Effect of magnesium sulfate pretreatment and significance of matrix metalloproteinase-1 and interleukin-6 levels in coronary reperfusion therapy for patients with acute myocardial infarction.

Magnesium (Mg) inhibits the influx of calcium in vascular smooth muscle cells. The purposes of this study were to test the hypothesis that an intravenous administration of magnesium might effect the complement response and to determine the effects of a magnesium pretreatment of patients with acute myocardial infarction (AMI) on the incidence of reperfusion injuries. Thirty-eight AMI patients were treated with coronary reperfusion therapy within 6 hours of onset. They were randomly divided into two groups: group pretreated with intravenous magnesium sulfate (0.27 mmol/kg) (magnesium group, n = 19), and nonpretreated controls (placebo group). The reperfusion injuries observed within 1 hour after the coronary reperfusion included arrhythmias, aggravated chest pain, and ST segment elevation in 12-lead electrocardiograms. Coronary recanalization was performed in 36 patients. The incidence of reperfusion arrhythmia was significantly lower in the magnesium group than in the placebo group (17% vs 78%, p<0.001). At the postreperfusion stage, there was a tendency for the degree of ST segment reelevation in the magnesium group lower than in the placebo group (2.5 +/- 2.3 mm vs 4.7 +/- 3.8 mm, p = 0.07). No marked difference was observed in the incidence of chest pain aggravation between the two groups (67% vs 73%, ns). The peak serum levels of interleukin-6 (IL-6) were significantly lower in the magnesium group than those in the placebo group (38.9 +/- 25.0 vs 92.3 +/- 76.5 pg/mL, p = 0.016). The peak serum levels of matrix metalloproteinase-1 (MMP-1) were lower than those in the placebo group (16.2 +/- 4.8 vs 19.7 +/- 9.0 ng/mL, p = 0.09), but the difference was not significant. A positive correlation was observed between the peak MMP-1 values and the peak IL-6 values (r = 0.57, p = 0.001) in all patients. Increased serum ionized Mg2+ may inhibit arrhythmic recurrence and the production of IL-6 and MMP-1 after reperfusion and prevent the increase of myocardial lesions caused by calcium overload on myocytes. The increased IL-6 production may induce MMP-1, leading to tissue organ injury. Pretreatment with magnesium sulfate may protect the myocardium of AMI patients from reperfusion injuries.     

依达拉奉治疗急性心肌梗死再灌注损伤疗效的Meta分析

目的系统评价依达拉奉治疗急性心肌梗死(AMI)再灌注损伤的有效性。方法计算机检索2001年1月至2013年8月中国期刊全文数据库、中文科技期刊数据库、中国生物医学文献数据库及Cochrane图书馆、PubMed等数据库,全面收集AMI患者接受依达拉奉治疗的文献,参照纳入、排除标准对文献进行筛选。由两名研究者提取资料、评价质量后,采用RevMan 4.2软件进行Meta分析。结果共纳入9项研究,合计急性心肌梗死再灌注损伤患者604例,其中依达拉奉组303例,对照组301例。Meta结果显示:两组冠状动脉血管再通率无统计学差异(OR=1.14,95%CI:0.63~2.08,P=0.66)。与对照组相比,依达拉奉组再灌注心律失常发生率降低(OR=0.29,95%CI:0.19~0.44,P0.0001),左室射血分数提高(WMD=7.68,95%CI:6.63~8.73,P0.0001)。结论当前证据表明,依达拉奉可改善AMI患者左心收缩功能,降低再灌注心律失常的发生,但由于纳入文献数量和质量有限,上述结论尚需高质量、大样本临床试验进一步证实。     

Suppressive effect of nicorandil in ventricular arrhythmias after reperfusion therapy in patients with acute myocardial infarction

