Optimized strategy of rotational atherectomy of underexpanded coronary stents in patients with acute coronary syndrome

BACKGROUND: Stent under-expansion is a main cause of acute coronary syndrome (ACS), which can lead to serious clinical outcomes. The rotational atherectomy of underexpanded coronary stents (academically called stent ablation, SA) by intravascular ultrasound (IVUS) may provide more visual reference in the intervention. We aim to analyze the procedural and long-term outcomes of the optimized strategy of SA in patients with ACS and to provide real-world data on this technique.     

急性冠脉综合征患者血清C-反应蛋白浓度的变化及意义

目的　研究急性冠脉综合征 (ACS)患者血清C -反应蛋白 (CRP)浓度水平并与对照组比较 ,探讨CRP是否为ACS的一种危险因子。方法　测定ACS患者和对照组血清CRP浓度 ,同时检测冠心病的常见危险因子并与CRP一起做Logis tic回归分析。结果　①ACS患者血清CRP浓度〔(18.5 0± 2 3.98)mg/L(SE 2 .5 1,n =91)〕显著高于对照组〔(3.89± 7.14 )mg/L(SE 0 .5 1,n =194 )〕 (P <0 .0 1)。②急性心肌梗死 (AMI)急性期患者CRP浓度〔(18.6 5± 2 4 .12 )mg/L〕和不稳定型心绞痛(UAP)CRP浓度〔(17.95± 2 4 .10 )mg/L〕显著高于正常对照组、稳定型心绞痛 (SAP)CRP浓度〔(3.94± 7.5 0 )mg/L〕、AMI患者恢复期〔(5 .93± 13.0 7)mg/L〕和陈旧性心肌梗死 (OMI)患者〔(4 .5 7± 8.2 7)mg/L〕(均P <0 .0 1) ;SAP患者、AMI患者恢复期和OMI患者之间CRP浓度无差别 (P >0 .0 5 ) ,并与正常人群比较无显著性差别 (P >0 .0 5 )。③每增加CRP 5mg/L ,ACS发生危险增加到近 2倍 (用Logistic回归 ,OR =1.6 5 ) ,故CRP是ACS一种潜在决定因子。结论　血清CRP浓度升高与ACS有极大的相关性 ,并提出CRP是ACS的一种新的危险因子。     

心脏标志物检测对急性冠状动脉综合征患者的作用及效果评价

目的探讨心脏标志物的临床变化,及其指导护理急性冠状动脉综合征（ACS）患者的作用效果。方法将心血管内科和CCU的ACS患者100例随机分为观察组和对照组各50例。对照组接受常规护理,观察组在常规护理组的基础上结合心脏标志物的阳性结果,对患者进行干预。比较2组患者B型钠尿肽、肌红蛋白、肌酸激酶同工酶、心肌钙蛋白I、心电图正常、心力衰竭、心源性休克等指标的变化情况,并比较2组患者及家属对护理人员的评价。结果B型钠尿肽、肌红蛋白、肌酸激酶同工酶、心肌钙蛋白I、心电图正常、心力衰竭、心源性休克等指标比较观察组显著优于对照组,观察组患者及家属对护理人员有较满意的评价。结论心脏标志物的检测不仅对ACS的诊断、危险分层和预后判断有重要意义,而且对指导护理ACS患者有着重要的作用,提高了护士对危险因素的识别能力,及时采取有效的措施,减少并发症,降低死亡率,提高患者与家属的满意度。     

