Meta-analysis of randomized trials on access site selection for percutaneous coronary intervention in ST-segment elevation myocardial infarction

Introduction

Superior outcomes with transradial (TRPCI) versus transfemoral coronary intervention (TFPCI) in the setting of acute ST-segment elevation myocardial infarction (STEMI) have been suggested by earlier studies. However, this effect was not evident in randomized controlled trials (RCTs), suggesting a possible allocation bias in observational studies. Since important studies with heterogeneous results regarding mortality have been published recently, we aimed to perform an updated review and meta-analysis on the safety and efficacy of TRPCI compared to TFPCI in the setting of STEMI.

Material and methods

Electronic databases were searched for relevant studies from January 1993 to November 2012. Outcome parameters of RCTs were pooled with the DerSimonian-Laird random-effects model.

Results

Twelve RCTs involving 5,124 patients were identified. According to the pooled analysis, TRPCI was associated with a significant reduction in major bleeding (odds ratio (OR): 0.52 (95% confidence interval (CI) 0.38–0.71, p < 0.0001)). The risk of mortality and major adverse events was significantly lower after TRPCI (OR = 0.58 (95% CI: 0.43–0.79), p = 0.0005 and OR = 0.67 (95% CI: 0.52–0.86), p = 0.002 respectively).

Conclusions

Robust data from randomized clinical studies indicate that TRPCI reduces both ischemic and bleeding complications in STEMI. These findings support the preferential use of radial access for primary PCI.     

替格瑞洛治疗急性心肌梗死行经皮冠状动脉介入术后患者效果观察

目的:探究替格瑞洛片对急性心肌梗死(Acute myocardial infarction,AMI)行经皮冠状动脉介入术(Percutaneous coronary intervention,PCI)术后患者血凝状态、心功能及细胞炎症反应的影响.方法:选取我科2018年1月至2019年6月期间收治的127例AMI行PC...     

Prognostic value of left atrium remodeling after primary percutaneous coronary intervention in patients with ST elevation acute myocardial infarction

The purpose of this study is to assess the relationship between left atrial (LA) size and outcome after acute myocardial infarction (AMI) in patients undergoing primary percutaneous coronary intervention (PCI) and to evaluate dynamic changes in LA size during long-term follow-up. Echocardiographic analyses were performed on 253 AMI patients (174 male and 79 female, 65.4 ± 13.7 yr) undergoing PCI. These subjects were studied at baseline and at 12 months. Clinical follow-up were done at 30.8 ± 7.5 months. We assessed LA volume index (LAVI) at AMI-onset and at 12-month. Change of LAVI was an independent predictor of new onset of atrial fibrillation or hospitalization for heart failure (P = 0.002). Subjects who survived the 12-month period displayed an increased LAVI mean of 1.86 ± 4.01 mL/m(2) (from 26.1 ± 8.6 to 28.0 ± 10.1 mL/m(2), P < 0.001). The subject group that displayed an increased LAVI correlated with a low left ventricular ejection fraction, large left ventricle systolic and diastolic dimensions and an enlarged LA size. In conclusion, change of LAVI is useful parameter to predict subsequent adverse cardiac event in AMI patients. Post-AMI echocardiographic evaluation of LAVI provides important prognostic information that is significantly greater than that obtained from clinical and laboratory parameters alone.     

Prognostic significance of preoperative C-reactive protein: albumin ratio in patients with clear cell renal cell carcinoma

We undertook a retrospective analysis to evaluate the C-reactive protein/albumin (CRP/Alb) ratio for its prognostic value in patients with clear cell renal cell carcinoma (CCRCC). The study comprised 406 CCRCC patients undergoing nephrectomy between 2003 and 2012 in our hospital. The correlations among the pretreatment CRP/Alb ratio, clinicopathological parameters, and overall survival (OS) were evaluated. An elevated CRP/Alb ratio was associated with older age at surgery (P=0.007), more advanced TNM stage (P<0.001), more presence of tumor necrosis (P<0.001) and lymphovascular invasion (P<0.001), lower concentration of hemoglobin (P<0.001) and calcium (P=0.005), and shorter OS (P<0.001). The multivariate analysis confirmed that the CRP/Alb ratio independently predicted the OS of patients with CCRCC (P<0.001), the Glasgow Prognostic Score (GPS) (P=0.001) and modified GPS (mGPS) (P=0.019) were independent prognostic factors also. At last, we evaluated the prognostic value of the CRP/Alb ratio compared with the similar inflammation-based prognostic scores GPS and mGPS using the area under the curve (AUC). Although the differences were not statistically significant, the AUC value of the CRP/Alb ratio (continuous, categorical) was higher compared with the GPS and mGPS, except that the AUC value for the CRP/Alb ratio (categorical) at 3 years was lower than that for the GPS. The CRP/Alb ratio could take the place of the GPS and mGPS in terms of predicting prognosis in CCRCC.     

