＰ可降低ＡＭＩ患者１月内充血性心衰（ＣＨＦ）,心源性休克和心源性死亡率;ＣＫ峰值降低,达峰时间缩短;     

Relationship among soluble CD105, hypersensitive C-reactive protein and coronary plaque morphology: an intravascular ultrasound study

Background Rupture of unstable plaque with subsequent thrombus formation is the common pathophysiological substrate of acute coronary syndrome （ACS）. It is of potential significance to explore the blood indexes predicting plaque characteristics. We investigated the relationship among soluble CD105, hypersensitive C-reactive protein （hs-CRP）, and coronary plaque morphology.
Methods A clinical study from April 2004 to December 2006 was conducted in 130 patients who were divided into 3 groups： 56 patients （43.1%） in stable angina （SA） group, 52 patients （40.0%） in unstable angina （UA） group and 22 patients （16.9%） in acute myocardial infarction group. The concentrations of soluble CD105 and hs-CRP were measured in all of the patients by cardioangiography （CAG）. Plasma samples of arterial blood were collected prior to the procedure. The levels of soluble CD105 and hs-CRP were measured by enzyme-linked immunosorbent assay （ELISA）.
Results Unstable and ruptured plaque was found more frequently in patients with acute myocardial infarction and UA. External elastic membrane cross-sectional area （EEM CSA）, plaque area, lipid pool area and plaque burden were significantly larger in the ruptured and unstable plaque group. Positive remodeling, thinner fabric-cap, smaller minimal lumen cross-sectional area （MLA）, dissection and thrombus were significantly more frequent in the ruptured and unstable plaque group. Remodeling index （RI） was positively correlated with the levels of soluble CD105 in the UA group （r=0.628, P〈0.01） and the acute myocardial infarction group （r=0.639, P〈0.01）. The levels of soluble CD105 and hs-CRP were higher in the ruptured plaque group. Soluble CD105 〉4.3 ng/ml was used to predict ruptured plaque with a receiver operating characteristic （ROC） curve area of 0.77 （95% confidence interval （CI）, 66.8%-87.2%）, a sensitivity of 72.8%, a specificity of 78.0% and an accuracy of 70.2% （P〈0.01）, similarly for hs-CRP 〉 5.0 mg/     

急性冠状动脉综合征患者PCI术前血清ICAM-1、ESM-1水平与术后冠状动脉慢血流/无复流的相关性

目的 探讨急性冠状动脉综合征(ACS)患者行经皮冠状动脉介入治疗(PCI)术前血清细胞间黏附分子-1(ICAM-1)、内皮细胞特异性分子-1(ESM-1)水平与PCI术后冠状动脉慢血流/无复流(CSF/CNR)的相关性.方法 选择2018年10月—2021年5月华北石油管理局总医院心内科行PCI术的ACS患者354例为...     

Effect of a low dose of empagliflozin on short-term outcomes in type 2 diabetics with acute coronary syndrome after percutaneous coronary intervention

Objectives:To study the effects of low dose of empagliflozin on improving outcomes in diabetic patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI).Methods:This double-blind controlled clinical trial was carried out on 93 diabetic patients (56 males and 37 females, mean age of 56.55 years) with ACS who underwent PCI at 2 university teaching hospitals in 2020, Ahvaz, Iran. The patients were randomly assigned to receive empagliflozin (10 mg once daily) or placebo at similar doses for 6 months after PCI. In addition, to standard treatments with another hypoglycemic agent. Cardiovascular outcomes (including all-cause mortality, coronary revascularization, rehospitalization due to unstable angina, hospitalization due to heart failure, cardiovascular death, non-fetal myocardial infarction, and non-fetal stroke) were evaluated during period of 6 months follow-up after the empagliflozin treatment.Results:There was no significant difference between the low dose empagliflozin and placebo groups after treatment in terms of cardiovascular mortality (2.2% versus [vs.] 4.2%; p=0.598), rehospitalization due to unstable angina (4.5% vs. 8.7%; p=0.433), and coronary revascularization (2.2% vs. 0%; p=0.312).Conclusion:The results of this study showed that adding low dose empagliflozin to standard care of ACS diabetic patients after PCI was associated with no significant reduction in negative cardiovascular outcomes during 6 months.     