BACKGROUND: Nicorandil is reported to inhibit reperfusion arrhythmias in patients with acute myocardial infarction (AMI), but few studies have counted ventricular arrhythmias with Holter electrocardiograms in patients treated with nicorandil following AMI reperfusion. OBJECTIVES: In the present study, we examined the effects of nicorandil by investigating the occurrence of ventricular arrhythmia with Holter electrocardiogram monitoring after percutaneous coronary intervention with acute myocardial infarction. METHODS: Forty patients with AMI who underwent successful percutaneous coronary intervention (PCI) were enrolled and randomly assigned to nicorandil or placebo groups. Following PCI, nicorandil was infused intravenously at 6 mg/hr for 24 hr, with Holter electrocardiogram monitoring. Patients with 100 or more premature ventricular contractions (PVCs) over the 24-hour period were studied. The total number of PVCs, frequency of occurrence of ventricular tachycardia, and clinical characteristics were compared between the two groups. RESULTS: Fourteen patients in the nicorandil group and 12 patients in the placebo group exhibited 100 or more PVCs over the 24-hour period. Lesion characteristics and procedural factors did not differ between the two groups. Fewer PVCs were counted in the nicorandil group than in the placebo group(144.6 +/- 106.5 vs 286.8 +/- 159.1 beats/day, p = 0.012). The frequency of coupled PVCs was lower in the nicorandil group (6.9 +/- 6.9 vs 16.3 +/- 12.8 beats/day, p = 0.025). Although the frequency of ventricular tachycardia did not differ between the two groups, ventricular tachycardia duration was significantly shorter in the nicorandil group (3.73 +/- 2.30 vs 8.34 +/- 7.45 sec, p = 0.03). CONCLUSIONS: Our study indicates nicorandil inhibits ventricular arrhythmias following PCI for patients with AMI. Nicorandil treatment following PCI for AMI is convenient and may reduce the rate of cardiac events by inhibiting ventricular arrhythmias, thereby potentially improving the prognosis.     

Increased plasma thioredoxin in patients with acute myocardial infarction

BACKGROUND AND HYPOTHESIS: Thioredoxin is an important biomarker for oxidative stress. We investigated whether thioredoxin levels were elevated in patients with acute myocardial infarction (AMI) and were associated with the results of coronary reperfusion. METHODS: The present study determined plasma thioredoxin levels in 51 patients with AMI, 30 patients with stable exertional angina (SEA), and 30 patients with chest pain syndrome (CPS). Plasma sampling was performed on admission, at 12 h, 1 week, 2 weeks, and 4 weeks in patients with AMI, and after admission in patients with SEA and CPS. RESULTS: Plasma thioredoxin levels on admission were higher in patients with AMI than in those with SEA and CPS. Plasma thioredoxin levels in patients with AMI were decreased in 12 h without further change thereafter. However, thioredoxin levels in patients with AMI remained higher than in those with SEA. In multivariate analysis, higher levels of thioredoxin on admission were a risk factor for failure in emergent reperfusion therapy in patients with AMI independent of other factors. CONCLUSION: Plasma thioredoxin levels are elevated in patients with AMI, and higher thioredoxin levels may predict subsequent failed coronary reperfusion therapy in patients with AMI.     

缺血后适应对急性心肌梗死患者临床及预后的影响

目的探讨急性心肌梗死(AMI)患者施行缺血后适应能否有效地降低缺血再灌注损伤,从而对心脏产生保护作用。方法选取AMI患者42例,随机分为对照组22例和缺血后适应组20例。监测2组患者PCI术前、术后2h、1、2、3d内肌酸激酶同工酶(CK-MB)值,并测定CK-MB峰值及各时间点下CK-MB平均值曲线下面积;监测PCI术前及术后2h血清C反应蛋白(CRP)、丙二醛和超氧化物歧化酶(SOD)水平;比较2组患者PCI术前及术后24h内心电图ST段回落情况。结果缺血后适应组CK-MB峰值明显低于对照组[(570.61±41.27)U/L vs(661.80±58.55)U/L,P<0.01];CK-MB平均值曲线下面积明显低于对照组[(5821.19±2912.07)%vs(9843.12±3578.02)%,P<0.01];缺血后适应组术后2hCRP下降幅度明显低于对照组(P<0.05);缺血后适应组术后丙二醛下降较对照组明显(P<0.05);缺血后适应组术后SOD升高较对照组明显(P<0.01);缺血后适应组ST段回落情况较对照组高(60.0%vs 45.5%,P<0.05),对照组中有2例患者因发生恶性心律失常死亡。结论AMI患者施行缺血后适应处理能够降低CK-MB的释放,降低氧自由基含量,减轻炎性反应,使冠状动脉恢复血流情况占有明显优势,能够明显降低再灌注损伤,发挥心脏保护作用。     

