Background: Approximately 70% patients with acute myocardial infarction (AMI) presented without ST-segment elevation on electrocardiogram. Patients with non-ST segment elevation myocardial infarction (NSTEMI) often pr...Background: Approximately 70% patients with acute myocardial infarction (AMI) presented without ST-segment elevation on electrocardiogram. Patients with non-ST segment elevation myocardial infarction (NSTEMI) often presented with atypical symptoms, which may be related to pre-hospital delay and increased risk of mortality. However, up to date few studies reported detailed symptomatology of NSTEMI, particularly among Asian patients. The objective of this study was to describe and compare symptoms and presenting characteristics of NSTEMI vs. STEMI patients. Methods: We enrolled 21,994 patients diagnosed with AMI from China Acute Myocardial Infarction (CAMI) Registry between January 2013 and September 2014. Patients were divided into 2 groups according to ST-segment elevation: ST-segment elevation (STEMI) group and NSTEMI group. We extracted data on patients' characteristics and detailed symptomatology and compared these variables between two groups. Results: Compared with patients with STEMI (N=16,315), those with NSTEMI (N=5679) were older, more often females and more often have comorbidities. Patients with NSTEMI were less likely to present with persistent chest pain (54.3% vs.71.4%), diaphoresis (48.6% vs.70.0%), radiation pain (26.4% vs.33.8%), and more likely to have chest distress (42.4% vs.38.3%) than STEMI patients (all P<0.0001). Patients with NSTEMI were also had longer time to hospital. In multivariable analysis, NSTEMI was independent predictor of presentation without chest pain (odds ratio: 1.974, 95% confidence interval:1.849-2.107). Conclusions: Patients with NSTEMI were more likely to present with chest distress and pre-hospital patient delay compared with patients with STEMI. It is necessary for both clinicians and patients to learn more about atypical symptoms of NSTEMI in order to rapidly recognize myocardial infarction.展开更多
Background：There remains significant debate as to the relationship between fragmented QRS （fQRS） complexes on electrocardiogram （ECG） and acute myocardial infarction （AMI）.Few studies have reported on this rela...Background：There remains significant debate as to the relationship between fragmented QRS （fQRS） complexes on electrocardiogram （ECG） and acute myocardial infarction （AMI）.Few studies have reported on this relationship in non-ST elevated AMI （NSTEMI）,and thus,we attempt to assess this relationship and its potential short-term prognostic value.Methods：This was a single-center,observational,retrospective cohort study.A total of 513 consecutive patients （399 men,114 women） with NSTEMI within 24 h who underwent coronary angiography at our department,between January 1,2014,and December 31,2014.Patients were divided into 2 groups according to the presence or absence of fQRS complex on the admission ECG.fQRS complexes were defined as the existence of an additional R＇ or crochetage wave,notching in the nadir of the S wave,RS fragmentation,or QS complexes on 2 contiguous leads.All patients were followed up for 6 months,and all major adverse cardiac events （MACE） were recorded.Results：In this study,there were 285 patients with fQRS ECG in the 513 patients with NSTEMI.The number of patients with 0-2 coronary arteries narrowed by ≥50% in fQRS group were less while patients with 3 narrowed arteries were more than in the non-fQRS group （P =0.042）.There were fewer Killip Class Ⅰ patients in the fQRS group （P =0.019）,while Killip Class Ⅱ,Ⅲ,and Ⅳ patients were more in the fQRS group than in the non-fQRS group （P =0.019）.Left ventricular ejection fraction levels were significantly lower in the fQRS group （P =0.021）.Baseline total cholesterol,low-density lipoprotein,creatinine,creatine kinase,homocysteine,high-sensitivity C-reactive protein （CRP）,and red blood cells distribution width levels were significantly higher in the fQRS group.Total MACE （MACE,P =0.028）,revascularization （P =0.005）,and recurrent angina （P =0.005） were also significantly greater in the fQRS group.On final logistic regression analysis,after adjusting for baseline variables,the following展开更多
