Verapamil Reverses Myocardial No-Reflow After Primary Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction

The present study evaluated the efficacy of intracoronary administration of verapamil to attenuate the no-reflow phenomenon following the primary percutaneous coronary intervention (PCI) in patients with the ST-segment elevation acute myocardial infarction (STEMI). A total of 201 patients with STEMI who underwent primary PCI within 12 h from the beginning of the heart attack were included. The no-reflow phenomenon was defined as substantial coronary anterograde flow of TIMI ≤2. Verapamil (100–200 μg) was injected into coronary artery immediately after no-reflow; the coronary arteriography was repeated later. Hundred and ninety-eight patients with STEMI successfully underwent primary PCI, and 246 stents were implanted with the average of 1.2 stents per patient. No-reflow occurred in 25 out of 198 patients (12.6 %). Twenty-one (84 %) patients developed the flow of TIMI ≥3 after intracoronary administration of verapamil, as revealed by repeated coronary angiography. Two patients developed transient hypotension which normalized without treatment within 3–5 min. Three patients showed sinus bradycardia, in one patient there was transient II sinoatrial block, and one patient developed type 1 atrioventricular block. All adverse effects were alleviated after intravenous injection of atropine (0.5–1 mg). In conclusion, the no-reflow phenomenon following primary PCI in patients with STEMI is significantly improved by intracoronary administration of verapamil which is useful to reduce cardiovascular events during operation.     

ST段抬高性和非ST 段抬高性急性心肌梗死患者的冠状动脉病变特点比较

目的:比较ST段抬高性和非ST段抬高性急性心肌梗死患者的冠状动脉病变特点。方法:选取100例在我院接受24h动态心电图和冠状动脉造影检查的急性心肌梗死患者,根据心电图结果分为观察组和对照组各50例。对照组为ST段抬高性心肌梗死(STEMI)患者,观察组为非ST段抬高性心肌梗死(NSTEMI)患者,比较两组患者冠状动脉病变的差异。结果:对照组LAD(左前降支)闭塞血管比例(52.00%)显著高于观察组(18.00%),差异具有统计学意义(P0.05)。对照组LCX(回旋支)闭塞血管比例(8.00%)显著低于观察组(50.00%),差异具有统计学意义(P0.05)。对照组RCA(右冠脉主干)闭塞血管比例(40.00%)和观察组(30.00%)比较,差异无统计学意义(P0.05)。对照组单支病变比例(46.00%)明显高于观察组(12.00%),对照组三支病变比例(20.00%)明显低于观察组(48.00%)比较,差异均具有统计学意义(P0.05)。对照组二支及正常血管比例与观察组比较,差异均无统计学意义(P0.05)。对照组罪犯血管狭窄程度在76%-90%、91%-99%及完全闭塞的比例与观察组比较差异均具有统计学意义(P0.05)。罪犯血管狭窄程度在50%及50%-75%时,两组差异无统计学意义(P0.05)。两组并发症发生情况比较,差异无统计学意义(P0.05)。结论:1NSTEMI罪犯血管闭塞以LCX多见,STEMI罪犯血管闭塞以LAD多见;2NSTEMI以三支血管病变较多见,STEMI以单支病变较多见。     

血小板与淋巴细胞比率对急性ST 段抬高型心肌梗死患者PCI术后无复 流的预测价值

目的:研究入院时血小板与淋巴细胞比率(Platelet-to-Lymphocyte Ratio,PLR)对急性ST段抬高型心肌梗死(ST-segment elevation myocardia1 infarction,STEMI)患者冠脉介入治疗后无复流的预测价值。方法:共收集190例急性STEMI患者,发病12小时内并且行PCI(primary coronary intervention)术。按术中TIMI血流分级将病人分为2组:正常复流组(138例)和无复流组(52例),比较两组患者的基本临床资料、实验室检查结果及PCI结果,用Logistic回归分析无复流的预测因素,用受试者工作特征曲线(ROC曲线)论证得到PLR预测无复流的最佳临界值及其敏感度和特异度。结果:无复流组PLR显著高于正常复流组(246±98VS 169±108,P0.01)。当PLR=188时,预测无复流的敏感度为70%,特异度为72%。结论:入院时PLR是急性STEMI患者PCI术后无复流的预测因素。     

Nicorandil in Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

Background

Nicorandil, as an adjunctive therapy with primary percutaneous coronary intervention (PCI), had controversial benefits in cardioprotection in patients with acute myocardial infarction (AMI).