Comparison of urinary biopyrrin levels in acute myocardial infarction (after reperfusion therapy) versus stable angina pectoris and their usefulness in predicting subsequent cardiac events

We examined the relation between oxidative stress and cardiac events in patients with acute myocardial infarction (AMI). There is now increasing evidence that reactive oxygen species cause reperfusion injury to the previously ischemic myocardium after reperfusion. We measured urinary biopyrrin/creatinine levels, an oxidative stress marker, in 41 patients with AMI, 34 patients with stable angina pectoris (SAP), and 29 control subjects. In the patients with AMI, urine samples were taken before, at 4 and 24 hours, and at 1 and 2 weeks after reperfusion therapy. Of these 41 patients with AMI, 38 received reperfusion therapy, and the urinary biopyrrin/creatinine levels (micromol/g.creatinine) before reperfusion were significantly higher than those of the other 2 groups (AMI 4.24 +/- 0.49, SAP 2.45 +/- 0.15, control subjects 2.31 +/- 0.16; p = 0.0003 vs AMI). The onset of reperfusion significantly increased the levels of urinary biopyrrins/creatinine, and this time course was mapped out, peaking at 4 hours (8.21 +/- 0.96 vs 4.24 +/- 0.49 before, p = 0.0001), and decreasing to control levels between 24 hours and 7 days. The peak levels of urinary biopyrrins/creatinine were higher in the positive cardiac event group than in the negative cardiac event group (11.89 +/- 1.77 vs 7.57 +/- 1.00 micromol/g.creatinine, p = 0.029). These findings add further evidence that oxidative stress contributes to the complications of reperfusion injury, and suggest that urinary assessment of biopyrrins may be useful in predicting subsequent cardiac events after reperfusion in AMI.     

Reperfusion arrhythmias: are they only a marker of epicardial reperfusion or continuing myocardial ischemia after acute myocardial infarction?

Reperfusion arrhythmias are associated with epicardial reperfusion but may also be a sign of vascular reperfusion injury which can be seen as no-reflow phenomenon on coronary angiography and predicts in-hospital complications and recovery of left ventricular (LV) function. No-reflow phenomenon (thrombolysis in myocardial infarction [TIMI] 相似文献   

依达拉奉治疗急性心肌梗塞的疗效观察

目的：观察依达拉奉治疗急性心肌梗塞（AMI）的疗效。方法：60例发病48h内行溶栓或经皮冠状动脉介入治疗（PCI）后的心肌梗塞患者被随机分为对照组（32例）、依达拉奉组（28例）,治疗2～3周后比较疗效。结果：与对照组相比,依达拉奉组患者左室射血分数（LVEF）明显升高[51．9±4．99）％：（55．31±5．36）％,P〈0．05],住院期间恶性心律失常发生率明显降低（25．9％：13．3％,P〈0．05）,但两组患者住院期间总体病死率无明显差异（P〉0．05）。结论：依达拉奉作为一种新型氧自由基清除剂,治疗急性心肌梗塞有明显的疗效。     

Association between serum paraoxonase activity and oxidative stress in acute coronary syndromes