BACKGROUND Cardiac injury may occur after acute pathology of central nervous system(CNS)without any evidence of primary cardiac diseases.The resulting structural and/or functional changes are called cerebrocardiac syn...BACKGROUND Cardiac injury may occur after acute pathology of central nervous system(CNS)without any evidence of primary cardiac diseases.The resulting structural and/or functional changes are called cerebrocardiac syndrome(CCS).The great majority of studies have been performed in patients with subarachnoid hemorrhage(SAH),while CCS data after intracerebral hemorrhage(ICH)are rare.It may cause diagnostic and therapeutic pitfalls for the clinician due to a lack of specific clinical manifestations and diagnostic methods.Understanding the underlying pathophysiological and molecular mechanism(s)following cerebrovascular incidents will help to implement prevention and treatment strategies to improve the prognosis.CASE SUMMARY A 37-year-old man with a history of hypertension presented to our department on an emergency basis because of a sudden dizziness and left limb weakness.Cerebral computed tomography(CT)suggested ICH in the occipital and parietal lobes,and the chosen emergency treatment was hematoma evacuation.Left ventricular(LV)dysfunction occurred after the next 48 h and the electrocardiogram(ECG)showed non-ST elevation myocardial infarction.CCS was suspected first in the context of ICH due to the negative result of the coronary CT angiogram.CONCLUSION Misinterpretation of ischemic-like ECGs may lead to unnecessary or hazardous interventions and cause undue delay of rehabilitation after stroke.Our objective is to highlight the clinical implications of CCS and we hope the differential diagnoses will be considered in patients with acute CNS diseases.展开更多
BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular ...BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular free wall rupture(FWR)occurs in approximately 2%of AMI patients and is notably rare in patients with non-STEMI.Types of cardiac rupture include left ventricular FWR,ventricular septal rupture,and papillary muscle rupture.The FWR usually leads to acute cardiac tamponade or electromechanical dissociation,where standard resuscitation efforts may not be effective.Ventricular septal rupture and papillary muscle rupture often result in refractory heart failure,with mortality rates over 50%,even with surgical or percutaneous repair options.CASE SUMMARY We present a rare case of an acute non-STEMI patient who suffered sudden FWR causing cardiac tamponade and loss of consciousness immediate before undergoing coronary angiography.Prompt resuscitation and emergency open-heart repair along with coronary artery bypass grafting resulted in successful patient recovery.CONCLUSION This case emphasizes the risks of AMI complications,shares a successful treatment scenario,and discusses measures to prevent such complications.展开更多
BACKGROUND GRACE and SYNTAX scores are important tools to assess prognosis in non-STelevation acute coronary syndrome(NSTE-ACS).However,there have been few studies on their value in patients receiving different types ...BACKGROUND GRACE and SYNTAX scores are important tools to assess prognosis in non-STelevation acute coronary syndrome(NSTE-ACS).However,there have been few studies on their value in patients receiving different types of therapies.AIM To explore the value of GRACE and SYNTAX scores in predicting the prognosis of patients with NSTE-ACS receiving different types of therapies.METHODS The data of 386 patients with NSTE-ACS were retrospectively analyzed and categorized into different groups.A total of 195 patients who received agents alone comprised the medication group,156 who received medical therapy combined with stents comprised the stent group,and 35 patients who were given agents and underwent coronary artery bypass grafting(CABG)comprised the CABG group.General information was compared among the three groups.GRACE and SYNTAX scores were calculated.The association between the relationship between GRACE and SYNTAX scores and the occurrence of major adverse cardiovascular events(MACEs)was analyzed.Pearson’s correlation analysis was used to determine the factors influencing prognosis in patients with NSTE-ACS.Univariate and multivariate analyses were conducted to analyze the predictive value of GRACE and SYNTAX scores for predicting prognosis in patients with NSTE-ACS using the Cox proportional-hazards model.RESULTS