The white blood cell count is an independent predictor of no‐reflow and mortality following acute myocardial infarction in the coronary interventional era

BACKGROUND. In the era before the use of coronary reperfusion therapy, an elevated white blood cell (WBC) count was associated with a higher risk of adverse events following acute myocardial infarction (AMI). However, the relationship between WBC count and prognosis after AMI has not been investigated since coronary intervention was introduced.

AIM. To evaluate whether a high WBC count within 48 hours of the onset of AMI predicts future adverse events in patients undergoing percutaneous coronary intervention (PCI).

METHOD. We evaluated 1,016 patients who underwent PCI in the acute phase of MI using the Japanese Acute Coronary Syndrome Study (JACSS) database.

RESULTS. WBC count was significantly associated with smoking, sudden onset AMI, and the no‐reflow phenomenon during PCI, as were age, peak creatine kinase level, and Killip class. An elevated WBC count was significantly associated with higher risk of in‐hospital mortality. Patients in the highest quartile of WBC count were about three times more likely to have a poor prognosis after AMI compared to those in the lowest quartile.

CONCLUSIONS. The WBC count is of great significance for stratifying patient risk and can be used as a universal marker for predicting future adverse events following any treatment for AMI.     

White blood cell count and C-reactive protein predict short-term prognosis in acute myocardial infarction

An elevated white blood cell (WBC) count and C-reactive protein (CRP) concentration are associated with acute myocardial infarction (AMI) and long-term mortality in patients with coronary artery disease. Their relationship with short-term prognosis following AMI is less clear, however. We investigated the relationship between WBC count and CRP concentration, obtained at the time of admission, and the development of subsequent ischaemic coronary events (SICE) within 30 days of AMI in 177 patients. After adjustment for confounding factors, CRP concentration was found to be a strong independent predictor for SICE within 30 days in patients with AMI. WBC count was not found to be an independent predictor, but there was a strong correlation between high WBC counts and the onset of SICE within 30 days in patients with AMI. We conclude that CRP concentration and WBC count could be used to predict the short-term prognosis of patients with AMI.     

基础白细胞计数增高的急性心肌梗死患者冠状动脉介入术后冠状动脉血流储备降低对远期预后的影响

目的急性心肌梗死(AMI)患者在接受了冠状动脉介入术(PCI)后,即刻冠状动脉血流储备(CFR)的降低,以及AMI急性期基础血液中白细胞计数的增加均被视为AMI患者远期预后不良的预测因子。我们现将这两项指标联合起来评价AMI患者的远期预后。方法选自2010年8月至2012年6月在医院就诊的AMI患者共72例,所有患者在发病24 h内接受了急诊PCI治疗,并于术后即刻应用经冠状动脉多普勒导丝测量的CFR。基础血白细胞计数以患者发病24 h内化验取得,并满足白细胞计数≥10.0×109/L。所有患者均进行了临床随访,平均随访时间(12.7±7.1)个月,以观察主要不良心脏事件(MACE)。根据MACE与CFR的关系,应用ROC曲线获得相关阈值,将患者分为2组进行对照分析,第一组:CFR<1.4;第二组:CFR≥1.4。结果第一组患者的基础血CK及CK-MB明显高于第二组患者,分别为(4 109±407)U/L vs.(2 685±562)U/L,P<0.05及(290.8±26.6)ng/ml vs.(255.7±65.6)ng/ml,P<0.05。第一组患者PCI术后即刻MBG3级占比明显低于第二组患者(25.9%vs.38.9%,P<0.05)。随访期间第一组患者的MACE明显高于第二组(40.7%vs.27.8%,P<0.05),主要体现在总死亡率的增高上(13.0%vs.0,P<0.05)。结论对于基础血白细胞计数增高的AMI患者,接受急诊PCI治疗后CFR<1.4是预示患者远期预后不良的重要因素,这部分患者的总死亡率明显高于CRF≥1.4的患者。这一结果进一步阐明了微血管功能及炎症反应与AMI患者的远期预后的关系。     