Methods and Results

We performed a systematic review of randomized controlled trials (RCTs) comparing treatment with nicorandil prior to reperfusion therapy with control (placebo or no nicorandil) in patients who suffered from AMI and performed primary PCI. PubMed, EMBASE and CENTRAL databases and other sources were searched without language and publication restriction. 14 trials involving 1680 patients were included into this meta-analysis. Nicorandil significantly reduced the incidence of thrombolysis in myocardial infarction (TIMI) flow grade ≤2 (risk ratio [RR], 0.57; 95% confidence interval [CI]: 0.42 to 0.79), the Timi frame count (TFC) (mean difference [MD], -5.19; 95% CI: -7.13 to -3.26), increased left ventricular ejection fraction (LVEF) (%) (MD, 3.08; 95% CI: 0.79 to 5.36), and reduced the incidence of ventricular arrhythmia (RR, 0.53; 95% CI: 0.37 to 0.76) and congestive heart failure (CHF) (RR, 0.41; 95% CI: 0.22 to 0.75). No difference in the pear creatine kinase (CK) value (MD, -290.19; 95% CI: -793.75 to 213.36) or cardiac death (RR, 0.39; 95% CI: 0.09 to 1.67) was observed.

Conclusions

Nicorandil prior to reperfusion is associated with improvement of coronary reflow as well as suppression of ventricular arrhythmia, and further improves left ventricular function in patients who suffered from AMI and underwent primary PCI. But the definite clinical benefits of nicorandil were not found, which may be due to the small sample size of the selected studies.     

小型猪心肌梗死介入治疗后无复流动物模型的制备

目的制备猪急性心肌梗死冠状动脉介入治疗（AMI—PCI）后无复流（no—reflow）动物模型。方法五指山小型猪26头,行左、右冠状动脉造影和左心室造影,记录有创血流动力学参数,通过球囊闭塞、微血栓注入造成左前降支无复流,监测体表和冠脉内心电图变化。结果制模共有21头猪成活,19头达到AMI—PCI后无复流动物模型标准,即TIMI血流≤2级,校正的TIMI血流记帧法（CTFC）≥36．2帧,制模成功率73．1％。无复流模型建立成功后心率增快,血压下降,心肌耗氧量增加,左心室舒张期末压和肺毛细血管楔压升高,较闭塞前均具有统计学差异（P〈0．05）。实验过程中,体表心电图和冠状动脉内心电图均出现类似人AMI再灌注的心电图演变规律。结论选择性冠状动脉前降支急性闭塞、再灌注、微血栓注入制备的无复流小型猪动物模型是可行的。     

Irisin 水平与急性心肌梗死患者PCI术后无复流的研究

目的：探讨血清Irisin 水平对急性心肌梗死(AMI)患者PCI术后无复流的预测价值。方法：连续收集西京医院心内科因AMI 行急诊PCI治疗的169 例患者的临床及冠脉影像学资料。根据TIMI血流分级,将病人分为两组,正常血流组和无复流组;采用酶 联免疫吸附试验(ELISA)检测患者血清中Irisin 水平,根据Irisin 水平分为低Irisin 组和高Irisin 组,分析Irisin 与无复流发生的关 系。结果：①169例患者发生无复流40 例,无复流发生率为23.6%（40/169）;②无复流组与正常血流组相比,血清Irisin 水平显著降 低（4766± 1725 ng/mLvs 8125± 2904 ng/mL,P<0.05）;③急性心梗发生后,血浆Irisin 水平逐渐升高,3 小时内组Irisin 水平显著低 于24 小时后组（4050± 1739 ng/mL vs8358± 3042 ng/mL,P<0.05）,且3 小时内组无复流显著高于24 小时后组（71.42%vs 12.9%, P<0.05）;④低Irisin 组中无复流的发生率显著高于高Irisin 组（58.1% vs 11.9%,P<0.05）;⑤多元Logistic 回归显示Irisin 是急诊 PCI术后无复流发生的保护因素(OR:0.861,95%CI:0.793-0.909,P<0.05)。结论：低水平的血清Irisin 能有效预测急性心肌梗死患者 PCI术后无复流的发生,且Irisin 能明显改善PCI术后无复流。     