The incidence of MACE increased with the elevation of GRACE and SYNTAX scores(all P<0.05).The incidence of MACE was 18.5%,36.5%,and 42.9%in the medication group,stent group,and CABG group,respectively.By comparison,the incidence of MACE was significantly lower in the medication group than in the stent and CABG groups(all P<0.05).The incidence of MACE was 6.2%,28.0%and 40.0%in patients with a low GRACE score in the medication group,stent group,and CABG group,respectively(P<0.05).The incidence of MACE was 31.0%,30.3%and 42.9%in patients with a medium GRACE score in the medication group,stent group,and CABG group,respectively(P>0.05).The incidence of MACE was 16.9%,46.2%,and 43.8%in patients with a high G展开更多
BackgroundFew studies have compared change in the health-related quality of life （HRQL） following treatment of non-ST-elevation acute coronary syndrome （NSTE-ACS） with either percutaneous coronary intervention （...BackgroundFew studies have compared change in the health-related quality of life （HRQL） following treatment of non-ST-elevation acute coronary syndrome （NSTE-ACS） with either percutaneous coronary intervention （PCI） or coronary artery bypass grafting （CABG）. This study is tocompare changes in HRQL six months after hospital discharge between NSTE-ACS pa-tients who underwent either PCI or CABG.Methods HRQL was assessed using the Seattle angina questionnaire at admission and six months after discharge in 1012 consecutive patients with NSTE-ACS. To assess associations of PCI and CABG with HRQL changes, logistic regression models were constructed treating changes in the score of each dimension of the Seattle angina question-naire as dependent variables.Results Although both the PCI and CABG groups experienced angina relief and other improvements at 6-month follow-up （P〈0.001）, the CABG relative to PCI group showed more significant improvements in angina frequency （P= 0.044） and quality of life （P= 0.028）. In multivariable logistic analysis, CABG also was an independent predictor for both im-provement of angina frequency （OR： 1.62, 95%CI： 1.09-4.63,P= 0.042） and quality of life （OR： 2.04, 95%CI： 1.26-6.92,P= 0.038） relative to PCI.Conclusions In patients with NSTE-ACS, both PCI and CABG provide great improvement in disease-specific health status at six months, with that of CABG being more prominent in terms of angina frequency and quality of life.展开更多
Background Antithrombotic and antiplatelet therapies have been proposed to treat non-ST elevation acute coronary syndrome （NSTEACS）, yet limited information is available about their applications from a multicenter ...Background Antithrombotic and antiplatelet therapies have been proposed to treat non-ST elevation acute coronary syndrome （NSTEACS）, yet limited information is available about their applications from a multicenter ＂real-world＂ clinical procedure, especially in China. This study was undertaken to characterize the use of antithrombotic and antiplatelet agents in relation to the risk levels of the NSTEACS patients who were enrolled in Sino-Global Registry of Acute Coronary Events （GRACEs） registry study. Methods We analyzed the data from 618 Chinese NSTEACS patients stratified into low-（n=151）, intermediate-（n=233）, and high-risk groups （n=-234） based on GRACE risk scores. The baseline characteristics, clinical presentations, antithrombotic and antiplatelet agents were recorded and compared among the three groups. Results The administration rates of low-molecular-weight heparins （LMWHs） （86.08%） and thienopyridines （85.92%） were higher whereas the administration rate of glycoprotein Ⅱb/Ⅲa inhibitor （1.78%） was much lower than those reported previously. Meanwhile, within the first 24 hours of admission, the use of heparin/LMWHs in the high-risk group was more than that in the intermediate- and low-risk groups （73.50% vs 63.09% vs 55.63%, P=0.001）. Furthermore, the combination of antithrombotic and antiplatelet medications showed no significant differences in all groups. Conclusions In the ＂real world＂ practice of China, the antithrombotic and antiplatelet therapies on NSTEACS are well adherent to the current guidelines except for several gaps, such as the very low use of glycoprotein Ⅱb/Ⅲa inhibitor. Moreover, these antithrombotic and antiplatelet treatments usually tend to be underused for the high-risk ones.展开更多
