目的:调查中国ST段抬高型心肌梗死(STEMI)患者急救医疗服务(EMS)的应用情况以及对治疗的影响。方法:入选中国急性心肌梗死(CAMI)注册研究2013年1月1日至2014年10月1日期间107家医院收治的13 549例STEMI患者,分为EMS组2 015例和自行来院...目的:调查中国ST段抬高型心肌梗死(STEMI)患者急救医疗服务(EMS)的应用情况以及对治疗的影响。方法:入选中国急性心肌梗死(CAMI)注册研究2013年1月1日至2014年10月1日期间107家医院收治的13 549例STEMI患者,分为EMS组2 015例和自行来院组11 534例进行分析。结果:仅2 015例(14.9%)患者呼叫救护车就诊。与自行来院组相比,EMS组接受再灌注治疗的比例较高(64.9%vs 52.9%,P<0.001),从症状发作到医院的中位时间较短(170min vs 240 min,P<0.0001),到达医院至溶栓时间(D2N)较短(47 min vs 53 min,P=0.003),但是门-球时间(即到达医院至球囊扩张时间)相似(106 min vs 108 min,P=0.932)。多因素Logistic回归分析显示,未使用EMS的独立预测因素是农村居民和家中症状发作,而应用EMS的预测因素是非前壁心肌梗死、持续胸痛、严重呼吸困难或晕厥、院前心脏骤停、Killip心功能分级> 2、收缩压<100mmHg(1 mmHg=0.133 kPa)、超重/肥胖以及至省级医院就诊。结论:中国STEMI患者应用EMS的比例仅15%左右。应用EMS的患者从症状发作到医院就诊时间较短,接受再灌注的比例较高,但门-球时间未缩短。中国应加强公众教育,鼓励胸痛患者使用EMS,以及加强EMS和医院的衔接。展开更多
Background Our previous studies have demonstrated that Tongxinluo （TXL）, a traditional Chinese medicine, can protect hearts against no-reflow and reperfusion injury in a protein kinase A （PKA）-dependent manner. Th...Background Our previous studies have demonstrated that Tongxinluo （TXL）, a traditional Chinese medicine, can protect hearts against no-reflow and reperfusion injury in a protein kinase A （PKA）-dependent manner. The present study was to investigate whether the PKA-mediated cardioprotection of TXL against no-reflow and reperfusion injury relates to the inhibition of myocardial inflammation, edema, and apoptosis. Methods In a 90-minute ischemia and 3-hour reperfusion model, minipigs were randomly assigned to sham, control, TXL （0.05 g/kg, gavaged one hour prior to ischemia）, and TXL ＋ H-89 （a PKA inhibitor, intravenously and continuously infused at 1.0 μg/kg per minute） groups. Myocardial no-reflow, necrosis, edema, and apoptosis were determined by pathological and histological studies. Myocardial activity of PKA and myeloperoxidase was measured by colorimetric method. The expression of PKA, phosphorylated cAMP response element-binding protein （p-CREB） （Ser133）, tumor necrosis factor a （TNF-a）, P-selectin, apoptotic proteins, and aquaporins was detected by Western blotting analysis. Results TXL decreased the no-reflow area by 37.4% and reduced the infarct size by 27.0% （P〈0.05）. TXL pretreatment increased the PKA activity and the expression of Ser133 p-CREB in the reflow and no-reflow myocardium （P 〈0.05）. TXL inhibited the ischemia-reperfusion-induced elevation of myeloperoxidase activities and the expression of TNF-a and P-selectin, reduced myocardial edema in the left ventricle and the reflow and no-reflow areas and the expression of aquaporin-4, -8, and -9, and decreased myocytes apoptosis by regulation of apoptotic protein expression in the reflow and no-reflow myocardium. However, addition of the PKA inhibitor H-89 counteracted these beneficial effects of TXL. Conclusion PKA-mediated cardioprotection of TXL against no-reflow and reperfusion injury relates to the inhibition of myocardial inflammation, edema, and apoptosis in the reflow and no-reflow myocardium.展开更多
The benefits of early perfusion in ST elevation myocardial infarctions(STEMI) are established; howeverearly perfusion of non-ST elevation myocardial infarctions has not been shown to be beneficial. In additionST eleva...The benefits of early perfusion in ST elevation myocardial infarctions(STEMI) are established; howeverearly perfusion of non-ST elevation myocardial infarctions has not been shown to be beneficial. In additionST elevation(STE) caused by conditions other thanacute ischemia is common. Non-ischemic STE may beconfused as STEMI, but can also mask STEMI on electrocardiogram(ECG). As a result, activating the primarypercutaneous coronary intervention(pPCI) protocooften depends on determining which ST elevation patterns reflect transmural infarction due to acute coronary artery thrombosis. Coordination of interpreting theECG in its clinical context and appropriately activatingthe pPCI protocol has proved a difficult task in borderline cases. But its importance cannot be ignored, asreflected in the 2013 American College of CardiologyFoundation/American Heart Association guidelines concerning the treatment of ST elevation myocardial infarction. Multiples strategies have been tested and studiedand are currently being further perfected. No mattethe strategy, at the heart of delivering the best care lies rapid and accurate interpretation of the ECG. Here, we present the different patterns of non-ischemic STE and methods of distinguishing between them. In writing this paper, we hope for quicker and better stratification of patients with STE on ECG, which will lead to be bet-ter outcomes.展开更多