非ST段抬高急性冠状动脉综合征不同危险分层的比较

目的 探讨非ST段抬高急性冠状动脉综合征(NSTE-ACS)不同危险分层预测预后的价值.方法 选取资料完整的NSTE-ACS患者301例,随访患者住院期间及出院后1年的终点事件(全因死亡和非致死性心肌梗死).分别计算每例患者的心肌梗死溶栓治疗(TIMI)评分、血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂依替巴肽治疗急性冠状动脉综合征(PURSUIT)评分、全球急性冠状动脉事件注册(GRACE)评分和进行传统2000年美国心脏病学会/美国心脏病协会(ACC/AHA)指南临床分层,分别描绘四种危险分层方法ROC曲线并计算曲线下面积(AUC),比较4种分层方法预测终点事件的准确度.结果 随访住院期间和出院后1年共发生终点事件50例(16.6%),其中死亡21例(7.0%),非致死性心肌梗死29例(9.6%).传统ACC/AHA危险分层、TIMI、PURSUIT和GRACE 4种分层方法预测NSTE-ACS住院期间和1年终点事件的准确度呈依次递增趋势,GRACE危险评分预测住院期间和1年终点事件的准确度分别是AUC=0.664,95%CI=0.526～0.803和AUC=0.721,95%CI=0.636～0.806),GRACE评分在135分时预测1年终点事件敏感度和特异度均较好,分别是0.600和0.825.GRACE危险评分预测1年终点事件的准确度优于TIMI危险评分,PURSUIT、GRACE两种危险评分预测1年终点事件的准确度优于传统ACC/AHA危险分层.结论 GRACE和PURSUIT两种危险评分方法预测NSTE-ACS近远期预后均有较好的准确度,GRACE评分在135分时预测1年终点事件敏感度和特异度均较好,可以指导临床,GRACE危险评分预测1年终点事件的准确度优于TIMI危险评分和传统ACC/AHA危险分层.     

心脏标志物检测对急性冠状动脉综合征患者的作用及效果评价

目的 探讨心脏标志物的临床变化,及其指导护理急性冠状动脉综合征(ACS)患者的作用效果.方法 将心血管内科和CCU的ACS患者100例随机分为观察组和对照组各50例.对照组接受常规护理,观察组在常规护理组的基础上结合心脏标志物的阳性结果,对患者进行干预.比较2组患者B型钠尿肽、肌红蛋白、肌酸激酶同工酶、心肌钙蛋白I、心电图正常、心力衰竭、心源性休克等指标的变化情况.并比较2组患者及家属对护理人员的评价.结果 B型钠尿肽、肌红蛋白、肌酸激酶同工酶、心肌钙蛋白I、心电图正常、心力衰竭、心源性休克等指标比较观察组显著优于对照组,观察组患者及家属对护理人员有较满意的评价.结论 心脏标志物的检测不仅对ACS的诊断、危险分层和预后判断有重要意义,而且对指导护理ACS患者有着重要的作用,提高了护士对危险因素的识别能力,及时采取有效的措施,减少并发症,降低死亡率,提高患者与家属的满意度.     

Fibrinolysis in patients with acute coronary syndrome

The reperfusion therapy including both fibrinolytic therapy and primary percutaneous coronary intervention (PCI) has been established in patients with ST-segment elevation acute myocardial infarction (STEMI). Fibrinolysis has the advantage of universal availability and short time to administration. Because the benefit of fibrinolysis is directly related to the time from symptom onset to treatment as demonstrated in many studies, every effort must be made to minimize any delays between symptom onset and the initiation of a safe and effective reperfusion strategy in patients with STEMI. Although the benefit of fibrinolysis is limited by inadequate reperfusion or reocclusion of the infarct-related artery in a sizable portion of patients, fibrinolysis followed by planned PCI can be one of approaches in patients presenting within 2 or 3 hours from onset of STEMI.     

肺炎衣原体血清学检测在急性冠状动脉综合征患者中的应用研究

目的探讨肺炎衣原体(Cpn)血清学检测在急性冠状动脉综合征(ACS)患者中的应用效果。方法采用聚合酶链反应(PCR)对2012年10月至2013年10月在该院诊治的ACS患者(冠脉组)和健康体检者(对照组)各80例进行Cpn DNA检测,根据检测结果,将ACS患者分为衣原体组和非衣原体组。同时进行血清肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)、细胞间黏附分子1(ICAM-1)、血脂水平检测,分析肺炎衣原体感染与ACS的关系。结果冠脉组Cpn阳性53例、阴性27例,对照组Cpn阳性7例、阴性83例,比较差异有统计学意义(P0.05)。ACS患者中,衣原体组血清TNF-α、CRP、ICAM-1、总胆固醇、三酰甘油、低密度脂蛋白胆固醇水平均高于非衣原体组(P0.05);而高密度脂蛋白胆固醇水平则低于非衣原体组(P0.05)。结论 Cpn感染与ACS具有一定的相关性。Cpn感染通过提高ACS患者炎性因子水平参与疾病发展,并使患者继发高血脂症。     