<strong>Background: </strong><span style="font-family:;" "=""><span style="font-family:Verdana;">The diagnosis of Non-ST Elevated Myocardial Infarction (NSTEM...<strong>Background: </strong><span style="font-family:;" "=""><span style="font-family:Verdana;">The diagnosis of Non-ST Elevated Myocardial Infarction (NSTEMI) is dependent on elevation of high sensitivity troponin (Hs-troponin). The current cutoff point for Hs-troponin is highly sensitive but not specific for obstructive coronary artery disease (CAD). This study aims to determine the best cutoff point for diagnosing CAD in patients presented with NSTEMI. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">Our study included all patients admitted as NSTEMI that underwent coronary angiography (CAG). They were grouped into two groups</span></span><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> A and B. Group A has obstructive CAD of 70% or more stenosis and group B with non-obstructive CAD. Patients were assessed for their demographics, clinical history, laboratory and imaging results. Using SPSS version 22, the pooled cohort of patients were analyzed at significant level <</span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.05 and the data were tested for significant correlations between two predetermined groups. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Group A comprised 87.6% of the patients and both groups had a median age of 53 years. In Group A, 91% were males, 54% diabetics, 54% hypertensives, and median Hs-troponin was 145 ng/L. While in group B, 88% were males, 39% diabetics, 60% hypertensives, and median Hs-troponin was 54 ng/L. There was significant correlation between the two groups in the percentage of diabetes and median troponin level (p < 0.05). A ROC curve has identified a level of 127 ng/dL as the best cutoff of Hs-troponin in detecting obstructive CAD (p = 0.03). Interestingly, 60% of patients in group B had alternative diagnoses. </span><b><span style="font-family:Verdana;">Conclusion: </span展开更多
Coronary ostial stenosis after surgical aortic valve replacement (SAVR) is a rare but potentially fatal complication. Surgeons must have a high level of vigilance regarding the presentation of acute myocardial ischemi...Coronary ostial stenosis after surgical aortic valve replacement (SAVR) is a rare but potentially fatal complication. Surgeons must have a high level of vigilance regarding the presentation of acute myocardial ischemia, arrhythmia, and heart failure after AVR. According to most reports, this event can be time-dependent divided into two groups;early acute phase that mostly happens intraoperative during weaning of CPB or in early ICU stay, and late presentation usually appears 1 - 6 months post surgery. Here, we describe an unusual subacute presentation of right coronary ostial stenosis 12 days after SAVR, which was treated successfully with redo beating heart coronary artery bypass grafting (CABG).展开更多
Objectives To analyze the clinical characteristics of 216 patients with non-ST segment elevation myocardial infarction （NSTEMI）. Methods A retrospective analysis was used. Two hundred and sixteen NSTEMI patients wer...Objectives To analyze the clinical characteristics of 216 patients with non-ST segment elevation myocardial infarction （NSTEMI）. Methods A retrospective analysis was used. Two hundred and sixteen NSTEMI patients were divided into two groups： （1） according to the age： age 〈65 years group and age ≥65 years group; （2） according to thrombolysis in myocardial ischemia trial （TIMI） lib risk stratification scoring system： score 〈4 group and ≥4 group; （3） according to serum creatinine （sCr） level： sCr level ≤ 178 μmol · L^-1 group and 〉 178 μmol · L^-1 group. Seven hundred and eighty six acute myocardial infarction （AMI） patients during the same period were divided into ST segment elevation myocardial infarction （STEMI） group and NSTEMI group. Clinical characteristics of the patients in the two groups were compared. Results （1） The number of NSTEMI patients in age ≥65 years group is significantly greater than that in age 〈 65 years group. Study revealed that the patients in age ≥ 65 years group were without chest pain, had hypertension, dyslipidemia, atrial fibrillation, cardiac and renal dysfunction （sCr 〉 178 μmol· L^-1 ）and triple vessel disease. Fewer patients in this group received coronary artery angiography （CAG）, percutaneous