急性心肌梗死患者冠脉介入治疗后血浆apelin的变化及作用

目的:观察急性心肌梗死(AMI)患者围手术期血浆apelin的表达变化,分析AMI合并2型糖尿病(T2DM)患者血浆apelin的表达与预后的相关性,探讨apelin在冠脉介入治疗(PCI)中的心脏保护作用。方法:72例于2012年2月~8月在我院心内科接受冠状动脉造影确诊为AMI并成功完成PCI的冠心病患者,分别在术前、术后0小时、术后4小时、术后24小时收集血清,酶联免疫吸附法测定血浆apelin-13水平;进一步对糖尿病及非糖尿病AMI患者(每组各20例)进行亚组分析,随访两组患者在术后6个月时主要不良心脑血管事件(MACCE)。结果:AMI患者术后0 h组apelin水平与术前基线水平明显降低(31.54±5.48 vs35.15±6.48 ng/L,P0.05);术后4小时及24小时组apelin水平较术前明显升高(39.65±5.48 vs 35.15±6.48 ng/L,43.93±5.37 vs35.15±6.48 ng/L,P0.05)。糖尿病与非糖尿病组apelin水平术前无明显差异;糖尿病组在术后各时间点的apelin水平均明显高于非糖尿病组(31.12±5.50 vs 29.21±6.53 ng/L,40.57±5.37 vs 33.49±3.89 ng/L,43.50±7.41 vs 34.54±3.52 ng/L,P0.05)。两组术后6个月随访T2DM组LVEF值改善明显高于NT2DM组,但MACCE事件无明显差异。结论:AMI患者PCI术后存在血浆apelin表达的升高,其中糖尿病患者在术后血浆apelin表达较非糖尿病患者明显增高,提示PCI冠脉血运重建可促进糖尿病患者apelin分泌,调节胰岛素抵抗改善预后。     

ST 段抬高心肌梗死靶血管长病变急诊介入治疗的安全性及疗效分析

目的:探讨ST段抬高急性心肌梗死(ST-elevation myocardial infarction,STEMI)患者靶血管长病变(病变>25 mm)急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的临床疗效及安全性。方法:回顾性收集2009年1月-2010年6月因STEMI就诊于沈阳军区总医院并急诊行PCI处理的患者442例,以靶病变长度分为两组,即≤25 mm为短病变组(n=235)和>25mm为长病变组(n=207),均急诊行PCI治疗,分析和比较两组患者术前的基线资料、术中资料及并发症的发生情况、辅助措施(临时起搏、IABP、血栓抽吸装置)应用情况,术后30天、2年电话或临床随访,记录主要不良心血管事件(major adverse cardiac events,MACE)的发生情况。结果:与短病变组比较,长病变组吸烟者更多(81.6%vs 62.6%,P=0.000);以三支病变偏多(34.8%vs 24.7%,P=0.037);多枚支架使用率更高(1.47±0.63 vs 1.04±0.28,P=0.000),平均支架总长度显著增加(29.80±7.02 mm vs 22.95±5.58mm,P=0.000),手术成功率、术中并发症及辅助措施应用情况比较差异无统计学意义(P>0.05),30天及2年随访MACE的发生率比较差异无统计学意义(P>0.05)。结论:与急诊PCI治疗的STEMI短病变患者对比,长病变患者虽然病变复杂,多枚支架使用率高,平均支架总长度增加,但术中并发症、30天、2年内MACE与短病变患者相当,提示在以药物洗脱支架为主的介入治疗时代,急诊PCI处理STEMI靶血管长病变具有良好的疗效及安全性。     

Histopathological Features of Aspirated Thrombi after Primary Percutaneous Coronary Intervention in Patients with ST-Elevation Myocardial Infarction

Background

Plaque disruption with superimposed thrombus is the predominant mechanism responsible for the onset of acute coronary syndromes. Studies have shown that plaque disruption and thrombotic occlusion are frequently separated in time. We established the histopathological characteristics of material aspirated during primary percutaneous coronary intervention (PCI) in a large consecutive ST-elevation myocardial infarction (STEMI) population.

Methodology/Principal Findings

Thrombus aspiration during primary PCI was performed in 1,362 STEMI patients. Thrombus age was classified as fresh (<1 day), lytic (1–5 days), or organized (>5 day). Further, the presence of plaque was documented. The histopathological findings were related to the clinical, angiographic, and procedural characteristics. Material could be aspirated in 1,009 patients (74%). Components of plaque were found in 395 of these patients (39%). Fresh thrombus was found in 577 of 959 patients (60%) compared to 382 patients (40%) with lytic or organized thrombi. Distal embolization was present in 21% of patients with lytic thrombus compared to 12% and 15% of patients with fresh or organized thrombus.

Conclusions/Significance

Material could be obtained in 74% of STEMI patients treated with thrombus aspiration during primary PCI. In 40% of patients thrombus age is older than 24 h, indicating that plaque disruption and thrombus formation occur significantly earlier than the onset of symptoms in many patients.     

