Background Prior studies have demonstrated that the achievement of faster coronary artery flow following reperfusion therapies is associated with improved outcomes among ST-elevation myocardial infarction (STEMI) pati...Background Prior studies have demonstrated that the achievement of faster coronary artery flow following reperfusion therapies is associated with improved outcomes among ST-elevation myocardial infarction (STEMI) patients. The association of patient age with angiographic characteristics of flow and perfusion after rescue/adjunctive percutaneous coronary intervention (PCI) following the administration of fibrinolytic therapy has not been previously investigated. Objectives and Methods We examined the association between age (≥ 70 years or ＜ 70years)and clinical and angiographic outcomes in 1472 STEMI patients who underwent rescue/adjunctive PCI following fibrinolytic therapy in 7 TIMI trials. We hypothesized that elderly patients would have slower post-PCI epicardial flow and worsened outcomes compared to younger patients. Results The 218 patients aged ≥ 70 years (14.8%) had more comorbidities than younger patients. Although these patients had significant angiographic improvement in TIMI frame counts and rates of TIMI Grade 3 flow following rescue/adjunctive PCI, elderly patients had higher (slower)post-PCI TIMI frame counts compared to the younger cohort (25 vs 22 frames, P = 0.039), and less often achieved post-PCI TIMI Grade 3 flow (80.1 vs 86.4%, P = 0.017). The association between age ( ≥70 years) and slower post-PCI flow was independent of gender, time to treatment, left anterior descending (LAD) lesion location, and pulse and blood pressure on admission. Elderly patients also had 4-fold higher mortality at 30 days (12.0 vs 2.7%,P = 0. 001 ). Conclusions This study suggests one possible mechanism underlying worsened outcomes among elderly STEMI patients insofar as advanced chronological age was associated with higher TIMI frame counts and less frequent TIMI Grade 3 flow after rescue/adjunctive PCI.展开更多
目的探讨基质金属蛋白酶-2(matrix metalloproteinases-2,MMP-2)/基质金属蛋白酶组织抑制剂-2(tissueinhibitor of matrix metalloproteinases-2,TIMP-2)与2型糖尿病大鼠心肌间质中胶原代谢的关系,及瑞舒伐他汀防治心肌间质纤维化的可...目的探讨基质金属蛋白酶-2(matrix metalloproteinases-2,MMP-2)/基质金属蛋白酶组织抑制剂-2(tissueinhibitor of matrix metalloproteinases-2,TIMP-2)与2型糖尿病大鼠心肌间质中胶原代谢的关系,及瑞舒伐他汀防治心肌间质纤维化的可能机制。方法30只雄性SD大鼠按随机数字表法抽取8只作为正常对照组,其余22只喂高脂,高糖饲料,并予低剂量链脲佐菌素单次腹腔注射。16只成模的糖尿病组大鼠按随机数字表法分成糖尿病组(n=8)与瑞舒伐他汀治疗组(n=8)。待血糖稳定后,治疗组开始给予瑞舒伐他汀干预处理,干预两个月后,处死大鼠,测定动物体质量,心脏质量,以计算心脏质量指数:心脏质量(g)/动物体质量(g)。酶联免疫吸附试验(ELISA)法分别测定3组大鼠血浆MMP-2、TIMP-2浓度,采用免疫组化方法检测心肌MMP-2、TIMP-2蛋白表达的水平和组织定位,采用Masson染色方法观察心肌间质胶原蛋白含量变化及分布。结果糖尿病组及治疗组血糖高于正常组,差异有统计学意义(P<0.05)。糖尿病组心脏质量指数高于治疗组和正常组,差异有统计学意义(P<0.05)。糖尿病组血浆MMP-2及TIMP-2浓度均比正常组高,差异有统计学意义(P<0.05)。治疗组血浆MMP-2及TIMP-2浓度比糖尿病组降低,差异有统计学意义(P<0.05)。然而,免疫组化检测到MMP-2在糖尿病组心肌间质中表达比正常组明显减少,在治疗组的表达比在糖尿病组增多,差异有统计学意义(P<0.05);TIMP-2在糖尿病组心肌间质中表达比正常组明显增多,在治疗组的表达比在糖尿病组减少,差异有统计学意义(P<0.05)。糖尿病组与正常组比较,MMP-2/TIMP-2比值下降;治疗组与糖尿病组比较,MMP-2/TIMP-2比值上升。心肌Masson染色:亮绿色纤维在糖尿病组心肌间质中明显比正常组增多,而治疗组比糖尿病组有所减少。结论糖尿病大鼠中MMP-2/TIMP-2比值下降可能是导致心肌间质纤维化的原因之一。瑞舒�展开更多