Clinical benefit of low molecular weight heparin for ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with glycoprotein IIb/IIIa inhibitor

The efficacy of low molecular weight heparin (LMWH) with low dose unfractionated heparin (UFH) during percutaneous coronary intervention (PCI) with or without glycoprotein (Gp) IIb/IIIa inhibitor compared to UFH with or without Gp IIb/IIIa inhibitor has not been elucidated. Between October 2005 and July 2007, 2,535 patients with ST elevation acute myocardial infarction (STEMI) undergoing PCI in the Korean Acute Myocardial Infarction Registry (KAMIR) were assigned to either of two groups: a group with Gp IIb/IIIa inhibitor (n=476) or a group without Gp IIb/IIIa inhibitor (n=2,059). These groups were further subdivided according to the use of LMWH with low dose UFH (n=219) or UFH alone (n=257). The primary end points were cardiac death or myocardial infarction during the 30 days after the registration. The primary end point occurred in 4.1% (9/219) of patients managed with LMWH during PCI and Gp IIb/IIIa inhibitor and 10.8% (28/257) of patients managed with UFH and Gp IIb/IIIa inhibitor (odds ratio [OR], 0.290; 95% confidence interval [CI], 0.132-0.634; P=0.006). Thrombolysis In Myocardial Infarction (TIMI) with major bleeding was observed in LMHW and UFH with Gp IIb/IIIa inhibitor (1/219 [0.5%] vs 1/257 [0.4%], P=1.00). For patients with STEMI managed with a primary PCI and Gp IIb/IIIa inhibitor, LMWH is more beneficial than UFH.     

Thrombosuction utilizing an export aspiration catheter during primary percutaneous coronary intervention in acute myocardial infarction

PURPOSE: Effective myocardial reperfusion after primary PCI for an AMI in lesions with a thrombus is limited by distal embolization and the slow/no reflow phenomenon. We evaluated the efficacy of a thrombus reduction technique using an export aspiration catheter for thrombosuction during primary PCI. MATERIALS AND METHODS: We analyzed 62 patients with AMIs who underwent primary PCI and had a thrombi burden during thrombosuction using an EAC (EAC group; n=31) or without thrombosuction (control group; n=31). RESULTS: Thrombosuction with an EAC was performed safely in all the patients in EAC group without any complications. After the PCI, restoration to a TIMI flow grade 3 was significantly more frequent in the EAC group (26/31 vs. 20/31, p < 0.05). However, the TIMI perfusion grade did not differ between the two groups. Further, the corrected TIMI frame counts were lower in the EAC group (23.9 +/- 15.1 vs. 34.8 +/- 22.5, p < 0.05). Although there was no statistical significance, a greater incidence of distal embolization was observed in the control group (16.1%, 5/31) as compared to the EAC group (0/31) (p= 0.056). However, the incidence of major adverse cardiac events at 1 and 6 months did not differ between the two groups. CONCLUSION: For AMIs, thrombosuction with an EAC before or during PCI is a safe and potentially effective method for restoration of the coronary flow.     

Efficacy and safety of bivalirudin bridging enoxaparin versus fondaparinux in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: evidence from a single-center study

IntroductionThis study aims to compare the safety and efficacy of bivalirudin bridging enoxaparin versus fondaparinux in patients with acute myocardial infarction (AMI) who were undergoing primary percutaneous coronary intervention (PPCI).MethodsThe study is a prospective, natural, and selective interventional trial based on real-world data for 482 AMI patients.ResultsAt the end of the follow-up, the two groups demonstrated similar major adverse cardiovascular and cerebrovascular events (MACCE) and bleeding rates. After propensity score matching (PSM), the fondaparinux group showed greater advantages in reducing MACCE and bleeding events.ConclusionsThe anticoagulation strategy of bivalirudin bridging fondaparinux seems to be superior to that of bivalirudin bridging enoxaparin in patients with AMI undergoing PPCI.     