OBJECTIVE: The oxidation of low-density lipoprotein (LDL) is believed to have a central role in atherogenesis. Under oxidative stress not only LDL, but all other serum lipids are exposed to oxidation. High-density lipoprotein (HDL)-associated paraoxonase (PON1) was shown to inhibit LDL and HDL oxidation. We investigated the relationship between PON1 and oxidative stress in acute myocardial infarction and unstable angina in a comparative fashion. METHODS AND RESULTS: Activities of PON1, concentrations of malondialdehyde (MDA), lipids and lipoproteins were measured in patients (38 subjects with acute myocardial infarction and 33 subjects with unstable angina pectoris) and in age- and sex-matched controls (32 subjects). Serum PONI activity was significantly lower in patients than in controls (p < 0.001). Patients had significantly increased serum MDA concentrations (p < 0.001) and there were strong negative correlations (p < 0.001) between serum PON1 and MDA levels in the acute myocardial infarction group (r = -0.673), in the unstable angina pectoris group (r = -0.868) and in healthy controls (r = -0.778). Serum HDL-cholesterol (HDL-C) concentrations were lower in patients than controls (p < 0.05). No correlation was observed between PON1 and HDL-C levels in patients or controls. Apo A I concentrations were significantly lower in the patient groups (p < 0.01), but were insignificant between patients with AMI and UAP. Apo A-I and PON1 levels did not show any correlation. Apo B concentrations were lowest in the healthy controls, higher in the UAPgroup and highest in the AMI group (p < 0.001). In the acute myocardial infarction group LDL/apo B ratio was lower than in healthy controls and in the UAP group, suggesting smaller LDL particle size. CONCLUSIONS: Results of this study indicate that lower serum PON1 activity is associated with oxidative stress and the activity of PON1 is not related to HDL-cholesterol.     

Significance of the antioxidant factor,thioredoxin, in heart failure

OBJECTIVES: Increases in oxidative stress may be involved in the progression of heart diseases. However, the serum levels of thioredoxin, a redox regulating protein, have been poorly investigated in patients with heart diseases. This study evaluated the clinical significance of the serum thioredoxin levels in patients with heart failure. METHODS: The serum thioredoxin levels were determined with a sandwich enzyme-linked immunosorbent assay in a total of 34 patients with dilated cardiomyopathy (n = 5), acute coronary syndrome (n = 7), and stable angina (n = 18), including effort angina (n = 7) and vasospastic angina (n = 11), and control subjects (n = 4). RESULTS: The serum thioredoxin levels were significantly elevated in patients with acute coronary syndrome (30.6 +/- 4.9 ng/ml, p < 0.001) and dilated cardiomyopathy (36.9 +/- 8.6 ng/ml, p < 0.001), but not in patients with stable angina (16.8 +/- 5.7 ng/ml, p = 0.27) compared with the control subjects (n = 4, 13.0 +/- 4.9 ng/ml). The serum thioredoxin level in patients with III and IV functional classes of the New York Heart Association (n = 8, 33.3 +/- 8.6 ng/ml, p < 0.001) was significantly higher than in the control subjects. In addition, the serum thioredoxin levels were negatively correlated with left ventricular ejection fractions of the patients (r = 0.59, p < 0.001). CONCLUSIONS: These results indicate a possible association between thioredoxin and the severity of heart failure.     

Effect of type of atrial fibrillation on prognosis in acute myocardial infarction treated invasively

To assess the incidence of atrial fibrillation (AF) and the clinical impact of AF types on outcomes in patients with acute myocardial infarction (AMI) treated invasively, we analyzed 2,980 consecutive patients with AMI admitted to our department from 2003 through 2008. Data collected by the insurer were screened to identify patients who died during the median follow-up of 41 months. AF was recognized in 282 patients (9.46%, AF group); the remaining 2,698 patients (90.54%) were free of this arrhythmia (control group). The AF group was divided into 3 subgroups: prehospital paroxysmal AF (n = 92, 3.09%), new-onset AF (n = 109, 3.66%), and permanent AF (n = 81, 2.72%). In-hospital and long-term mortalities were significantly higher (p <0.001 for the 2 comparisons) in the AF than in the control group (14.9% vs 5.3%, 37.2% vs 17.0%, respectively). Long-term mortality was significantly higher (p <0.001 for the 2 comparisons) in the new-onset AF (35.8%) and permanent AF (54.3%) groups than in the control group but did not differ significantly between the prehospital AF and control groups (21.7% vs 17.0%, p = NS). Considering types of arrhythmia separately, only permanent AF (hazard ratio 2.59) was an independent risk factor for death in the studied population. In conclusion, AF occurs in 1 of 10 patients with AMI treated invasively, with nearly equal distributions among prehospital, new-onset, and permanent forms. Although arrhythmia is a marker of worse short- and long-term outcomes, only permanent AF is an independent predictor for death in this population.     

