Decreased door-to-balloon time in patients with ST-segment elevation myocardial infarction during the early COVID-19 pandemic in South Korea: An observational study

The coronavirus disease 2019 (COVID-19) resulted in a marked decrease in the number of patient visits for acute myocardial infarction and delayed patient response and intervention in several countries. This study evaluated the effect of the COVID-19 pandemic on the number of patients, patient response time (pain-to-door), and intervention time (door-to-balloon) for patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI).Patients with STEMI or NSTEMI visiting a hospital in South Korea who underwent primary coronary intervention during the COVID-19 pandemic (January 29, 2020, to December 31, 2020) were compared with those in the equivalent period from 2018 to 2019. Patient response and intervention times were compared for the COVID-19 pandemic window (2020) and the equivalent period from 2018 to 2019.We observed no decrease in the number of patients with STEMI (P = .88) and NSTEMI (P = 1.00) during the COVID-19 pandemic compared to that in the previous years. Patient response times (STEMI: P = .39; NSTEMI: P = .59) during the overall COVID-19 pandemic period did not differ significantly. However, we identified a significant decrease in door-to-balloon time among patients with STEMI (14%; P < .01) during the early COVID-19 pandemic.We found that the number of patients with STEMI and NSTEMI was consistent during the COVID-19 pandemic and that no time delays in patient response and intervention occurred. However, the door-to-balloon time among patients with STEMI significantly reduced during the early COVID-19 pandemic, which could be attributed to decreased emergency care utilization during the early pandemic.     

不同剂量替罗非班联合替格瑞洛对急性期NSTEMI患者的疗效及血栓抑制作用分析

目的探讨不同剂量替罗非班联合替格瑞洛对急性期非ST段抬高心肌梗死(NSTEMI)患者的疗效及血栓抑制作用。方法以我院2014年1月至2015年4月收治的180例急性期NSTEMI患者为研究对象,根据用药方法分为替格瑞洛组、常规剂量联合组和低剂量联合组,每组60例。所有患者均给予常规治疗,替格瑞洛组患者加用单纯替格瑞洛治疗,常规剂量联合组患者加用常规剂量替罗非班联合替格瑞洛治疗,低剂量联合组患者加用小剂量替罗非班联合替格瑞洛治疗。观察各组复合心血管事件及单项终点事件,各组血小板聚集率缓解情况,纤维蛋白原水平变化情况,药物治疗安全性等。结果药物治疗30 d时,联合用药组患者的复合心血管事件发生率较单纯替格瑞洛组患者降低(P<0.05);与单纯替格瑞洛组比较,联合用药组患者能够在更短的时间内迅速降低血小板聚集率,且效果更显著(P<0.01或P<0.05),纤维蛋白原水平减少更显著(P<0.01或P<0.05)。低剂量联合组不良反应发生率低于常规剂量联合组、单纯替格瑞洛组,差异有统计学意义(P<0.05)。结论替罗非班联合替格瑞洛的疗效优于单纯替格瑞洛,且起效快、不良反应轻微,能够较好地抑制血小板聚集,降低纤维蛋白原水平。低剂量替罗非班联合替格瑞洛能够减少高剂量替罗非班的不良反应发生率,且治疗效果无显著差异,是急性期NSTEMI的有效治疗方案。     

Advances in Percutaneous Coronary Interventions for Elderly Patients

Coronary heart disease (CHD) is one of the leading causes of morbidity and the most common cause of death in older adults. Paradoxically, elderly patients tend to be systematically excluded from randomized-controlled cardiovascular trials, which complicates decision-making in this population. Management of CHD in the elderly is frequently more difficult in virtue of chronic comorbid conditions and aging-intrinsic dynamics. Despite these challenges, the number of elderly and very elderly patients undergoing percutaneous coronary interventions (PCI) is increasing. Elderly patients in many registries and large clinical series exhibit even a greater benefit from interventional procedures than younger patients, but they have a higher rate of overall complications. We present an overview of the current available evidence of PCI in older adults with stable and unstable CHD, including comparisons between drug-eluting and bare-metal stents, transfemoral and transradial access, and methods of revascularization. Adjuvant antiplatelet and antithrombotic therapies are also discussed.     