老老年急性心肌梗死患者介入治疗的疗效及近期安全性评价

目的评价老老年（≥80岁）急性心肌梗死（AMI）患者行急诊与择期经皮冠状动脉介入治疗术（PCI）的有效性和近期安全性。方法将120例老老年冠心病患者分为急性心肌梗死组（AMI组）和非心肌梗死组（对照组）,其中AMI组发病12h内行直接PCI的患者为AMI急诊组,其他AMI患者（AMI择期组）和对照组患者均行择期PCI,两组合称为非急诊组,对各组的临床资料及冠脉介入特点进行回顾性分析。结果 AMI急诊组PCI即刻成功率（72.2%）低于非急诊组（92.2%）,差异有统计学意义（P=0.036）。AMI急诊组并发症比非急诊组和AMI择期组高,差异有统计学意义（P〈0.001,P=0.039）,AMI组并发症及主要不良心脏事件发生率、院内死亡率均比对照组高（P〈0.05）。结论在老老年AMI患者中,急诊与择期PCI手术成功率均较高,虽然急诊PCI术发生并发症的风险较高,但两者在院内死亡率和主要不良心脏事件发生率方面差异无统计学意义。     

Increased neutrophil-to-lymphocyte ratio predicts persistent coronary no-flow after wire insertion in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

OBJECTIVES:

Acute ST-segment elevation myocardial infarction patients presenting persistent no-flow after wire insertion have a lower survival rate despite successful mechanical intervention. The neutrophil-to-lymphocyte ratio has been associated with increased mortality and worse clinical outcomes in ST-segment elevation myocardial infarction. We hypothesized that an elevated neutrophil-to-lymphocyte ratio would also be associated with a persistent Thrombolysis In Myocardial Infarction flow grade of 0 after wire insertion in patients undergoing primary percutaneous coronary intervention.

METHODS:

A total of 644 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention within 12 hours of symptom onset were included in our study. Blood samples were drawn immediately upon hospital admission. The patients were divided into 3 groups according to their Thrombolysis In Myocardial Infarction flow grade: Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion, Thrombolysis In Myocardial Infarction flow grade 1-3 after wire insertion and Thrombolysis In Myocardial Infarction flow grade 1-3 at baseline.

RESULTS:

The neutrophil-to-lymphocyte ratio was significantly higher in the group with Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion compared with the group with Thrombolysis In Myocardial Infarction flow grade 1-3 after wire insertion and the group with Thrombolysis In Myocardial Infarction flow grade 1-3 at baseline. The group with Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion also had a significantly higher in-hospital mortality rate. Persistent coronary no-flow after wire insertion was independently associated with the neutrophil-to-lymphocyte ratio.

CONCLUSIONS:

An increased neutrophil-to-lymphocyte ratio on admission is significantly associated with persistent coronary no-flow after wire insertion in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.     

In-hospital daily insulin dose predicts long-term adverse outcome in patients with diabetes with ST-elevation myocardial infarction treated with successful primary percutaneous angioplasty

Introduction

Early initiation of reperfusion therapy including primary percutaneous coronary revascularization (PPCI) has been recognized as a crucial factor determining clinical outcomes in the acute phase of myocardial infarction. In unstable patients with type 2 diabetes mellitus (T2D) the clear benefit from PPCI was proven. We aim to evaluate the prognostic value of factors describing glycometabolic state on admission in patients with T2D undergoing PPCI in acute ST-elevation myocardial infarction (STEMI).

Material and methods

Prospective analysis of clinical and laboratory variables (mean daily short acting exogenous insulin dose (DID), admission blood glucose, glycated hemoglobin (HbA_1c), microalbuminuria) was performed in 112 consecutive patients with T2D with STEMI who underwent PPCI. Women comprised 58% of the group.