Effect of pre-myocardial infarction angina pectoris on post-myocardial infarction arrhythmias after reperfusion therapy

It has not been concluded whether there is a relation between pre-myocardial infarction angina pectoris (pre-MIAP) and reperfusion arrhythmia, although pre-MIAP has been reported to have a beneficial effect in preserving left ventricular function. Moreover, factors that are associated with reperfusion arrhythmias in patients with acute myocardial infarction (AMI) who have been successfully reperfused by reperfusion therapy are unknown. This study examined the predictive factors of reperfusion arrhythmias in patients with AMI who underwent successful reperfusion. The Japanese Intervention Trial in Myocardial Infarction study is a prospective, randomized trial that compares the outcome in patients with AMI who undergo intracoronary thrombolysis or primary percutaneous conventional coronary balloon angioplasty. One hundred ten consecutive patients with AMI who had been successfully reperfused in this study were categorized into 2 groups according to whether or not patients showed reperfusion arrhythmias. Multivariate logistic regression analysis was performed using 11 clinical factors to clarify the determinants of reperfusion arrhythmia. Reperfusion arrhythmias developed in 65 of 110 patients (59%). Multivariate logistic regression analysis confirmed that inferior AMI and pre-MIAP were independently associated with reperfusion arrhythmia. The odds ratio that predicted reperfusion arrhythmias was 2.37 (p = 0.0056) for inferior AMI. In contrast, the odds ratio was minimal at 0.24 for pre-MIAP (p = 0.036). In conclusion, pre-MIAP suppresses reperfusion arrhythmias, and inferior AMI is an independent factor for reperfusion arrhythmias.     

ECG and enzymatic indicators of therapeutic success after intravenous streptokinase for acute myocardial infarction

Thrombolytic therapy has been documented to result in reperfusion of jeopardized myocardium and reduction in the size of the acute myocardial infarction (AMI). The effect of intravenous streptokinase on a creatine kinase-MB (CK-MB) reperfusion index and an ECG estimate of myocardial salvage was therefore studied in 65 patients with a first AMI, randomized to treatment with streptokinase (n = 33) or placebo (control group, n = 32). Reperfusion was defined as a CK-MB appearance rate constant (k1) greater than 0.185. The final AMI size was first predicted from the admission standard ECG by previously developed formulas based on ST segment elevation. The final AMI size was estimated from the QRS score on the predischarge ECG. Myocardial salvage was defined as a greater than or equal to 20% decrease from predicted to final AMI size. The k1 value in the control group was significantly lower than that in the streptokinase group (median 0.157 versus 0.328; p = 0.0001). Accordingly the reperfusion rate was higher in the streptokinase group than in the control group (88% versus 34%; p = 0.0002). The difference in AMI size (final-predicted) was significantly greater in the streptokinase group than in the control group (median -7% versus +1%; p = 0.0001). Myocardial salvage occurred in 60% and 19%, respectively (p = 0.004). A significant correlation was found between CK-MB reperfusion and ECG salvage: 19 of 20 streptokinase-treated patients with salvage also had reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)     

Randomized, Double-Blind Placebo-Controlled Trial of Coenzyme Q10 in Patients with Acute Myocardial Infarction

The effects of oral treatment with coenzyme Q10 (120 mg/d) were compared for 28 days in 73 (intervention group A) and 71 (placebo group B) patients with acute myocardial infarction (AMI). After treatment, angina pectoris (9.5 vs. 28.1), total arrhythmias (9.5% vs. 25.3%), and poor left ventricular function (8.2% vs. 22.5%) were significantly (P < 0.05) reduced in the coenzyme Q group than placebo group. Total cardiac events, including cardiac deaths and nonfatal infarction, were also significantly reduced in the coenzyme Q10 group compared with the placebo group (15.0% vs. 30.9%, P < 0.02). The extent of cardiac disease, elevation in cardiac enzymes, and oxidative stress at entry to the study were comparable between the two groups. Lipid peroxides, diene conjugates, and malondialdehyde, which are indicators of oxidative stress, showed a greater reduction in the treatment group than in the placebo group. The antioxidants vitamin A, E, and C and beta-carotene, which were lower initially after AMI, increased more in the coenzyme Q10 group than in the placebo group. These findings suggest that coenzyme Q10 can provide rapid protective effects in patients with AMI if administered within 3 days of the onset of symptoms. More studies in a larger number of patients and long-term follow-up are needed to confirm our results.     