急性冠脉综合征患者血清胆红素测定的临床意义

目的探讨急性冠脉综合征（ACS）病人血清胆红素变化的临床意义。方法108例ACS病人分为ST段抬高的心肌梗死组（STEMI组,40例）,非ST段抬高的心肌梗死组（NSTEMI组,30例）,不稳定型心绞痛组（UAP组,38例）,对照组45例为健康查体人员。108例病人中66例行冠状动脉造影后分为单支病变组（26例）,双支病变组22例,三支病变组（18例）,选择同期冠状动脉造影正常的30例非冠心病病人作为对照组。以上各组均测定血清总胆红素、直接胆红素等临床指标。结果对照组总胆红素、直接胆红素均高于其他各组（P〈0．05）;其中UAP组高于STEMI组（P〈0．05）。造影正常组血清胆红素也高于其他三组（P〈0．05）,单支病变组高于多支病变组（P〈0．05）。结论ACS病人血清胆红素低于正常人,低血清胆红素水平可能与ACS患者病情严重程度有关。     

急性冠脉综合征患者的护理

笔对34例急性冠脉综合征患进行分析，提出护理要点：按心肌梗死常规护理，加强相关指标的监测。尽早明确诊断；预防并发症，重视不典型表现，注意体温的变化，加强监护；积极做好原发病的防治及护理；加强心理护理及康复指导。     

血浆半乳糖凝集素3检测在急性冠脉综合征患者的应用价值

目的探讨半乳糖凝集素3(Galectin-3)作为炎性标志物评价冠状动脉斑块稳定性的可行性。方法连续入选74名急性心肌梗死患者和115名不稳定心绞痛患者。所有患者均接受冠脉动脉造影检查。造影前抽取桡动脉血,检测血浆中Galectin-3和C反应蛋白(CRP)表达水平。结果急性心肌梗死组中Galectin-3和CRP血浆表达水平显著高于不稳定心绞痛组(P0.05),Galectin-3与CRP表达呈正相关性。Galectin-3和CRP诊断急性心肌梗死的AUC差异无统计学意义(P0.05)。结论急性心肌梗死患者血浆中Galectin-3表达水平显著升高,对心血管损伤的炎性反应更敏感。     

Electrocardiographic diagnosis in patients with acute coronary syndrome

Electrocardiographic role in a diagnosis of ischemic heart disease has still important value. As important electrocardiographic findings of myocardial ischemia, there are ST elevation or depression, increase high T wave (hyperacute T wave), negative T wave and negative U wave, but it is particularly important to compare those findings and manifestation. Because the patient can always carry it, event ECG is advantageous in that they can record electrocardiography by themselves when they have some symptom. It is necessary to have attention to what abnormal findings of the electrocardiogram which it is easy to be overlooked such as increase T wave or negative U wave appear in early stage of phase of acute coronary syndrome. When the patient has some symptom that acute coronary syndrome is thought about, it is necessary to record electrocardiograms on several times and to do follow up even if there is no electorcardiographic abnormalities at first recording.     

Carbohydrate exchange in patients with acute coronary syndrome

Blood sugar measurement may be important for determining therapeutic tactics in patients in urgent pathological conditions. The role of hyperglycemia in the development of acute myocardial ischemia is under constant study, because the risk of death from myocardial infarction (MI) in patients with diabetes mellitus (DM) is twice higher than in those who do not suffer from DM. Having studied literature data, presented in the article, the authors report preliminary results of their work. Carbohydrate exchange disturbances are found almost in a half (49.1%) of patients with acute coronary syndrome (ACS). In patients with substantial and severe ACS manifestations that were considered to be those of acute myocardial infarction (MI) with ST interval elevation, as well as in patients with a repeated MI, carbohydrate exchange disorder was revealed in 65% and 77% of cases. In 30% of patients with a repeated MI, and in 14% of patients with MI with ST interval elevation, hyperglycemia was transient and disappeared on its own. Evaluation of this group of patients revealed type 2 DM in 44% of cases, which once more confirmed the information that DM patients were more liable to atherothrombosis. In half of the patients DM was newly revealed. This can be explained by the fact that a stressful situation urged revealing of the disease, which otherwise could be concealed. Data that suggest a higher hyperglycemia level in patients who finally could not be saved are of certain importance.     