Results

Insulin dosing was targeted to obtain a mean daily glucose level < 7.8 mmol/l. During 12-month follow-up 33 (29.5%) major adverse cardiac events (major adverse cardiac events (MACE) consisting of death, reinfarction, and repeated target vessel revascularization) were reported. Microalbuminuria was present in 68 (60.5%) patients. The mean HbA_1c level was 7.9%. In the multivariate logistic regression model only DID > 44 IU remained an independent risk factor for MACE (p = 0.02, OR = 5.2).

Conclusions

In patients with diabetes with STEMI treated with PPCI, simple measurement of DID during hospitalization can add valuable prognostic information about the future risk of MACE.     

入院血糖对急性心肌梗死患者介入治疗后住院死亡率的预测价值

目的探讨入院即刻血糖水平对急性心肌梗死（AMI）患者行经皮冠状动脉介入（PCT）治疗后住院死亡率的预测价值。方法因急性心肌梗死在笔者所在医院行急诊PCI治疗的非糖尿病患者456例,其中男性319例,女性137例,年龄29～85岁,平均年龄61．30岁。按入院即刻血糖（SG）水平分为3组：SG〈7．8mmol/L为A组248例,7．8mmol／L≤SG≤11.1mmol／L为B组156例,SG〉11．1mmol/L为C组52例,分别对3组患者住院期间心力衰竭、恶性心律失常、心脏性死亡,再梗死、梗死后心绞痛及主要不良心脏事件（MACE）的发生率进行对比分析。结果在年龄、性别、冠心病家族史、吸烟、既往高血压、心房纤颤、前降支和右冠状动脉病变、多支病变、梗死后心绞痛、胸痛发作至PCI时间等方面3组之间差异均无统计学意义（P〉0．05）;而C组多于一个部位心肌梗死、入院Killip’s分级≥2级的比例明显多于A、B两组（P〈0．05）;C组白细胞计数明显高于A、B组（P〈0．05）;在肌酸激酶（CK）、肌酸激酶同功酶峰值（CK／CK—MB）及住院期间左心室射血分数方面3组差异均有统计学意义（P〈0．05）;C组急性心力衰竭的发生率明显高于A、B组;C组心肌梗死再发生率亦高于A组,而B、C组未显示差异有统计学意义;C组恶性心律失常发生率明显高于A组,A、B组差异亦有统计学意义（P〈0．05）;而MACE发生率及住院期间死亡率分别为C组46．2％和13．7％,B组34．0％和4．5％,A组19．0％和1．6％,3组之间差异均有统计学意义（P〈0．001）。结论入院即刻血糖升高的急性心肌梗死患者实施急诊PCI治疗后院内死亡率及总的心血管事件发生率高,提示预后不良。     

氯吡格雷抵抗对急性心肌梗死合并糖尿病患者冠脉介入治疗预后的影响

目的：观察急性心肌梗死合并糖尿病且接受直接经皮冠脉介入治疗的患者氯吡格雷抵抗发生的情况及其对远期预后的影响。方法：连续入选2011年1月1日~2012年12月31日在我院接受直接经皮冠脉介入治疗,出院后随访>1年的急性心肌梗死合并糖尿病患者119例,所有患者均在服用氯吡格雷负荷量24 h后进行血栓弹力图检测,根据ADP诱导的血小板抑制率分为对照组(ADP抑制率≥50%,82例)和观察组(即氯吡格雷抵抗组,ADP抑制率<50%,37例)。记录患者的临床特点、生化指标、随访期间死亡和主要不良心血管事件(main adverse cardiac events,MACE)发生情况。结果：临床随访平均(783±241) d,氯吡格雷抵抗的发生率为31%。随访1年内总的MACE发生率为7.6%。氯吡格雷抵抗组1年内的MACE发生率明显高于对照组(16.2% vs.3.7%,P=0.025)。氯吡格雷抵抗和长期(1年以上)MACE发生无关(P=0.334);多因素Cox回归分析,氯吡格雷抵抗对患者的长期死亡率无明显影响。结论：接受直接经皮冠状动脉介入治疗的糖尿病合并急性心肌梗死患者存在明显的氯吡格雷抵抗现象。氯吡格雷抵抗会增加这些患者介入术后1年内发生主要心脏不良事件的风险,而对其1年以上的长期预后无显著影响。     