Usefulness of serum troponin T levels on day three or four in predicting survival after acute myocardial infarction

The appearance of serum troponin T (tn-T) on day 1 after acute myocardial infarction (AMI) strongly depends on coronary reperfusion. In contrast, the kinetics of tn-T release after day 1 after AMI are unaffected by the reperfusion status, and reflect the degradation of myofilaments in irreversibly damaged cells. However, it is not known whether serum tn-T levels after day 1 after AMI can be used to predict the long-term outcome. The purpose of this study was to elucidate the prognostic value of determining the tn-T level on day 3 or 4 after AMI. Serum tn-T levels on day 3 or 4 after AMI were measured in 121 patients (92 men and 29 women, mean age 65 years). Mean follow-up period was 526 days. There were 12 deaths (9 cardiac and 3 noncardiac) during the follow-up period. By Kaplan-Meier analysis, patients with tn-T levels higher than the median level (6.9 ng/ml) had a significantly higher mortality rate than those with submedian levels (p <0.01). By multivariate Cox proportional-hazards regression analysis, the serum tn-T level was an independent predictor of the long-term outcome after AMI (p <0.01). Futhermore, in patients with a first AMI, the serum tn-T level exhibited a significant negative linear correlation with left ventricular ejection fraction assessed 4 weeks after AMI (r = -0.48, p <0.001). Increased serum tn-T levels on day 3 or 4 after AMI are a powerful noninvasive predictor of poor long-term prognosis, reflecting residual left ventricular function after AMI.     

Early reperfusion assessment and repeated thrombolysis in acute myocardial infarction estimated by repeated standard electrocardiography. A randomised, double-blind, placebo-controlled pilot study

Thrombolytic therapy with streptokinase (SK) in acute myocardial infarction (AMI) does not result in early reperfusion in approximately 25% of patients. We hypothesized that early repeated thrombolysis with rt-PA in patients with early failed reperfusion would result in myocardial reperfusion. Fifty-nine AMI patients with a symptom delay of <6 h, treated with SK were included. ECG was taken on admission and after 90 and 180 min. An ST recovery of > or =25% at 90 min was interpreted as successful reperfusion. Sixteen patients had failed reperfusion at 90 min and were randomized to repeated thrombolysis with rt-PA or placebo. At 180 min from SK start, ST recovery was higher in the placebo group than in the rt-PA group (71 vs. 40%, p = 0.05). No serious bleeding complications were observed. Due to the limited sample size it was not possible to draw prominent conclusions.     

急性心肌梗塞患者福辛普利干预前后校正QT间期离散度的变化

目的 :探讨急性心肌梗塞 (AMI)患者福辛普利 (fosinopril)干预前后校正 QT间期离散度 (QTcd)的变化。　　方法 :46例 AMI患者分基础治疗 福辛普利 10 mg/ d治疗组 (A组 ,2 3例 )和基础治疗组 (B组 ,2 3例 ) ,并对治疗前和治疗 7天后的 QTcd进行对比分析。另设正常人组 2 0例 (C组 )作对照。　　结果 :A组、B组患者 QTcd较 C组明显增加 (P<0 .0 1) ,在 46例 AMI患者中伴室性心律失常者 (n=30 )高于无室性心律失常者 (n=16 ,P<0 .0 1) ,前壁心肌梗塞 (n=31)与下后壁心肌梗塞 (n=15 )间 QTcd差异无显著性 (P>0 .0 5 )。治疗 7天后 A、B两组的 QTcd均较治疗前明显降低 (P均 <0 .0 1) ,但 A组较 B组下降更为显著 ,两组间有显著性差异 (P<0 .0 1)。　　结论 :AMI患者早期 QTcd增加 ,并且与室性心律失常的发生有关 ,福辛普利可降低 AMI早期 QTcd。本结果对改善 AMI近期预后有重要意义。     