Successful reperfusion for acute ST elevation myocardial infarction is associated with a decrease in WBC count

BACKGROUND: Elevated white blood cell (WBC) count on admission in patients with ST segment elevation myocardial infarction (STEMI) has been associated with an adverse prognosis. Whether successful reperfusion by primary percutaneous coronary intervention (PCI) is associated with a decrease in WBC count is unknown. METHODS: In this subanalysis of the On-TIME trial, WBC count was measured on admission and 6 h and 24 h after primary PCI for STEMI (n = 364). Angiographic measurements of reperfusion, including TIMI-flow and myocardial blush grade, were compared with changes in WBC count. RESULTS: Restoration of TIMI 3 flow by primary PCI was associated with a significant decrease in median WBC count (11.5 (9.7-14.2), 10.7 (9.0-12.5), 9.9 (8.5-11.5) at baseline, 6 h and 24 h), whereas after unsuccessful PCI (TIMI < 3 flow) WBC count remained elevated (12.5 (9.5-14.6), 12.1 (9.9-14.4), and 11.4 (9.2-15.2)). Improved myocardial blush was also related to a decrease in WBC count. After multivariate analysis, improved myocardial perfusion (TIMI 3 flow and myocardial blush grade 3) was an independent predictor of a decrease of WBC count after PCI. CONCLUSION: Impaired myocardial reperfusion after primary PCI for STEMI is associated with persistent WBC elevation.     

The Association between White Blood Cell Count and Acute Myocardial Infarction In-hospital Mortality: Findings from the National Registry of Myocardial Infarction

OBJECTIVES: Although cross-sectional and prospective studies have shown that the white blood cell (WBC) count is associated with long-term mortality for patients with ischemic heart disease, the role of the WBC count as an independent predictor of short-term mortality in patients with acute myocardial infarction (AMI) has not been examined as extensively. The objective of this study was to determine whether the WBC count is associated with in-hospital mortality for patients with ischemic heart disease after controlling for potential confounders. METHODS: From July 31, 2000, to July 31, 2001, the National Registry of Myocardial Infarction 4 enrolled 186,727 AMI patients. A total of 115,273 patients were included in the analysis. RESULTS: WBC counts were subdivided into intervals of 1,000/mL, and in-hospital mortality rates were determined for each interval. The distribution revealed a J-shaped curve. Patients with WBC counts >5,000/mL were subdivided into quartiles, whereas patients with WBC counts <5,000/mL were assigned to a separate category labeled "subquartile" and were analyzed separately. A linear increase in in-hospital mortality by WBC count quartile was found. The unadjusted odds ratio (OR) for the fourth versus the first quartile showed strong associations with in-hospital mortality among the entire population and by gender: 4.09 (95% confidence interval [95% CI] = 3.83 to 4.73) for all patients, 4.31 (95% CI = 3.93 to 4.73) for men, and 3.65 (95% CI = 3.32 to 4.01) for women. Following adjustment for covariates, the magnitude of the ORs attenuated, but the ORs remained highly significant (OR, 2.71 [95% CI = 2.53 to 2.90] for all patients; OR, 2.87 [95% CI = 2.59 to 3.19] for men; OR, 2.61 [95% CI = 2.36 to 2.99] for women). Reperfused patients had consistently lower in-hospital mortality rates for all patients and by gender (p < 0.0001). CONCLUSIONS: The WBC count is an independent predictor of in-hospital AMI mortality and may be useful in assessing the prognosis of AMI in conjunction with other early risk-stratification factors. Whether elevated WBC count is a marker of the inflammatory process or is a direct risk factor for AMI remains unclear. Given the simplicity and availability of the WBC count, the authors conclude that the WBC count should be used in conjunction with other ancillary tests to assess the prognosis of a patient with AMI.     

入院时白细胞计数对急性ST段抬高型心肌梗死患者长期预后的影响

目的探讨入院时外周血白细胞计数对急性ST段抬高型心肌梗死(STEMI)患者长期预后的影响。方法回顾性分析2015年1月至2020年1月于首都医科大学附属北京友谊医院和清华大学玉泉医院心脏重症监护病房确诊急性STEMI且接受急诊经皮冠状动脉介入治疗(PCI)的274例患者的临床资料。到院时采集静脉血,测定白细胞计数(WBC),按照WBC水平不同分为两组,≤9.5×10⁹/L为A组,>9.5×10⁹/L为B组,对两组患者的临床资料、心血管事件以及长期预后进行比较。出院后对患者进行随访,评价长期预后。患者出院后随访36个月的主要心脏不良事件(MACE),MACE发生率的比较使用生存分析Kaplan-Meier法;采用Cox回归分析多个变量与临床长期预后的关系。结果随访36个月,两组患者的累积MACE发生率A组(4.8%)明显低于B组(10.3%),差异有统计学意义(P=0.012)。Cox回归分析显示年龄(HR:1.135,95%CI:1.011~1.275,P=0.033)、吸烟史(HR:0.689,95%CI:0.519~0.915,P=0.010)、WBC(HR:1.356,95%CI:1.005~1.831,P=0.046)是MACE的危险因素。结论入院时外周血WBC计数可能是影响急性STEMI且接受PCI患者的长期预后的危险因素。     

急性心肌梗死急诊PCI支架术后无复流现象的临床分析

目的 研究对急性心肌梗死(AMI)患者行急诊经皮冠状动脉介入(PCI)时无复流的发生率及其死亡率,评估其影响因素.方法 将169名AMI行急诊PCI支架术的患者,分成无复流组和血流正常组,评估无复流现象的发生率,住院期间死亡率及各项临床指标对无复流的意义.结果 两组在平均年龄、性别、合并糖尿病、高血压、高脂血症、吸烟、心梗部位等方面没有显著差异,但在缺乏梗死前心绞痛史、冠脉开通时间,入院时心功能分级(Killip分级)、入院时白细胞计数、肌酸磷酸激酶同工酶(CK-MB)、肌钙蛋白Ⅰ(cTnI)及住院期间死亡率等方面具有显著差异.无复流的发生率17.2%.结论 无梗死前心绞痛史、冠脉开通时间长、入院时心功能分级低、白细胞计数高、CK-MB与cTnI水平高等是无复流现象发生的独立的危险因素,PCI后出现无复流现象提示预后不良.     

急性心肌梗死患者入院血糖水平与经皮冠状动脉介入治疗后预后的关系

目的 观察急性心肌梗死 (AMI) 患者随机血糖水平对介入治疗后预后的影响.方法 选取急性心肌梗死患者354例,根据入院第一次随机血糖分为3组:A组:132例,血糖＜7.80 mmol/L;B组120例,血糖7.80～11.00 mmol/L;C组102例,血糖≥11.00 mmol/L.结果 与A组相比,C组血胆固醇、低密度脂蛋白、甘油三酯浓度较高(P<0.05).冠状动脉造影示B、C组多支病变比例高于A组,但差异无统计学意义(P>0.05).B、C组校正TIMI帧数(CTFC)值高于A组(P<0.05).B、C组主要心血管事件发生率及病死率高于A组,其中C组与A组相比差异有统计学意义(P<0.05).结论 入院随机血糖升高的急性心肌梗死患者,进行直接介入治疗后预后较差,心血管事件发生率及病死率较高.     

急性心肌梗死患者介入术后使用替罗非班的疗效和安全性评价

目的观察急性心肌梗死患者介入治疗术后应用替罗非班的疗效和安全性。方法回顾性查阅本院2007-2008年急性心肌梗死患者病历共150份,均为发病12h内行急诊PCI术。其中对照组患者72例,替罗非班组在对照组用药基础上使用替罗非班的患者有78例,观察PCI术前、术后梗死相关血管TIMI血流情况,术后4周内并发症及主要不良事件的发生情况。结果替罗非班组和对照组无复合终点事件的发生;替罗非班组PCI术后慢复流发生率低于对照组,差异有统计学意义（P〈0．05）;替罗非班组出现不良反应的患者有24例,不良反应发生率为30．8％。对照组出现不良反应的患者共18例,不良反应发生率为25．7％,差异无统计学意义（P〉0．05）。结论应用替罗非班能改善急性心肌梗死患者PCI术后梗死相关血管的TIMI血流,不良反应发生率与对照组相似,临床应用安全有效。     

Cardiac magnetic resonance imaging safety following percutaneous coronary intervention

In the first 8 weeks after percutaneous coronary intervention (PCI), possible negative interactions exist between the cardiac magnetic resonance (CMR) imaging environment and the weakly ferromagnetic material in coronary stents. There are circumstances when CMR would be indicated shortly following PCI, such as acute myocardial infarction (AMI). The purpose of this study is to demonstrate CMR safety shortly following stent PCI in AMI patients. We performed a retrospective analysis of safety data in AMI patients with recently placed coronary artery stents enrolled in a multi-center phase II trial for gadoversetamide. Patients underwent 1.5T CMR within 16 days of PCI. Vital signs (blood pressure, heart rate, respiratory rate, and body temperature) and ECGs were taken pre-CMR, 1, 2, and 24 h post-CMR. Any major adverse cardiac event (MACE) or other serious adverse events in the first 24 h after MRI were recorded. There were 258 stents in 211 AMI patients. The mean delay to CMR following PCI was 6.5 ± 4 days, with 62 patients (29 %) receiving CMR within 3 days and 132 patients (63 %) within 1 week. Patients showed no significant vital sign changes following CMR. Ten patients (4.7 %) showed mild, transient ECG changes. Within the 24-h follow-up group, 4 patients (1.9 %) had moderate to severe events, including chest pain (1) and elevated cardiac enzymes (1), resolving in 24 h; heart failure (1) and ischemic stroke (1). There were no deaths. This study demonstrates fewer MACE in AMI patients undergoing 1.5T CMR within 16 days of stent placement in comparison to post-stent event rate reported in the literature. This study adds to the CMR after stent PCI safety profile suggested by previous studies and is the largest and first study that uses multicenter data to assess stent safety following CMR examination.     

超敏C反应蛋白及白细胞计数对冠心病的评估价值

目的 探讨血清超敏C反应蛋白(hs-CRP)的浓度及外周血的白细胞计数(WBC)对冠心病危险程度的评估价值.方法 采用胶乳增强免疫透射比浊法测定55例稳定型心绞痛(SAP) 患者,38例不稳定型心绞痛(UAP)患者,33例急性心肌梗死(AMI)型心绞痛患者血清中hs-CRP的浓度,同时用贝克曼血液分析仪测定患者外周血的WBC.结果 心肌梗死患者血清hs-CRP平均浓度及外周血WBC均数明显高于健康人.根据冠状动脉病变程度采用随机方差分析:hs-CRP浓度及WBC在健康对照组、SAP组、UAP组、AMI组依次增高,两种比较差异均有统计学意义,与冠脉病变程度呈正相关.结论 冠心病患者血清hs-CRP及外周血WBC比健康人高,根据血清hs-CRP及外周血WBC升高评估冠心病危险性程度.     

转运冠状动脉介入治疗在老年急性心肌梗死中的临床研究

目的 探讨转运经皮冠状动脉介入（PCI）治疗对老年急性心肌梗死（AMI）患者的临床疗效及安全性。方法 13例老年AMI患者，其中5例在起病6h内进行急诊转运PCI治疗，8例在第7天时进行延迟转运PCI治疗，术后即刻行血管造影进行评价，并观察住院及随访期间的情况。结果 13例患者梗死相关动脉（IRA）重建后血流TIMI 3级，残余狭窄〈20％。住院期间无心脏性死亡、急性再闭塞、急诊冠状动脉旁路移植术及严重出血发生。随访8～12个月，均无血栓形成及主要心脏事件（心脏性死亡、与靶血管相关的心绞痛、心肌梗死及再次血管重建）发生。结论 急诊转运PCI治疗老年AMI患者不仅有良好的住院及近期临床疗效，而且安全可靠。这也是上海心脏介入治疗实行准入制度以来，探索没有被准入的医疗机构如何有效地保护患者的利益。     

急性心肌梗死伴白细胞增多患者的临床特点及意义

目的 探讨急性心肌梗死（AMI）早期外周血细胞数与预后的关系。方法 100例AMI分为白细胞正常组及增高组，比较两组病例的特点。结果 AMI白细胞增高组易并发左心衰、心律失常及应激性高血糖，具有较高的心电图QRS积分及CK峰值，住院病死率高。结论 白细胞计数对于AMI具有重要的预后意义。     

替罗非班对直接冠脉介入术中心肌缺血-再灌注损伤的影响

目的 探讨急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者直接经皮冠状动脉腔内介入治疗(percutaneous coronary intervention,PCI)术前应用国产血小板膜糖蛋白GpⅡb/Ⅲa受体拮抗剂替罗非班对术中心肌缺血-再灌注损伤(myocardial ischemical reperfusion iniury,MIRI)发生的影响及其机制.方法 2006年12月至2008年8月在广州市第一人民医院心内科住院诊断为STEMI并接受直接PCI治疗的患者158例,随机(随机数字法)按PCI术前是否静脉应用替罗非班分为替罗非班组76例和对照组82例,比较两组患者之间PCI术中MIRI发生情况、术后的心肌灌注水平、心肌型肌酸激酶同工酶(CK-MB)峰值及峰值时间、以及术后30 d内主要心脏不良事件(major adverse cardiac events,MACE)发生率的差异.结果 两组患者的临床基线特征及冠脉造影资料差异无统计学意义,但替罗非班组患者术中的MIRI发生率明显低于对照组(11.84%vs.26.83%,P<0.05),而在反映术后心肌灌注水平及心肌损伤严重程度的指标:包括校正TIMI帧计数、术后2 h ST段回落、CK-MB峰值、峰值时间,以及术后30 d内MACE发生率等方面,替罗非班组均优于对照组.多因素logistic回归分析显示直接PCI术前应用替罗非班是MIRI发生的独立保护因子.结论 对于STEMI患者,直接PCI术前静脉使用替罗非班能显著降低术中MIRI的发生率,减轻心肌损伤并进一步改善患者的预后.     

Effects of receipt of chronic statin therapy before the onset of acute myocardial infarction: a retrospective study in patients undergoing primary percutaneous coronary intervention

BACKGROUND: Studies have reported an association between receipt of statin therapy and a reduction in complications after elective percutaneous coronary intervention (PCI). However, there are limited data on the effects of chronic statin therapy before the occurrence of an acute myocardial infarction (AMI). OBJECTIVE: This study investigated whether administration of chronic statin therapy before AMI was associated with a reduction in reperfusion injury in AMI patients undergoing PCI. METHODS: This was a retrospective study of consecutive patients with a first AMI who underwent successful reperfusion therapy with PCI within 24 hours after the onset of AMI between April 1998 and October 2003. Patients were stratified according to whether they had or had not been receiving chronic statin therapy for > or = 1 month before the onset of AMI. The following end points were compared after PCI: electrocardiographic resolution of ST segment elevation, defined as a reduction of > or = 50% from the initial value; achievement of Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow; corrected TIMI frame count (cTFC); maximum serum creatine kinase (CK) level; and the type and frequency of ventricular arrhythmias. RESULTS: The study enrolled 386 patients, 40 of whom had been receiving statin therapy before the onset of AMI. The clinical characteristics of the 2 groups were similar at baseline, with the exceptions of a significantly higher rate of hyperlipidemia in the statin group compared with the nonstatin group (P < 0.001), significantly greater chronic use of aspirin therapy (P < 0.001), and significantly greater chronic use of antihypertensive medications (beta-blockers: P = 0.004; angiotensin-converting enzyme inhibitors/angiotensin II-receptor blockers: P = 0.007; calcium channel blockers: P = 0.006). Electrocardiographic ST segment resolution after PCI was observed in 87.5% and 69.9% of the statin and nonstatin groups, respectively (hazard ratio [HR]: 3.01; 95% CI, 1.15-7.90; P = 0.025). Achievement of TIMI grade 3 flow after PCI was seen in 95.0% of the statin group and 83.5% of the nonstatin group (HR: 3.75; 95% CI, 0.88-16.0; P = NS). Patients treated with a statin had a significantly lower mean (SD) maximum CK level compared with the nonstatin group (2300 [1449] vs 3538 [3170] IU/mL, respectively; P = 0.015) and a lower cTFC after PCI (18.8 [4.0] vs 24.2 [14.2]; P = 0.017). The difference in reperfusion arrhythmias between groups was not statistically significant. After adjustment for baseline covariates, pretreatment with a statin was found to be an independent predictor of ST segment resolution after PCI (HR: 2.95; 95% CI, 1.08-8.09; P = 0.035) and prevention of impaired coronary flow (HR: 3.00; 95% CI, 1.63-5.55; P < 0.001). CONCLUSION: In this study, receipt of chronic statin therapy before the onset of AMI was associated with improvement in epicardial perfusion and a reduction in myocardial necrosis after PCI.     

Leukocytosis: A New Look at an Old Marker for Acute Myocardial Infarction

Objective: To determine the test performance of leukocytosis for identifying acute myocardial infarction (AMI) in patients with nondiagnostic ECGs, admitted to rule out AMI. Methods: A retrospective, comparative test performance study was conducted using patients admitted to a university teaching hospital to rule out AMI. Clinical and laboratory information was reviewed and hospital laboratory ranges were used to define threshold elevations: total creatine kinase (CK), 275 U/L; CK-MB, 7.5 μg/L; white blood cell (WBC) count, 11.5 × 10⁹/L; and absolute neutrophil count (ANC), 8.0 × 10⁹. Sensitivity, specificity, and predictive values of the total CK, CK-MB, WBC count, and ANC were calculated, and receiver operating characteristic (ROC) curves constructed. Test performances of marker combinations also were determined. Results: The initial WBC count was significantly higher for the subjects who had AMI (11.1 vs 8.8 × 10⁹/L, p < 0.001). For the 688 subjects who had nondiagnostic ECGs, sensitivities for the initial total CK, CK-MB, WBC, and ANC were 39%, 73%, 35%, and 36%, respectively, while the corresponding specificities were 94%, 93%, 85%, and 86%. Logistic regression analysis confirmed leukocytosis as an independent predictor of AMI (adjusted odds ratio 4.08, 95% CI 1.73–9.63). While CK-MB alone was 73% sensitive for AMI, the decision rule of either an elevated CK-MB or an elevated WBC count increased this sensitivity to 88% (corresponding specificity 79%). Similarly, while CK-MB alone was 93% specific for AMI, the combination of an elevated CK-MB and an elevated WBC count increased this specificity to 99% (corresponding sensitivity 20%). Conclusions: Leukocytosis is significantly associated with AMI, and is a weak but independent laboratory predictor of this condition. In this preliminary study of admitted patients suspected of AMI, the combination of the WBC and the CK-MB may have, additional diagnostic value over an isolated CK-MB result. Neither parameter in isolation was satisfactorily sensitive for AMI. Prognostic assessment of the role of the WBC count in clinical decision making should address its complementary role to that of other clinical and ancillary test parameters.     