糖化血红蛋白对老年急性心肌梗死患者接受直接经皮冠脉介入治疗远期预后的影响

目的:评价糖化血红蛋白(glycosylatedhemoglobin,HbA1c)对老年急性心肌梗死患接受直接经皮冠脉介入治疗远期预后的影响.方法:入选2008年6月31日~2012年12月31日在我院接受直接经皮冠脉介入治疗,年龄60岁以上,入院后24小时内测定HbA1c并且出院后随访>1年的急性心肌梗死患233例,根据HbA1c水平分为3组,组I(HbA1c≤5.6%,46例)、组II(5.7%≤HbA1c≤6.4%,92例)、组III(HbA1c≥6.5%,95例).分析三组患1年内主不良心脏事件(mainadversecardiacevents,MACE)和全因死亡率,了解患入院后HbA1c水平与急性心肌梗死1年以上长期预后的关系.结果:临床随访平均(977±438)d,随访1年死亡12例(5.2%),发生不良心脏事件18例(7.7%).将入选患分为否认糖尿病组和糖尿病组,否认糖尿病组患1年内MACE发生率与死亡率三组均一致,组III(12.5%)明显高于组II(2.6%)和组I(0%;P=0.026),但组I与组II之间无明显差异;糖尿病组患将组I与组II合并后与组III比较在1年内的MACE发生率(P=0.059)及死亡率(P=0.328)上无统计学差异.多因素Cox回归分析,校正其他因素后,HbA1c是患长期(1年以上)死亡率的独立预测因子(HR:1.258;95%CI:1.114~1.421;P<0.001).结论:在接受直接经皮冠状动脉介入治疗的老年急性心肌梗死患,HbA1c是长期死亡发生的独立预测因子.对于既往无糖尿病病史患,HbA1c≥6.5%与其1年内发生死亡和主心脏不良事件显著相关..     

Combination of biomarkers to predict mortality in elderly patients with myocardial infarction

OBJECTIVE: The elderly subjects affected by Acute Myocardial Infarction (AMI) have the highest risk of mortality. Our study was designed to improve the capability of mortality risk stratification in elderly AMI patients through the concurrent evaluations of different biomarkers, including genetic markers. METHODS AND RESULTS: One-year follow-up study was performed in 250 elderly AMI patients. The combination of high total Homocysteine (tHcy), low folate and vitamin B12 plasma levels (18.0+/-9.0 micromol/l; 4.4+/-1.2 ng/ml; 404.2+/-287.5 pg/ml, respectively) and elevated CRP plasma levels (> or =6 mg/dl) identify the highest-risk pathway of heart mortality (RR=4.20, IC 95% 1.62-10.89, P<0.002) with respect to the combination of low total tHcy, high folate and vitamin B12 plasma levels (12.4+/-5.2 micromol/l; 8.9+/-2.5 ng/ml; 546.9+/-379.8 pg/ml, respectively) and low CRP plasma levels (<6 mg/dl). CONCLUSION: In elderly AMI patients the concomitant elevation of CRP and tHcy, associated with folate and vitamin B12 low levels, could be considered a significant predictive heart mortality risk factor.     