老年急性心肌梗死后梗死相关动脉再灌注对QT离散度的影响

目的了解老年急性心肌梗死(AMI)后梗死相关动脉(IRA)早期静脉溶栓再灌注或冠状动脉内支架置入术对QT离散度(QTd)的影响。方法对58例老年AMI患者(AMI组)予以静脉内溶栓,溶栓后选择性冠状动脉造影,对判定为心肌梗死溶栓试验性疗法(TIMI)2级以下者,部分行冠状动脉内支架置入术。溶栓前后测量分析QTd,并与48例冠状动脉造影正常的老年人(对照组)和50例健康体检非老年患者(非老年组)进行对照。结果AMI组溶栓前与对照组和非老年组间QTd有显著性差异(P<0.01);静脉溶栓后冠状动脉造影显示IRA血流达到TIMI 2~3级者,溶栓后2 h QTd显著降低,而IRA未开通者其QTd始终保持较高水平。16例溶栓前有室性心律失常者其QTd明显高于无心律失常者(P<0.05),结论IRA早期再灌注可使QTd显著降低,可减少恶性心律失常的发生。     

Diabetes mellitus is associated with insufficient microvascular reperfusion following revascularization for anterior acute myocardial infarction

OBJECTIVE: The purpose of this study was to test the hypothesis that lack of microvascular reperfusion following revascularization might be associated with a poor clinical outcome in diabetic patients with acute myocardial infarction (AMI). METHODS: We studied 134 patients with a first anterior AMI who underwent successful revascularization within 6 hours. We assessed microvascular reperfusion by using electrocardiogram recordings just before revascularization and on return to the coronary care unit. Lack of microvascular reperfusion was defined as the absence of decrease of > or = 20% in the sum of ST segment elevation (sigmaST). RESULTS: Twenty-four patients had diabetes and 110 patients did not. SigmaST before revascularization was similar between diabetic and nondiabetic patients. After revascularization, reduction of sigmaST was significantly smaller (1.3 +/- 8.4 mm vs 6.5 +/- 10.8 mm, p = 0.03), and lack of microvascular reperfusion was significantly more frequent (62.5% vs 33.6%, p = 0.01) in diabetic patients. A multivariate analysis showed that diabetes was associated with insufficient microvascular reperfusion (odds ratio 3.18, p = 0.03). Major adverse cardiac events occurred more frequently in patients with a lack of microvascular reperfusion (30.8% vs 15.9%, p = 0.04). CONCLUSION: These findings suggest that lack of microvascular reperfusion following revascularization may be one of the mechanisms of a poor clinical outcome in diabetic patients with AMI.     

Effects of intravenous thrombolysis with alteplase combined with edaravone on cerebral hemodynamics and T lymphocyte level in patients with acute cerebral infarction

Our study aimed to investigate the effect of intravenous thrombolysis with alteplase and edaravone on cerebral hemodynamics and T lymphocyte level in patients harboring acute cerebral infarction.There involved a total of 118 patients with acute cerebral infarction from November 2017 to May 2019 in our hospital were randomly divided into 2 groups: the observation group (59 patients were treated with intravenous thrombolysis with alteplase combined with edaravone) and the control group (59 patients were treated with intravenous thrombolysis of alteplase). The clinical effect, neurological function, cerebral hemodynamic index, T lymphocyte level, oxygen free radical scavenging level and oxidative stress index of the 2 groups were observed and compared.Before the treatment, there were no significant differences in neurological function, cerebral hemodynamic indexes, T-lymphocyte level, oxygen free radical scavenging level and oxidative stress indexes between the 2 groups (P > .05). After the treatment, the neurological function, cerebral hemodynamic indexes, T-lymphocyte level, oxygen free radical scavenging level and oxidative stress indexes of the 2 groups were significantly improved. In addition, the observation group exerted greater beneficial effect in terms of the clinical effect, neurologic function, cerebral hemodynamic index, T lymphocyte level, oxygen free radical scavenging level and oxidative stress index than those of the control group (P < .05).The intravenous thrombolysis with alteplase and edaravone is effective in the treatment of acute cerebral infarction, which also provides better results in terms of improving the clinical efficacy and prognosis of patients and might be an alternative option for clinical practice.