Statin treatment in patients with acute coronary syndrome

In PROVE IT trial, intensive lipid-lowering therapy with statin (80 mg of atorvastatin daily) provides greater protection against cardiovascular events than does a standard regimen (40 mg of pravastatin daily) in patients with acute coronary syndrome (ACS), indicating that such patients benefit from early and continued lowering of LDL cholesterol to levels substantially below current target levels. However, differences between Japanese and Westerns as far as atherogenesis and response to statins are concerned, remain an unsolved problem that requires additional investigation. New guideline for the management of patients with ACS is needed for Japanese patients.     

DNA methylation profile in the whole blood of acute coronary syndrome patients with aspirin resistance

BackgroundAspirin resistance (AR) results in major adverse cardiovascular events, and DNA methylation might participate in the regulation of this pathological process.MethodsIn present study, a sum of 35 patients with AR and 35 non‐AR (NAR) controls were enrolled. Samples from 5 AR and 5 NAR were evaluated in an 850 BeadChip DNA methylation assay, and another 30 AR versus 30 NAR were evaluated to validate the differentially methylated CpG loci (DML). Then, qRT‐PCR was used to investigate the target mRNA expression of genes at CpG loci. Finally, Gene Ontology (GO) as well as Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed to reveal the enriched pathways.ResultsThe AR and NAR groups displayed significant differences in DNA methylation at 7707 positions, with 270 hypermethylated sites (e.g., cg09555818 located in APOC2) and 7437 sites hypomethylated sites (e.g., cg26828689 located in SLC12A5). Six DML were validated by pyrosequencing, and it was confirmed that DNA methylation (cg16391727, cg21008208, cg21293749, and cg13945576) was related to the increasing risk of AR. The relative mRNA expression of the ROR1 gene was also associated with AR (p = 0.007), suggesting that the change of cg21293749 in DNA methylation might lead to differential ROR1 mRNA expression, ultimately resulting in AR. Furthermore, the identified differentially methylated sites were associated with the molecular pathways such as circadian rhythms and insulin secretion.ConclusionHence, the distinct DNA methylation might play a vital role in the biological regulation of AR through the pathways such as circadian rhythms.     

Impact of gender in patients with acute coronary syndrome

In this article, we review the impact of gender on the pathophysiology, management and outcomes after acute coronary syndrome (ACS). We searched the English-language literature indexed in MEDLINE, Scopus and EBSCOhost Research databases from 1988 through January 2009 using the indexing terms ‘gender’, ‘short- and long-term outcomes’ and ‘acute coronary syndrome’ and ‘myocardial infarction’. Data comparing gender differences in outcomes after ACS showed that females have a higher mortality rate than males. Observational studies showed that guideline-recommended management strategies are used significantly less frequently in females than males. The undertreatment and worse outcome of female patients with ACS are probably multifactorial and have been reported in different ethnicities and cultures. However, there are conflicting data regarding to the impact of gender on early versus long-term outcomes, the benefit of early intervention in low- and high-risk females and the influence of unmeasured selection biases in the use of therapies in the observational data. These gender discrepancy trends warrant close follow-up, as this might reflect changes in primary and secondary prevention in the community. Furthermore, gender discrepancy gives an indication of healthcare quality and whether care is given in an unbiased manner. All high-risk females, and males with ACS, should receive optimal medical management, coronary angiography and revascularization whenever indicated.     

急性冠脉综合征370例护理体会

对370例急性冠脉综合征患者进行分析，提出护理要点：尽早明确诊断；加强相关指标的监测；预防并发症；加强心理护理及康复指导；积极做好原发病的防治及护理。     

急性冠脉综合征患者白介素-18及基质金属蛋白酶-9检测的意义

目的探讨白介素-18（IL—18）及基质金属蛋白酶-9（MMP-9）预测急性冠脉综合征（ACS）的意义。方法心内科住院患者79例，根据临床表现及冠脉造影结果分为对照组24例、不稳定性心绞痛（UAP）组预测3l例和急性心肌梗死（AMI）组24例，用酶联免疫吸附法（ELISA）测量其股动脉血清IL—18及MMP-9水平。结果IL—18水平，对照组较UAP组显著降低（P〈0．01），UAP组较AMI组显著降低（P〈0．01）；MMP-9水平，对照组较UAP组显著降低（P〈0．01），UAP组较AMI组显著降低（P〈0．01）。结论IL—18及MMP-9在正常人中表达，在ACS患者中显著升高，可作为ACS重要预测指标，并可能成为ACS的治疗靶点。