血栓抽吸联合PCI术前阿托伐他汀强化治疗急性ST段抬高型心肌梗死

目的:探讨急性ST段抬高型心肌梗死急诊经皮冠状动脉介入治疗(PCI)中应用GOODMAN血栓抽吸装置联合术前阿托伐他汀强化治疗对心肌组织灌注及临床预后的影响.方法:选择梗死相关血管心肌梗死溶栓试验血流0级的急性ST段抬高型心肌梗死患者80例,随机分为血栓抽吸联PCI术前阿托伐他汀强化治疗组(试验组)40例和标准PCI治疗组(对照组)40例.比较两组患者术后心肌梗死溶栓试验(TIMI)血流分级、TIMI心肌灌注分级(TMPG)、心电图ST段回落百分比、左心室射血分数(LVEF)及住院期间主要心血管不良事件(MACE).结果:试验组TIMI血流分级、TMPG、ST段回落百分比、LVEF均明显优于对照组(P＜0.05).两组患者住院期间MACE发生率比较,差异无统计学意义(P＞0.05).结论:在急性ST段抬高型心肌梗死急诊经皮冠状动脉介入治疗(PCI)中应用血栓抽吸联合术前阿托伐他汀强化治疗安全可行,可有效清除冠状动脉内血栓,改善心肌组织灌注及术后心脏功能,并且不增加主要心血管事件的发生率.     

急性下壁心肌梗死急诊PCI术中应用临时起搏器与阿托品的对比研究

目的：探讨临时起搏器与阿托品在急性下壁心肌梗死急诊经皮冠状动脉介入治疗（PCI）中应用的疗效。方法：入选2012 年2 月至2013 年8 月我院收治的发病12 小时内,诊断为急性下壁心肌梗死并接受急诊PCI治疗的患者92 例,依据治疗方法的不同 将病例分为临时起搏组和阿托品组,并对病例进行为期一年的追踪随访,收集患者平均住院天数、平均住院费用、再灌注心律失 常、心肌梗死后心绞痛、心肌梗死后心衰发生率资料。结果：临时起搏组的平均住院天数、平均住院费用、心肌梗死后心绞痛、心肌 梗死后心衰发生率均显著低于阿托品治疗组（P 均<0.05）,阿托品治疗组的再灌注心律失常发生率则明显低于临时起搏组（P<0. 05）。结论：急性下壁心肌梗死急诊PCI中应用临时起搏器,具有治疗成本低,降低心血管事件发生率的优点,而阿托品治疗在改 善再灌注心律失常的疗效上则显著优于临时起搏治疗。     

急性心肌梗死行PCI患者炎症因子的检测及其与预后的关系

目的:探讨急性心肌梗死行经皮冠状动脉介入治疗(PCI)血清炎症因子的改变及其与预后的关系。方法:选择126例拟行PCI治疗的急性心肌梗死患者为研究对象,比较PCI手术前后血清超敏C反应蛋白(hs-CRP)及肿瘤坏死因子α(TNF-α)的改变。同时比较PCI术后3月发生心血管事件患者与未发生心血管事件患者术后12h血清hs-CRP及TNF-α的差别。结果:患者PCI术后血清hs-CRP及TNF-α水平均显著升高,与术前相比差别具有统计学意义(P<0.05);PCI术后3月发生心血管事件患者PCI术后12h血清hs-CRP及TNF-α水平显著高于未发生心血管事件患者(P<0.05);Logistic回归结果显示:hs-CRP及TNF-α与心血管事件发生率显著相关。结论:急性心肌梗死行PCI患者术后发生急性炎症反应,hs-CRP及TNF-α水平升高与患者心血管事件发生密切相关,可作为评估预后的血清学指标。     

PCI术前与术后主动脉内球囊反搏治疗急性心肌梗死合并心功能不全患者的疗效比较

目的:比较急性心肌梗死合并心功能不全患者冠状动脉介入(PCI)术前及术后植入主动脉内球囊反搏术(IABP)的效果及其安全性.方法:选择50例2010年1月至2011年6月在南京市第一医院CCU病房应用IABP治疗的急性心肌梗死患者,分为两组,A组为术前组,B组为术后组,各25例,观察并比较两组的即刻病情改善率、住院期间并发症及术后30天心功能、主要心血管事件(MACE)发生率.结果:A组IABP即刻病情改善显著高于B组(36％ vs.12％,P＜0.05).两组住院期间并发症的发生率均无统计学差异(P＞0.05).术后30天,A组LVEF显著低于B组(40.2± 7.7％vs.35.6±5.0％,P＜0.05).MACE事件,A组非致死性心肌梗死、再次PCI/CABG术及死亡发生率低于B组,其中A组死亡率显著低于B组,差异有统计学意义(58％vs.32％,P＜0.05).结论:PCI术前植入IABP对于急性心肌梗死合并心功能不全患者的疗效优于PCI术后植入,且不提高并发症的发生率.     