文摘Background Prior studies have demonstrated that the achievement of faster coronary artery flow following reperfusion therapies is associated with improved outcomes among ST-elevation myocardial infarction (STEMI) patients. The association of patient age with angiographic characteristics of flow and perfusion after rescue/adjunctive percutaneous coronary intervention (PCI) following the administration of fibrinolytic therapy has not been previously investigated. Objectives and Methods We examined the association between age (≥ 70 years or ＜ 70years)and clinical and angiographic outcomes in 1472 STEMI patients who underwent rescue/adjunctive PCI following fibrinolytic therapy in 7 TIMI trials. We hypothesized that elderly patients would have slower post-PCI epicardial flow and worsened outcomes compared to younger patients. Results The 218 patients aged ≥ 70 years (14.8%) had more comorbidities than younger patients. Although these patients had significant angiographic improvement in TIMI frame counts and rates of TIMI Grade 3 flow following rescue/adjunctive PCI, elderly patients had higher (slower)post-PCI TIMI frame counts compared to the younger cohort (25 vs 22 frames, P = 0.039), and less often achieved post-PCI TIMI Grade 3 flow (80.1 vs 86.4%, P = 0.017). The association between age ( ≥70 years) and slower post-PCI flow was independent of gender, time to treatment, left anterior descending (LAD) lesion location, and pulse and blood pressure on admission. Elderly patients also had 4-fold higher mortality at 30 days (12.0 vs 2.7%,P = 0. 001 ). Conclusions This study suggests one possible mechanism underlying worsened outcomes among elderly STEMI patients insofar as advanced chronological age was associated with higher TIMI frame counts and less frequent TIMI Grade 3 flow after rescue/adjunctive PCI.
文摘目的探讨基质金属蛋白酶-2(matrix metalloproteinases-2,MMP-2)/基质金属蛋白酶组织抑制剂-2(tissueinhibitor of matrix metalloproteinases-2,TIMP-2)与2型糖尿病大鼠心肌间质中胶原代谢的关系,及瑞舒伐他汀防治心肌间质纤维化的可能机制。方法30只雄性SD大鼠按随机数字表法抽取8只作为正常对照组,其余22只喂高脂,高糖饲料,并予低剂量链脲佐菌素单次腹腔注射。16只成模的糖尿病组大鼠按随机数字表法分成糖尿病组(n=8)与瑞舒伐他汀治疗组(n=8)。待血糖稳定后,治疗组开始给予瑞舒伐他汀干预处理,干预两个月后,处死大鼠,测定动物体质量,心脏质量,以计算心脏质量指数:心脏质量(g)/动物体质量(g)。酶联免疫吸附试验(ELISA)法分别测定3组大鼠血浆MMP-2、TIMP-2浓度,采用免疫组化方法检测心肌MMP-2、TIMP-2蛋白表达的水平和组织定位,采用Masson染色方法观察心肌间质胶原蛋白含量变化及分布。结果糖尿病组及治疗组血糖高于正常组,差异有统计学意义(P<0.05)。糖尿病组心脏质量指数高于治疗组和正常组,差异有统计学意义(P<0.05)。糖尿病组血浆MMP-2及TIMP-2浓度均比正常组高,差异有统计学意义(P<0.05)。治疗组血浆MMP-2及TIMP-2浓度比糖尿病组降低,差异有统计学意义(P<0.05)。然而,免疫组化检测到MMP-2在糖尿病组心肌间质中表达比正常组明显减少,在治疗组的表达比在糖尿病组增多,差异有统计学意义(P<0.05);TIMP-2在糖尿病组心肌间质中表达比正常组明显增多,在治疗组的表达比在糖尿病组减少,差异有统计学意义(P<0.05)。糖尿病组与正常组比较,MMP-2/TIMP-2比值下降;治疗组与糖尿病组比较,MMP-2/TIMP-2比值上升。心肌Masson染色:亮绿色纤维在糖尿病组心肌间质中明显比正常组增多,而治疗组比糖尿病组有所减少。结论糖尿病大鼠中MMP-2/TIMP-2比值下降可能是导致心肌间质纤维化的原因之一。瑞舒�
