急性ST段抬高型心肌梗死急诊PCI术前负荷剂量阿托伐他汀治疗的中期疗效观察

目的对急性ST段抬高型心肌梗死急诊PCI术前负荷剂量阿托伐他汀治疗的中期疗效进行探讨。方法随机抽取我院在2012年1月-2013年12月治疗的急性ST段抬高型心肌梗死患者40例,分为A、B、C三组,A组患者在手术前服用80mg的阿托伐他汀,在手术后继续按照每日40mg的剂量继续服用,手术后一个月改为每日服用20mg;B组患者在手术前并未服用阿托伐他汀,而在手术后每日服用40mg,手术后一个月改为每日服用20mg;C组患者在手术前并未服用阿托伐他汀,而在手术后每日服用20mg,对不同剂量的阿托伐他汀在急性ST段抬高型心肌梗死急诊PCI术前的治疗效果进行分析和比较。结果在笔者抽取的40例急性ST段抬高型心肌梗死患者中,在入院时存在的差异不大,在手术后出现较为明显的差异,具备统计学意义(P0.05)。结论阿托伐他汀在急性ST段抬高型心肌梗死患者中的应用,不仅能够对患者的炎症进行有效的控制,而且还能够对患者的心脏心室的收缩进行完善,有效降低了MACE事件的发生率,具有非常重要的意义,值得在临床治疗中大范围的推广和应用。     

不同剂量阿托伐他汀治疗非ST段抬高型急性冠脉综合征效果比较

目的比较不同剂量阿托伐他汀治疗非ST段抬高型急性冠脉综合征患者的临床效果。方法选取2017-01～2018-12间住院治疗的41例非ST段抬高型急性冠脉综合征患者,采用随机数字表法将其分为治疗组(n=21)和对照组(n=20)。两组患者均予常规治疗,治疗组在常规用药基础上加用20 mg阿托伐他汀;对照组在常规治疗基础上第1天口服80 mg阿托伐他汀,后继续服用阿托伐他汀40 mg/d,疗程均为6个月。比较两组患者治疗前后不同时间总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)等指标改变情况及心血管事件发生情况。结果治疗组与对照组在治疗后2周、4周及24周的血清TC、TG、LDL-C水平均低于治疗前,差异均有统计学意义(P0.05);在治疗后2周及4周时,对照组TC、LDL-C水平低于治疗组,而TG水平高于治疗组,差异均有统计学意义(P0.05)。在治疗24周时,治疗组与对照组TC、LDL-C、TG水平及心血管不良事件发生率比较差异无统计学意义(P0.05)。结论阿托伐他汀(20 mg/d)与阿托伐他汀(40 mg/d)治疗非ST段抬高型急性冠脉综合征,在降低血脂及减少心血管不良事件的发生上有着相似的作用,值得临床推广应用。     

及早应用阿托伐他汀与溶栓治疗急性ST段抬高心肌梗死的疗效研究

目的 探讨及早应用阿托伐他汀与溶栓治疗急性ST段抬高心肌梗死（STEMI）的疗效与安全性及对心血管事件的影响.方法 选取2008年11月-2009年9月住院治疗行急诊溶栓成功的72例患者.治疗组（37例）在常规治疗的基础上,24h内加服阿托伐他汀80mg,1次/晚,用药12个月;对照组（35例）按急性STEMI常规溶栓、抗栓、抗缺血等治疗.观察两组患者治疗4个月和随访1年的临床情况,包括血脂、超敏C反应蛋白（hs-CRP）、心血管事件发生率、不良反应和并发症.结果 用药治疗4个月,治疗组血脂、hs-CRP变化明显优于对照组;随访 1 年间治疗组心血管事件发生率明显低于对照组,且无严重不良反应发生.结论 及早应用大剂量阿托伐他汀与溶栓治疗急性ST段抬高心肌梗死,能减少心血管事件发生率,改善临床预后;且用药较安全、不良反应少,未增加溶栓后的并发症.     

80mg阿托伐他汀对急性ST段抬高型心肌梗死PCI术中出现无复流风险的影响

目的探讨80mg负荷剂量的阿托伐他汀对急性ST段抬高型心肌梗死(ASTEMI)患者经皮冠状动脉介入术中出现无复流风险的影响。方法选取我院144例经皮冠状动脉介入治疗的ASTEMI患者,分为对照组术前1h给予40mg阿托伐他汀,术后40mg/d,治疗14d后改为20mg/d进行长期治疗;观察组术前80mg阿托伐他汀,术后40mg/d,治疗14d后改为20mg/d进行长期治疗,两组各72例,对比两组术中无复流的发生情况。结果观察组术中无复流的发生率为5.56%,对照组为23.61%,差异具有统计学意义(χ~2=8.54,P0.01);两组术中均未发生严重不良反应。结论采取80mg负荷剂量的阿托伐他汀可以明显减少ASTEMI患者经皮冠状动脉介入术中无复流的发生率,进而有助于提高临床疗效。     

围术期阿托伐他汀序贯治疗对急性ST段抬高性心肌梗死患者组织灌注和临床预后的探讨

目的:探讨围术期阿托伐他汀序贯治疗对急性ST段抬高性心肌梗死(STEMI)患者组织灌注和临床预后的影响。方法:纳入实行直接经皮冠状动脉介入治疗(PCI)的STEMI患者143例,随机分为他汀标准组与他汀强化组。他汀标准组73例,术后起阿托伐他汀20mg/天,持续1个月。他汀强化组70例,术前给予负荷量的阿托伐他汀钙片80mg,继之给予40mg/天,持续1个月。记录患者一般临床资料、药物使用情况、超声心动图、化验检查结果等。胸痛发作12小时内行急诊冠状动脉造影及介入治疗,术中心肌梗死溶栓分级(TIMI)血流分级及校正的TIMI血流帧数(CTFC),收集并阅读冠状动脉造影及介入治疗光盘及手术记录等资料,电话随访了解术后1个月内主要心血管事件(MACE)发生情况,了解他汀的肝肾及肌肉损害等不良反应的发生情况。结果:他汀标准组术中发生无复流或慢血流为17例(23.3%),他汀强化组为14例(20%,P=0.39);前组手术结束前仍为慢复流者为4例(5.5%),后组为3例(4.3%,P=0.52),差异无统计学意义。他汀标准组1个月内MACE事件发生12例(16.4%),他汀强化组发生6例(8.6%),P=0.12,两组差异无统计学意义。其中,2组均无死亡,非致死性心肌梗死分别为2例(2.7%)vs.1(1.4%),P=0.51;缺血驱动靶血管血运重建分别为[9例(12.3%)vs.5例(7.1%),P=0.22];支架内血栓分别为[1例(1.4%)vs.0,P=0.51]。他汀药物不良反应两组分别为[3例(4.1%)vs.4例(5.7%),P=0.47],差异无统计学意义。结论:研究期间未发现STEMI患者行急诊PCI围术期,强化阿托伐他汀序贯治疗改善心肌组织灌注及改善临床预后,也未增加肝肾及肌肉损害发生率。     

大剂量阿托伐他汀序贯治疗对急性非ST段抬高型心肌梗死患者围手术期对比剂肾病的影响

目的探讨大剂量阿托伐他汀序贯治疗对急性非ST段抬高型心肌梗死行择期经皮冠状动脉介入治疗(PCI)患者对比剂肾病(CIN)的影响。方法将100例急性非ST段抬高型心肌梗死并择期行PCI患者随机分为大剂量阿托伐他汀序贯治疗组(简称序贯治疗组)和对照组。所有患者入院即刻给予80 mg阿托伐他汀钙,随后40 mg/d,术前均给予水化治疗。序贯治疗组术前6 h内追加40 mg阿托伐他汀钙,对照组术前未追加阿托伐他汀钙。所有患者分别于PCI术前、术后24 h、48 h测定并比较血清肌酐(Scr)、内生肌酐清除率(Ccr)和CIN发生率。结果两组患者术前、术后24 h、48 h Scr和Ccr相比差异均无统计学意义;与术前相比,序贯治疗组术后24 h、48 h Scr和Ccr均无明显变化,对照组术后24 h Scr和Ccr无明显变化,术后48 h Scr明显上升,Ccr明显下降(P0.05)。与术后24 h比较,两组术后48 h Scr明显上升,Ccr明显下降(P=0.00)。所有CIN患者术后7~10天Scr均降至正常范围内;两组患者CIN发生率相比差异无统计学意义(16%比15%,P=0.585)。结论对于术前已使用阿托伐他汀钙40 mg/d调脂方案患者,围手术期再次予阿托伐他汀钙40 mg治疗并不能降低CIN发生率。     