基层医院开展静脉溶栓治疗急性心肌梗死临床研究

目的探讨静脉溶栓与急诊介入治疗急性心肌梗死的近期预后,评估在基层医院开展静脉谱检治疗,实现早期再灌注的有效性。方法对131例接受静脉溶栓治疗（溶栓组）,98例接受急诊介入治疗（急诊组）的急性心肌梗死患者的平均年龄、发病到就诊时间、就诊到干预时间、TIMI血流情况、治疗后1mo内主要心血管事件发生率等因素进行对比分析。结果溶栓组从就诊到干预时间显著早于急诊组（P〈0.01）,溶栓治疗后进行PCI患者的发病到就诊时间、就诊到干预时间显著早于急诊组,TIMI3级及TIMI3级和2级血流均显著高于急诊组（P均〈0.01）。两组患者治疗后1mo内,心源性死亡、再发心肌梗死、再发心绞痛、亚急性血栓、再次介入治疗、室间隔缺损等主要MACE发生率比较均无显著性差异（P均〉0.05）。结论急性心肌梗死患者给予静脉溶栓治疗可以更快地实现早期再灌注,宜在基层医院推广应用。     

High post-treatment platelet reactivity identified low-responders to dual antiplatelet therapy at increased risk of recurrent cardiovascular events after stenting for acute coronary syndrome

Summary.  Background and objectives: Low response to antiplatelet therapy may be a risk factor for the development of ischemic complications in patients with non-ST segment elevation acute coronary syndrome (NSTE ACS) undergoing coronary stenting. Methods: We prospectively studied the platelet response to both clopidogrel and aspirin in 106 NSTE ACS consecutive patients undergoing percutaneous coronary intervention (PCI) with stenting. A single post-treatment blood sample was obtained just before PCI and analyzed by platelet aggregometry using both ADP and arachidonic acid (AA) as agonists to explore the responses to clopidogrel and aspirin, respectively. Patients were divided into quartiles according to the ADP or AA induced maximal intensity of platelet aggregation. Patients of the highest quartile (quartile 4) were defined as the 'low-responders'. Results: Twelve recurrent cardiovascular (CV) events occurred during the 1-month follow-up. Clinical outcome was significantly associated with platelet response to clopidogrel [Quartile 4 vs. 1, 2, 3: OR (95% CI) 22.4 (4.6–109)]. Low platelet response to aspirin was significantly correlated with clopidogrel low response ( P  = 0.003) but contributed less to CV events [OR (95%CI): 5.76 (1.54–35.61)]. Conclusions: A post-treatment ADP-induced platelet aggregation performed just before PCI identifies low responders to dual antiplatelet therapy with an increased risk of recurrent CV events.     

急性心肌梗死反向转运经皮冠状动脉介入治疗的临床观察

目的 评估借助外埠心脏介入专家赶赴县市级医院(反向转运),就地急诊经皮冠状动脉介入(PCI)治疗急性心肌梗死的安全性、可行性及有效性.方法 2004年3月至2008年9月,我院共对81例急性心肌梗死患者采用外请心脏介入专家(转运医生),就地实施急诊PCI进行治疗.男46例,女35例;年龄36.0 ～ 83.0岁,平均(68.6±3.6)岁;前壁心肌梗死56例,下壁心肌梗死25例(其中11例并右心室梗死).起病时间2.0 ～12.0 h,平均(6.2±1.8)h.结果 81例中,除3例病变严重,转上级医院行冠状动脉搭桥外,对78例就地实施了急诊PCI,66例为直接PCI,12例为补救性PCI,梗死相关动脉共植入支架81枚.1例因球囊不能通过病变而失败,手术成功率98.7％.共有4例发生围手术期心脏事件,其中死亡2例.随访32 ～86个月,共4例死亡,其中1例为心源性死亡,3例非心源性死亡,剩余患者中无致死性心血管事件发生.结论 采用外请专家就地行急诊PCI术(反向转运PCI)治疗急性心肌梗死的方法安全、可行、有效.但有必要进行大规模临床研究证实.