文摘目的:调查中国ST段抬高型心肌梗死(STEMI)患者急救医疗服务(EMS)的应用情况以及对治疗的影响。方法:入选中国急性心肌梗死(CAMI)注册研究2013年1月1日至2014年10月1日期间107家医院收治的13 549例STEMI患者,分为EMS组2 015例和自行来院组11 534例进行分析。结果:仅2 015例(14.9%)患者呼叫救护车就诊。与自行来院组相比,EMS组接受再灌注治疗的比例较高(64.9%vs 52.9%,P<0.001),从症状发作到医院的中位时间较短(170min vs 240 min,P<0.0001),到达医院至溶栓时间(D2N)较短(47 min vs 53 min,P=0.003),但是门-球时间(即到达医院至球囊扩张时间)相似(106 min vs 108 min,P=0.932)。多因素Logistic回归分析显示,未使用EMS的独立预测因素是农村居民和家中症状发作,而应用EMS的预测因素是非前壁心肌梗死、持续胸痛、严重呼吸困难或晕厥、院前心脏骤停、Killip心功能分级> 2、收缩压<100mmHg(1 mmHg=0.133 kPa)、超重/肥胖以及至省级医院就诊。结论:中国STEMI患者应用EMS的比例仅15%左右。应用EMS的患者从症状发作到医院就诊时间较短,接受再灌注的比例较高,但门-球时间未缩短。中国应加强公众教育,鼓励胸痛患者使用EMS,以及加强EMS和医院的衔接。
文摘Background Our previous studies have demonstrated that Tongxinluo （TXL）, a traditional Chinese medicine, can protect hearts against no-reflow and reperfusion injury in a protein kinase A （PKA）-dependent manner. The present study was to investigate whether the PKA-mediated cardioprotection of TXL against no-reflow and reperfusion injury relates to the inhibition of myocardial inflammation, edema, and apoptosis. Methods In a 90-minute ischemia and 3-hour reperfusion model, minipigs were randomly assigned to sham, control, TXL （0.05 g/kg, gavaged one hour prior to ischemia）, and TXL ＋ H-89 （a PKA inhibitor, intravenously and continuously infused at 1.0 μg/kg per minute） groups. Myocardial no-reflow, necrosis, edema, and apoptosis were determined by pathological and histological studies. Myocardial activity of PKA and myeloperoxidase was measured by colorimetric method. The expression of PKA, phosphorylated cAMP response element-binding protein （p-CREB） （Ser133）, tumor necrosis factor a （TNF-a）, P-selectin, apoptotic proteins, and aquaporins was detected by Western blotting analysis. Results TXL decreased the no-reflow area by 37.4% and reduced the infarct size by 27.0% （P〈0.05）. TXL pretreatment increased the PKA activity and the expression of Ser133 p-CREB in the reflow and no-reflow myocardium （P 〈0.05）. TXL inhibited the ischemia-reperfusion-induced elevation of myeloperoxidase activities and the expression of TNF-a and P-selectin, reduced myocardial edema in the left ventricle and the reflow and no-reflow areas and the expression of aquaporin-4, -8, and -9, and decreased myocytes apoptosis by regulation of apoptotic protein expression in the reflow and no-reflow myocardium. However, addition of the PKA inhibitor H-89 counteracted these beneficial effects of TXL. Conclusion PKA-mediated cardioprotection of TXL against no-reflow and reperfusion injury relates to the inhibition of myocardial inflammation, edema, and apoptosis in the reflow and no-reflow myocardium.
基金Supported by John S Dunn Chair in Cardiology Research and Education
文摘The benefits of early perfusion in ST elevation myocardial infarctions(STEMI) are established; howeverearly perfusion of non-ST elevation myocardial infarctions has not been shown to be beneficial. In additionST elevation(STE) caused by conditions other thanacute ischemia is common. Non-ischemic STE may beconfused as STEMI, but can also mask STEMI on electrocardiogram(ECG). As a result, activating the primarypercutaneous coronary intervention(pPCI) protocooften depends on determining which ST elevation patterns reflect transmural infarction due to acute coronary artery thrombosis. Coordination of interpreting theECG in its clinical context and appropriately activatingthe pPCI protocol has proved a difficult task in borderline cases. But its importance cannot be ignored, asreflected in the 2013 American College of CardiologyFoundation/American Heart Association guidelines concerning the treatment of ST elevation myocardial infarction. Multiples strategies have been tested and studiedand are currently being further perfected. No mattethe strategy, at the heart of delivering the best care lies rapid and accurate interpretation of the ECG. Here, we present the different patterns of non-ischemic STE and methods of distinguishing between them. In writing this paper, we hope for quicker and better stratification of patients with STE on ECG, which will lead to be bet-ter outcomes.