长期应用阿托伐他汀对溶栓治疗急性ST段抬高心肌梗死的心肌保护作用

目的探讨阿托伐他汀对溶栓治疗急性ST段抬高心肌梗死(STEMI)的心肌保护作用。方法 80例因STEMI而行静脉溶栓的患者按照就诊前3个月是否持续服用阿托伐他汀钙分为他汀组和对照组各40例,比较两组患者:①血肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK-MB)的峰值浓度、峰值时间(发病至峰值浓度的时间)、发病至恢复正常的时间;②溶栓治疗后再通指征、并发症及4周病死率。结果他汀组cTnI和CK-MB的峰值浓度均低于对照组(P均<0.05),他汀组cTnI和CK-MB的峰值时间、恢复正常时间均显著短于对照组(P均<0.05)。他汀组血管再通率高于对照组(P<0.05);他汀组的再灌注心律失常、心力衰竭、梗死后心绞痛的发生率均低于对照组(P均<0.05);两组不良反应发生率无统计学差异(χ2=0.392,P>0.05)。结论阿托伐他汀可减轻心肌缺血再灌注损伤,保护心脏功能,减少心脏不良事件。     

瑞舒伐他汀对急性ST段抬高型心肌梗死患者介入治疗后动脉粥样硬化及炎症反应的影响

目的探讨瑞舒伐他汀对急性ST段抬高型心肌梗死(STEMI)患者行经皮冠状动脉介入治疗(PCI)后动脉粥样硬化及炎症反应的影响。方法 2013年6月至2015年8月该院收治的STEMI患者71例,采用随机数字法分为观察组(36例)和对照组(35例),两组患者均给予抗血小板聚集、抗凝、β受体阻滞剂、血管紧张素转换酶抑制剂及硝酸酯类药物等常规治疗,在常规治疗基础上观察组患者每晚给予10 mg瑞舒伐他汀,对照组患者每晚给予40 mg辛伐他汀;比较两组患者在治疗前与治疗12个月后的血浆C-反应蛋白(CRP)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6水平、颈动脉内膜中层厚度(IMT)及~(99m)Tc-甲氧基异丁基异腈(~(99m)Tc-MIBI)摄取分数的变化。结果治疗后两组患者血浆CRP、TNF-α及IL-6水平、IMT及~(99m)Tc-MIBI摄取分数均显著下降(P0.05),且观察组均显著低于对照组(P0.05)。结论在常规治疗的基础上给予PCI STEMI患者瑞舒伐他汀能够显著改善机体炎症反应,降低颈动脉IMT厚度,改善存活心肌细胞功能。     

阿托伐他汀早期强化治疗对STEMI患者急诊PCI术后的影响

目的：探讨急诊经皮冠状动脉介入术（PCI）术前阿托伐他汀强化治疗对ST段抬高心肌梗死（STEMI）患者术后ST段回落、血清炎症因子及内皮功能的影响。方法纳入2010年3月~2010年12月武警总医院发病时间＜12 h、拟行急诊PCI的STEMI患者95例,按照随机信封法随机分为3组：A组（n=34,术前给予负荷剂量阿托伐他汀80 mg,术后给予阿托伐他汀40 mg/d）;B组（n=34,术前不服用他汀类药物,术后给予阿托伐他汀40 mg/d）;C组（n=30,术前不服用他汀类药物,术后给予常规剂量阿托伐他汀20 mg/d）,观察术后90 min内ST段回落情况以及术后24 h、3 d、7 d高敏C反应蛋白（hs-CRP）及NO合酶（NOS）的变化情况。结果术后90 min内A组ST段回落比例更高,同时回落幅度也更大,与B组和C组均有统计学差异（P＜0.05）;术后24 h,A组高敏C反应蛋白（hs-CRP）水平下降,但与B组和C组无统计学差异;术后3 d和7 d,A组hs-CRP进一步下降,且与B组和C组达到统计学差异（P＜0.05）;术后24 h及术后3 d,A组一氧化氮合成酶（NOS）水平高于B组和C组,但与B组和C组比较无统计学差异（P＞0.05）;术后7 d,A组NOS水平继续升高,与B组和C组达到统计学差异（P＜0.05）。结论急诊PCI术前一次性给予大剂量（80 mg）阿托伐他汀强化治疗有利于STEMI患者心肌灌注恢复,并能够降低炎症反应,改善血管内皮功能。     