厄贝沙坦对老年非ST段抬高型心肌梗死患者血清肝细胞生长因子水平的影响

目的：观察厄贝沙坦对老年非ST段抬高型心肌梗死(NSTEMI)者血清肝细胞生长因子(HGF)水平的影响。方法选择2013年10月~2014年5月哈尔滨医科大学附属第四医院老年NESTMI患者38例,将入选患者中因各种原因不能服用厄贝沙坦的17例患者作为对照组,余21例为药物组。对照组给予硝酸酯药物、β受体阻滞剂、阿托伐他汀、拜阿司匹林、低分子肝素等常规治疗;药物组在此基础上给予常规治疗联合厄贝沙坦(150 mg/d)。分别于治疗前、治疗后第7天、治疗后第14天检测两组患者血清超敏C反应蛋白(hs-CRP)、同型半胱氨酸(Hcy);采用酶联免疫吸附试验检测血清中HGF含量。结果治疗后第14天时药物组血清hs-CRP及Hcy水平均较治疗前明显降低(P<0.05),且明显低于对照组(P<0.05);治疗后第7天两组患者血清HGF水平明显高于治疗前(P<0.05),但药物组明显低于对照组(P<0.05);两组患者治疗后第14天时HGF水平均较治第7天下降(P<0.05),但两组组差异无统计学意义(P>0.05)。结论老年非NSTEMI患者应用厄贝沙坦2周时可使血清中hs-CRP、Hcy水平明显下降,厄贝沙坦可降低老年NSTEMI患者血清HGF水平。     

Antiplatelet therapy for postdischarge medical management of acute coronary syndrome

Postdischarge management of patients with acute coronary syndrome is often suboptimal, despite their high risk of a subsequent event. Updated American College of Cardiology/American Heart Association guidelines emphasize the need for aggressive modification of risk factors and treatment with antiplatelet, antihypertensive, and lipid-lowering agents commenced in-hospital and continued long-term. Antiplatelet therapy involving aspirin and clopidogrel is the mainstay of secondary risk reduction. Increased adherence to medication and risk factor modification at discharge has been demonstrated with acute care quality improvement initiatives. Extension of these initiatives to postdischarge care will provide data on medication adherence post acute coronary syndrome and functional outcomes in the community setting. Successful secondary prevention of cardiovascular events requires implementation of evidence-based guidelines by physicians, and adherence to pharmacotherapy and lifestyle modifications by patients. Primary care physicians are well placed to influence adherence through their ongoing relationships with patients and can save lives by implementing secondary risk reduction measures after discharge.     

Nonroutine Use of Intra-Aortic Balloon Pump in Cardiogenic Shock Complicating Myocardial Infarction With Successful and Unsuccessful Primary Percutaneous Coronary Intervention

Objectives

The authors sought to compare outcomes of patients with myocardial infarction and cardiogenic shock (CS) treated with percutaneous coronary intervention (PCI) with or without intra-aortic balloon pump (IABP) support according to final epicardial flow in the infarct-related artery.

Takotsubo cardiomyopathy has a unique cardiac biomarker profile: NT-proBNP/myoglobin and NT-proBNP/troponin T ratios for the differential diagnosis of acute coronary syndromes and stress induced cardiomyopathy

Background

Takotsubo cardiomyopathy (TC) usually is not recognized until heart catheterization reveals typical wall motion abnormalities in the absence of significant coronary artery disease. It was our aim to identify TC by its unique cardiac biomarker profile at an early stage and, preferably, with non-invasive procedures only.

Methods

Ratios of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and myoglobin, NT-proBNP and troponin T (TnT), NT-proBNP and creatinekinase-MB (CK-MB) were compared in patients with TC (n = 39), patients with ST-elevation myocardial infarction (STEMI, n = 48) and patients with non-ST-elevation myocardial infarction (NSTEMI, n = 34). Biomarkers were recorded serially at admission and at the three consecutive days. Optimal cut-off values to distinguish TC from STEMI and NSTEMI were calculated with receiver operator characteristic (ROC) curves.

Results

At admission a NT-proBNP (ng/l)/myoglobin (μg/l) ratio of 3.8, distinguished TC from STEMI (sensitivity: 89%, specificity: 90%), while a NT-proBNP (ng/l)/myoglobin (μg/l) ratio of 14 separated well between TC and NSTEMI (sensitivity: 65%, specificity: 90%). Best differentiation of TC and ACS was possible with the ratio of peak levels of NT-proBNP (ng/l)/TnT (μg/l). A cut-off value of NT-proBNP (ng/l)/TnT (μg/l) ratio of 2889, distinguished TC from STEMI (sensitivity: 91%, specificity: 95%), while a NT-proBNP (ng/l)/TnT (μg/l) ratio of 5000 separated well between TC and NSTEMI (sensitivity: 83%, specificity: 95%).

Conclusions

TC goes along with a singular cardiac biomarker profile, which might be useful to identify patients with TC among patients presenting with acute coronary syndromes (ACS).