丹红注射液对急性心肌梗死患者经皮冠状动脉介入治疗后血清IL-6和IL-17水平的影响

目的:探讨丹红注射液对急性心肌梗死(acute myocardial infarction,AMI)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)后血清IL-6和IL-17水平的影响.方法:选取2014年6月至2016年1月在第四军医大学唐都医院心内科急诊PCI术后的120例ST抬高型心肌梗死(ST-elevation myocardial infarction,STEMI)患者,随机分为对照组和研究组,每组各60例.两组均给予常规治疗,而研究组则在常规治疗基础上给予静脉滴注丹红注射液治疗.观察两组临床症状和体征的改善情况、心电图的恢复情况及不良反应发生情况,评估两组的临床疗效.ELISA测定两组患者治疗前和治疗3,7 d后血清IL-6和IL-17的水平.比较两组治疗前后左室射血分数和心肌梗死面积的变化.随访6个月,观察两组患者主要不良心血管事件(major adverse cardiovascular events,MACE)的发生情况.结果:研究组治疗的总有效率为90.00%,显著高于对照组的76.67%,两组间差异有统计学意义(P<0.05);研究组治疗3,7 d后血清IL-6水平分别为(56.38±10.75)ng/mL,(42.52±8.14)ng/mL,均显著低于对照组的(62.73±12.08)ng/mL,(51.65±9.78)ng/mL,两组间差异有统计学意义(P<0.05);研究组治疗3,7 d后血清IL-17水平分别为(28.73±5.68)ng/mL,(22.54±4.55)ng/mL,均显著低于对照组的(34.39±6.21)ng/mL和(29.82±5.74)ng/mL,两组间差异有统计学意义(P<0.05);研究组治疗后的LVEF为54.72%±5.64%,显著高于对照组的49.38%±4.57%,两组间差异有统计学意义(P<0.05);研究组治疗后的心肌梗死面积为10.64%±4.38%,明显低于对照组的16.74%±5.49%,两组间差异有统计学意义(P<0.05);研究组的MACE发生率为5.00%,显著低于对照组的16.67%,两组间差异有统计学意义(P<0.05).结论:丹红注射液可有效降低PCI术后STEMI患者血清L-6和IL-17的水平,改善患者心功能,缩小心肌梗死面积,降低MACE的发生率,安全有效,值得应用于临床.     

直接经皮冠状动脉介入治疗80岁以上急性心肌梗死患者的临床评价

目的 探讨直接经皮冠状动脉介入(PCI)治疗80岁以上急性心肌梗死(AMI)患者的临床疗效和安全性.方法 94例80岁以上AMI患者,入院后直接PCI.观察手术成功率、并发症、住院病死率和主要心脏不良事件,出院前测定左心室射血分数(LVEF).结果 冠状动脉造影示梗死相关血管(IRA)心肌梗死溶栓治疗(TIMI)m流分级0～1级,除2例心源性休克患者术中因室颤死亡,其余病例均成功开通IRA,操作成功率97.9%.术后76例血流TIMI 3级,16例TIMI 2级.术后6例因左心功能衰竭死亡.26例心功能Killip Ⅲ级以上者使用主动脉内球囊反搏(IABP)辅助循环,持续反搏时间78～154(98.3±34.5)h.多支病变者除18例3支病变外均在术后3～7 d行非IRA的PCI.住院总病死率8.5%(8/94),Killip Ⅲ级以上者病死率30.8%(8/26).仅3.3%(3/92)发生需输血的出血并发症.住院期间无主要心脏不良事件发生.生存的86例患者出院前测LVEF中位值为43%(26%～62%).存活者术后30 d和180 d主要心脏不良事件发生率分别为1.2%和4.6%.结论 对于80岁以上老年AMI患者行直接PCI安全可行,且成功率较高.     

Feasibility of the radial artery as a vascular access route in performing primary percutaneous coronary intervention

We aimed to evaluate the feasibility of transradial primary percutaneous coronary intervention (PCI) in patients with ST elevation myocardial infarction (STEMI) by comparing the procedural results and complications with those of transfemoral intervention. From April 1997 to October 2004, we enrolled 352 consecutive cases of STEMI who underwent primary PCI. The femoral route was used in 132 cases (TFI group) and the radial route was used in 220 cases (TRI group). Cases with Killips class IV, a negative Allen test or a non-palpable radial artery were excluded from our study. Baseline clinical and angiographic profiles were comparable in both groups. Vascular access time was 3.8 +/- 3.5 min in the TFI group and 3.6 +/- 3.1 min in the TRI group, and cath room to reperfusion time was 25 +/- 11 min in the TRI group and 26 +/- 13 min in the TRI group. The procedural success rate was 89% in the TFI group and 88% in the TRI group. Crossover occurred in 9 cases (4%) due to approaching vessel tortuosity in the TRI group. Major access site complications occurred in 7 cases (5%) in the TFI group, and there were no complications in the TRI group (p < 0.001). Although radial occlusion occurred in 5 cases of the TRI group, there was no evidence of hand ischemia. The total hospital stay was significantly shorter in TRI group than in TFI group. In conclusion, use of the radial artery might be a potential vascular access route in performing primary PCI in selected cases.     