阿托伐他汀对急性ST段抬高型心肌梗死患者血清淀粉样蛋白A和脂联素水平的影响

目的观察不同剂量阿托伐他汀干预对急性ST段抬高型心肌梗死(STEMI)患者血清淀粉样蛋白A(SAA)及脂联素(APN)水平的影响。方法采用酶联免疫吸附法测定急性ST段抬高型心肌梗死患者(63例)、健康体检者(30例)SAA和APN水平。将STEMI患者随机分为阿托伐他汀20 mg干预组(n=31)和阿托伐他汀40 mg干预组(n=32),并于治疗前后分别测定SAA和APN水平。结果干预前SAA水平在2 0 mg组和4 0 mg组均比健康组高,APN水平在2 0 mg和4 0 mg组比健康组低(P<0.05);2周后SAA在20 mg组和40 mg组均较干预前降低,APN在20 mg和40 mg组均较干预前升高(P<0.05);干预后40 mg组与2 0 mg组比较SAA和APN的浓度变化幅度更大(P<0.0 5)。STEMI患者的血清淀粉样蛋白A与脂联素呈负相关(r=-0.478,P<0.05)。结论 STEMI患者SAA水平升高,APN水平降低;阿托伐他汀干预后可降低SAA浓度,升高APN浓度;大剂量可使SAA和APN浓度变化更大。     

体温升高对急性ST段抬高型心肌梗死患者直接PCI术后的影响

目的观察急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗术后体温升高对其近期预后的不良影响。方法回顾性分析282例直接经皮冠状动脉介入治疗的急性ST段抬高型心肌梗死患者,按照直接经皮冠状动脉介入治疗术后患者住院期间所测体温的峰值分为两组:体温37.5℃(体温升高组)和体温≤37.5℃(对照组)。比较两组6个月主要心脏不良事件的发生率(心源性死亡、非致死性心肌梗死及再血管化重建)。结果体温升高组占总人数37.6%(106/282)。白细胞计数、高敏C反应蛋白及肌钙蛋白I水平体温升高组均高于对照组(P0.05);既往心肌梗死发生频率及左心室射血分数体温升高组均低于对照组(P0.05);在高血压、高脂血症、糖尿病、血管造影及介入治疗等方面,两组差异无统计学意义(P0.05)。6个月主要心脏不良事件体温升高组患者明显高于对照组(P0.05)。结论体温升高是急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗术后近期预后的不良预测因子。     

Postprocedure Anticoagulation in Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

ObjectivesThis study sought to assess the association between postprocedural anticoagulation (PPAC) use and several clinical outcomes.BackgroundPPAC after primary percutaneous coronary intervention (pPCI) in patients with ST-segment elevation myocardial infarction (STEMI) may prevent recurrent ischemic events but may increase the risk of bleeding. No consensus has been reached on PPAC use.MethodsUsing data from the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome registry, conducted between 2014 and 2019, we stratified all STEMI patients who underwent pPCI according to the use of PPAC or not. Inverse probability of treatment weighting and a Cox proportional hazards model with hospital as random effect were used to analyze differences in in-hospital clinical outcomes: the primary efficacy endpoint was mortality and the primary safety endpoint was major bleeding.ResultsOf 34,826 evaluable patients, 26,272 (75.4%) were treated with PPAC and were on average younger, more stable at admission with lower bleeding risk score, more likely to have comorbidities and multivessel disease, and more often treated within 12 hours of symptom onset than those without PPAC. After inverse probability of treatment weighting adjustment for baseline differences, PPAC was associated with significantly reduced risk of in-hospital mortality (0.9% vs 1.8%; HR: 0.62; 95% CI: 0.43-0.89; P < 0.001) and a nonsignificant difference in risk of in-hospital major bleeding (2.5% vs 2.2%; HR: 1.05; 95% CI: 0.83-1.32; P = 0.14).ConclusionsPPAC in STEMI patients after pPCI was associated with reduced mortality without increasing major bleeding complications. Dedicated randomized trials with contemporary STEMI management are needed to confirm these findings.     