静脉溶栓联合早期经皮冠状动脉介入治疗急性ST段抬高型心肌梗死的荟萃分析

目的 系统评价静脉溶栓联合早期经皮冠状动脉介入(PCI)治疗急性ST段抬高心肌梗死(24 h)的有效性和安全性.方法 计算机检索MEDLINE、EMBASE、Elsevier、Cochrane数据库及中国万方、中国知网(CNKI)数据库,收集静脉溶栓联合早期PCI治疗急性ST段抬高心肌梗死的随机对照试验(RCT),2名研究者独立检索和评价相关文献,应用RevMan 5.0和Stata 10.0软件进行数据统计学处理.结果 共纳入8项研究(NORDI-STEMI,TRANSFER-AMI,WEST,CARESS-AMI,CAPITAL-AMI,GRACIA-Ⅰ,SIAMI Ⅲ,PRAGUE-Ⅰ),3157例病人.(1) 溶栓后早期PCI治疗组30d复合终点事件低于对照组(RR=0.52,95％CI 0.42～0.65,P<0.001);(2)溶栓后早期PCI治疗组30 d非致死性心肌梗死发生率低于对照组(RR=0.57,95％CI 0.40～0.81,P=0.002);(3) 溶栓后早期PCI治疗组30 d再发心肌缺血发生率低于对照组(RR=0.27,95％CI 0.14～0.52,P<0.001);(4) 溶栓后早期PCI治疗组30 d出血并发症发生率(RR=1.07,95％CI 0.78～1.46,P=0.69)、30d心血管性死亡发生率(RR=0.86,95％CI 0.62～1.20,P=0.38),组间比较差异无统计学意义.结论 静脉溶栓联合早期PCI治疗急性ST段抬高心肌梗死能够降低30 d复合终点事件、非致死性心肌梗死发生率和再发心肌缺血发生率,而不增加出血和死亡风险.

Abstract：

Objective To evaluate the efficacy and safety of early percutaneous coronary intervention (PCI) within 24 hours of thrombolysis in acute ST-elevation myocardial infarction. Methods The databases of Medline, EMBASE, Elsevier, Cochrane library, Wanfang and CNKI were searched for randomized controlled trials. Quality assessment and data extraction were performed by two independent reviewers. Statistical analyses were conducted with Stata 10.0 and RevMan 5.0 software. Results Eight studies (NORDI-STEMI, TRANSFER-AMI, WEST, CARESS-AMI, CAPITAL-AMI, GRACIA-Ⅰ, SIAMI Ⅲ & PRAGUE-Ⅰ) involving a total of 3157 patients fulfilled the inclusion criteria. Meta-analysis results showed that, as compared with the control group, (1) the combined endpoint of 30 day mortality, re-infarction and ischemia was significantly lower in early PCI within 24 h of thrombolysis group [relative risk (RR)=0.52, 95% confidence interval (CI)0.42-0.65, P<0.001]; (2) 30-day re-infarction decreased in early PCI within 24 h of thrombolysis group (RR=0.57, 95% CI 0.40-0.81, P=0.002); (3) 30-day ischemia had a significant reduction in early PCI within 24 h of thrombolysis group (RR=0.27, 95% CI 0.14-0.52, P<0.001); (4) 30-day major hemorrhage or mortality rates were not significantly different between two groups (RR=1.07, 95% CI 0.78-1.46, P=0.69; RR=0.86, 95% CI 0.62-1.20, P=0.38 respectively). Conclusion When primary PCI is not feasible, our meta-analysis favors early PCI within 24 h of thrombolysis for acute ST-elevation myocardial infarction. Early PCI is associated with a lowered recurrence of major adverse cardiac events, ischemia and re-infarction. But there is no elevated risk of major hemorrhage and mortality.     

急性冠脉综合征病人脑卒中发生率及其预后

目的探讨急性冠脉综合症(ACS)病人合并卒中的危险因素及其预后。方法共2623例ACS住院病人入选,观察基本临床资料和相关事件。结果住院期间51例(1.94%)发生卒中,其中16例(31.37%)死亡,ST段抬高的心肌梗塞组的卒中发病率(3.11%)明显高于不稳定性心绞痛组(1.61%),P<0.05,院内卒中的发生与其它血管事件密切相关,包括心力衰竭、心源性休克、心跳骤停、心房纤颤、急性肾功能衰竭和糖尿病。结论ACS住院病人发生卒中率虽不高但其病死率高达31.37%,对此高危人群应采取个体化治疗措施。