急性ST段抬高心肌梗死新型区域协同救治模式探讨

针对我国目前STEMI患者救治延迟问题,结合本地区实际情况,以能够实施直接PCI的医院为中心,依托于能够实时传输数据的急救物联网,联合周边二级医院、乡镇医院及社区卫生服务机构建立新型区域协同救治模式,将对STEMI患者的救治流程提前到院前的急救与转运过程中,为我国中小城市STEMI患者的救治模式提供了有益探索与实践。     

急性心肌梗死PCI术后早期T波倒置与左室功能的关系

目的:探讨急性ST段抬高心肌梗死直接PCI术后早期T波倒置与左心室功能的关系.方法:对急性ST段抬高心肌梗死直接PCI术后78例患者,以24小时抬高的T波是否倒置分组,采用超声心动描记术检测左室射血分数、心肌活动指数,评价早期T波倒置与左室功能的关系.结果:早期T波倒置组左心功能优于T波未倒置组(P＜0.01),T波深倒置组左心功能优于浅倒置组(P＜0.05).结论:急性ST段抬高心机梗死早期T波倒置可早期评估左心功能、判断预后.     

维拉帕米对急性前壁心肌梗死行急诊PCI术患者再灌注室性心律失常的影响

目的:探讨经指引导管早期应用维拉帕米对急性前壁心肌梗死行急诊经皮冠状动脉介入治疗术(Percutaneous Coronary Intervention,PCI)患者再灌注室性心律失常的影响。方法:采用单中心、随机对照、前瞻性研究方法。选取2014年5月-2016年11月诊断为急性前壁心肌梗死并于我院行急诊PCI的患者,共纳入162例患者,按随机方法(随机数字表)分成2组,其中治疗组82例,对照组80例。治疗组患者在首次球囊扩张后早期经指引导管内给予维拉帕米(200μg),对照组患者则给予生理盐水。观察再灌注后室性心律失常发生率,PCI术后冠脉血流情况,心肌梗死相关血清指标(CK-MB,cTn I)的峰值,住院期间发生的主要不良心血管事件(MACE)。结果:维拉帕米治疗组患者再灌注心律室性失常及无复流的发生率显著低于生理盐水对照组(P0.05);维拉帕米治疗组患者cTnI和CK-MB峰值分别为(46.63±13.77)μg/L和(139.87±35.45)U/L,生理盐水组cTnI和CK-MB峰值为(54.36±12.59)μg/L和(158.34±40.18)U/L,两组比较,P均0.01。MACE事件两组间未见有统计学差异。结论:急性前壁心肌梗死患者急诊PCI术前经导管早期给予维拉帕米不但可显著减少无复流现象,还可显著减少再灌注后室性心律失常的发生,住院期间MACE事件的发生率无显著性差异。     

Depression and Anxiety after Acute Myocardial Infarction Treated by Primary PCI

AimsThe main objective of the study was to find out prevalence of depression and anxiety symptoms in the population of patients with AMI with ST-segment elevation (STEMI), treated with primary PCI (pPCI). Secondary target indicators included the incidence of sleep disorders and loss of interest in sex.ConclusionsPatients with STEMI treated by primary PCI have relatively low overall prevalence of symptoms of depression and anxiety. A significant decrease in mental stress was observed before discharge from the hospital, but in a period of one year after pPCI, prevalence of both symptoms was gradually increasing, which should be given medical attention.     

不同剂量氯吡格雷治疗急性ST 段抬高心肌梗死的疗效及安全性分析

目的:探讨不同剂量氯吡格雷治疗急性ST段抬高心肌梗死(STEMI)的疗效及安全性。方法:178例急性STEMI患者随机分为高剂量组和常规剂量组,每组各69例。两组均给予阿司匹林、静脉溶栓、抗凝及降脂等常规治疗,高剂量组和常规剂量组分别口服氯吡格雷负荷量600 mg、300 mg,之后两组患者给予维持量75 mg/d。结果:治疗30 d后,高剂量组总有效率为91.0%,常规剂量组为77.5%,差异有统计学意义(P<0.05);高剂量组治疗后36 h及30d的MACE发生率为3.4%和6.7%,常规剂量组为12.4%和18.0%,差异均有统计学意义(P<0.05);两组出血发生率分别为9.0%,5.6%,差异无统计学意义(P>0.05)。结论:高剂量(600 mg)氯吡格雷治疗急性STEMI疗效优于常规剂量(300 mg),且具有良好的安全性。