Outcomes for Cancer Patients with Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Background/PurposeThe incidence of cardiovascular disease in cancer patients is rising. The risk of in-hospital complications for cancer patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) is not well defined.Methods/MaterialsA retrospective single-center cohort assessing STEMI patients with a history of cancer (n = 58) and without a history of cancer (n = 551) who underwent primary PCI between January 1, 2012 and June 30, 2017 was conducted. The primary outcome was a composite of in-hospital complications including reinfarction, cardiogenic shock, new heart failure, stroke, new atrial fibrillation, ventricular tachycardia/fibrillation, cardiac arrest, bleeding, new dialysis requirement, mechanical circulatory support, hospice requirement, and in-hospital mortality.ResultsOverall in-hospital complications occurred in 229 (37.6%) patients. There was no significant difference in overall complications in patients with a history of cancer (39.7%), compared to those without a cancer history (37.4%) (adjusted OR 0.84 [0.46–1.51], p = 0.58; unadjusted OR 1.10 [0.61–1.92], p = 0.73); there were no differences exhibited in any of the individual complications. Patients with a history of cancer were significantly more likely to be readmitted within 30 days (12.7% vs. 5%; p = 0.03) and receive bare metal stents (50% vs. 30.4%; p = 0.004) as compared to patients without a history of cancer.ConclusionsThere was no significant difference for in-hospital complications in patients with a history of cancer and those without a history of cancer undergoing primary PCI for STEMI. Patients with a history of cancer were more likely to readmitted within 30 days and receive bare metal stents.SummaryThe risk of in-hospital complications for cancer patients with STEMI undergoing primary PCI is not well defined. In a single-center retrospective cohort, there was no significant difference for in-hospital complications between patients with a history of cancer and those without a history of cancer undergoing primary PCI for STEMI.     

Hyperbaric Oxygen Therapy Following Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

IntroductionHyperbaric oxygen therapy (HBOT) is a promising treatment modality for ischemic heart disease including myocardial infarction where outcomes are frequently poor despite early revascularization.ObjectiveTo compare single-photon emission computed tomography (SPECT) findings in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) treated with HBOT vs. control at 6 weeks.MethodsIn this pilot study, 24 patients were randomly allocated to HBOT (n = 13) and control groups (n = 11). Both groups underwent PPCI and were treated following the guidelines for STEMI management. The HBOT group received additional 15 and 90-minute HBOT sessions. All participants underwent SPECT at initial presentation (within 48 h of PPCI) and at follow up.ResultsBaseline characteristics were similar in both groups. The number of affected SPECT segments in the HBOT group at baseline and 6 weeks were 47.1 ± 14.6% vs. 33.7 ± 16.2%, respectively, with p = 0.039, and in the control group, the number of affected segment at these times were 55.5 ± 19.5% vs. 45.9 ± 17.9%, respectively, with p = 0.090. At follow-up, a decrease in the summed rest score was noted in both groups (HBOT: 20 ± 6.0 vs. 12.7 ± 8.1; p = 0.0017; control: 23 ± 8.2 vs. 16.7 ± 6.6; p = 0.031). The left ventricular ejection fraction in the HBOT group improved from 44 ± 22.1% to 57.2 ± 15.4% (p = 0.011) and in the control group from 45.9 ± 18.2% to 55 ± 12.1% (p = 0.044).ConclusionsHBOT use in STEMI patients was associated with an improvement in perfusion and an increase in ejection fraction following PPCI. These observations warrant a larger randomized clinical trial.     

Clinical Characteristics and Outcomes in Young Patients With ST-Segment Elevation Myocardial Infarction After Primary Percutaneous Coronary Intervention

Background

There are few published studies of ST-segment elevation myocardial infarction (STEMI) in younger individuals. The differences between these “younger” and “older” individuals may not be fully appreciated by clinicians. The aim of this study was to determine the reasons for the earlier presentation and help to identify strategies for prevention of recurrent myocardial infarction (MI) in younger patients.

冠状动脉介入治疗急性非ST段拾高性心肌梗死

目的探讨急性非ST段抬高性心肌梗死急诊冠状动脉介入治疗的有效性及合理性.方法回顾性总结我院及中日友好医院对急性非ST段抬高性心肌梗死12例进行急诊冠状动脉介入治疗.结果12例病人中完全性闭塞7例,次全闭塞5例,其中三支病变3例.10例接受了PCI及支架术,共治疗病变25处,成功植入支架23枚.再灌注心律失常2例.术后心功能均有不同程度的改善.1例保守治疗;急诊外科搭桥1例.结论急性非ST段抬高性心肌梗死病人及早行冠状动脉造影检查,能尽早对病变血管作出正确的判断,对预后及治疗选择均有重要意义,早期对高危病人行介入治疗有利于改善病人预后.