Transdisciplinary approach to the follow-up of patients after myocardial infarction

OBJECTIVES: To compare conventional and transdisciplinary care in a tertiary outpatient clinic for patients after their first acute myocardial infarction. METHODS: One hundred fifty-three patients with acute myocardial infarction were randomized at hospital discharge and followed-up to compare conventional (n=75) and transdisciplinary care (n=78). They were submitted to a clinical evaluation, received a dietary plan, and were re-evaluated twice in 60-180 days by a nurse, dietitian and physician, when new clinical and laboratory data were collected. The primary outcome was clinical improvement, as evaluated by an index including reduction of body weight, lowering of blood pressure, smoking cessation, increase in physical activity and compliance with medication. RESULTS: The groups were similar at baseline: 63.4% were men, 89.9% had an acute myocardial infarction with ST-segment-elevation, 32.7% were diabetic, and 72.2% were hypertensive. The clinical improvement index was similar between the studied groups: in 33.3 % (transdisciplinary care) vs. 30.4 % (conventional care) of patients, the improvement was very good (P=1.000). Rates of re-hospitalization and death (p=0.127) were similar between transdisciplinary and conventional care. Compliance with diet was higher for transdisciplinary care (50.0%) vs. conventional care (26.1%) (p=0.007), as was compliance with visits (73.3 vs. 40.3%, respectively, p<0.001). CONCLUSIONS: Compliance with diet and visits was higher for transdisciplinary care vs. conventional care; however, the transdisciplinary approach did not provide more clinical benefits than the conventional approach after patients' first acute myocardial infarction in this setting.     

阿托伐他汀对急性ST段抬高型心肌梗死患者外周血内皮祖细胞表面标志物表达的影响

目的:比较不同剂量的阿托伐他汀对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者中内皮祖细胞(endothelial progenitor cells,EPCs)功能变化的影响。方法:选择确诊为STEMI的患者共40例,根据服用阿托伐他汀钙片的剂量不同,随机分为20 mg组及40 mg组。采用流式细胞术,在不同时点(服药前及服药后第5、10、15、20、30、60、90、120天)对STEMI患者的循环EPCs进行识别及量化分析,检测EPCs表面标志物CXC趋化因子受体(CXCR)4、血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)、沉默信息调节因子1(SIRT1)的表达。结果:第5天40 mg组细胞增殖力及CXCR4、VEGF、bFGF的表达高于20 mg组(P0.05);第10~120天20 mg组细胞增殖力及CXCR4、VEGF、bFGF的表达高于40 mg组(P0.05)。SIRT1在第30天前2组的表达差异无统计学显著性;在第30天后出现明显变化,第60天达高峰,随后呈下降趋势,各时点均可见20 mg组大于40 mg组(P0.05)。结论:在STEMI急性期,40 mg阿托伐他汀提升机体修复功能优于20mg。然而,长期低浓度的他汀治疗在改善血管内膜功能和促进血管新生作用方面优于高剂量。     

分支DNA技术检测血浆游离DNA方法的建立及在急性心肌梗死患者中的初步应用简

 目的 采用分支DNA（bDNA）信号放大定量技术建立检测血中游离DNA（cf-DNA）—ALU基因表达的方法并分析其在急性心肌梗死（AMI）患者血浆中的含量。方法 根据ALU基因序列特点设计探针,建立检测血ALU的bDNA信号放大定量方法,并对其线性、灵敏度及精密度进行评价;根据标准曲线计算出AMI患者血浆中ALU的含量,并与肌钙蛋白I（cTnI）、肌酸激酶同功酶MB（CK-MB）和肌红蛋白（MYO）进行相关性分析。结果 线性范围为0~400 ng/mL,相关系数为0.99,批内变异系数（CV）为7.85%~11.75%,批间CV为10.05%~14.32%。AMI患者和健康对照组血浆ALU的含量分别是中位数4223 ng/mL和118 ng/mL,四分位数区间2285~7864 ng/mL和81~218 ng/mL（P＜0.001）,提示AMI患者血浆ALU含量上调,但与cTnI、CK-MB和MYO浓度无相关性。ALU的ROC曲线下面积为0.99,敏感度98.8%,特异性100.0%。结论 本研究建立的检测方法具有灵敏、重复性好等优点,升高的ALU含量与AMI存在一定相关性。