coronary intervention （PCI） and coronary artery bypass graft （CABG）. More number of deaths in this group compared with the age 〈 65 years group. （2） The number of NSTEMI patients in TIMI score 〉 4 group is significantly greater than that in TIMI score 〈 4 group. Four major complications such as acute left ventricular failure, cardiogenic shock, serious arrhythmia and deaths, increased significantly in TIMI score 〉 4 group comparing with TIMI score ≤〈4 group. （3） Obviously, more number of elderly patients, non-insulin dependant diabetes mellitus （NIDDM）, patients with cardiac troponin T （CTnT） 〉3.0 ng· L^-1 and deaths occurred in sCr 〉 178 μmol · L^-1 group.（4） STEMI a展开更多
Acupuncture anesthesia is a technique by partially or completely replacing anesthetics with acupuncture in surgery based on the traditional acupuncture analgesia mechanism.It emerged in the 1950s,went viral in the 197...Acupuncture anesthesia is a technique by partially or completely replacing anesthetics with acupuncture in surgery based on the traditional acupuncture analgesia mechanism.It emerged in the 1950s,went viral in the 1970s and then gradually fell into decline.In the recent years,this technique has regained attention and further research.Acupuncture anesthesia can be classified as either pure acupuncture anesthesia or acupuncture-medication combined anesthesia.To expand the application of this technique,a patient with non-ST elevation acute coronary syndrome in urgent need of percutaneous coronary intervention (PCI) received pure acupuncture anesthesia because of an allergy to lidocaine,and the operation went successfully.This is the first time that pure acupuncture anesthesia and coronary arteriography were combined,which is of great significance in further study and development of acupuncture anesthesia.展开更多
Background Whether glycated hemoglobin(HbA1c)implicates as a prognosis predictor in patients with coronary artery diseaseremains controversial. We investigated whether HbA1 c is an independent predictor of mid-term mo...Background Whether glycated hemoglobin(HbA1c)implicates as a prognosis predictor in patients with coronary artery diseaseremains controversial. We investigated whether HbA1 c is an independent predictor of mid-term mortality in non-ST segment elevation acute coronary syndrome(NSTEACS)patients undergoing percutaneous coronary intervention(PCI). Methods In a single-center study,1075 patients undergoing PCI were included. HbA1 c was measured at admission,along with other standard laboratory values. The outcome was all-cause mortality during a 1.48-year median follow-up period. Results Kaplan-Meier curve showed that HbA1c≥6.5% was associated with all-cause mortality. According to multivariate analysis(after adjusting for potential confounding factors),HbA1c≥6.5% predicted mid-term mortality(hazard ratio:2.02;95% CI:1.03-3.98;P=0.041). The other risk factors for mortality were hemoglobin,low-density lipoprotein cholesterol,and triglyceride. Conclusions InNSTEACS patients undergoing PCI,HbA1c≥6.5% is associated with mid-term mortality.展开更多
Objective To investigate the relationship between CRP, plasminogen activator inhibitor type 1 （PAI-1） levels, PAI-1 gene promoter 4G/5G polymorphism and the type of acute myocardial infarction （ST elevation myocard...Objective To investigate the relationship between CRP, plasminogen activator inhibitor type 1 （PAI-1） levels, PAI-1 gene promoter 4G/5G polymorphism and the type of acute myocardial infarction （ST elevation myocardial infarction, STEMI vs the non-ST elevation Myocardial infarction, NSTEMI）. Methods One hundred seventy-six consecutive patients with AMI were included for the study, of whom 60 had STEMI and 56 had NSTEMI, and 60 adults without cardiovascular and cerebrovascular disease were selected as controls. Blood samples were obtained from patients within 6 h of AMI and the plasma PAI-1, CRP, and the gene polymorphism were measured. Results Plasma levels of PAI- 1 and CRP were higher in AMI groups, compared those in the control group, and plasma levels of PAI-1 were significantly higher in patients with STEMI compared to those with NSTEMI （80.12ng/ml VS.73.01ng/ml, P 〈0.01）, while CRP levels were not significantly different between patient with STEMI and NSTEMI （3.87 ± 0.79 mg/ml VS.4.01 ±0.69mg/ml, P〉0.05）. PAI-1 levels presented a significant correlation with CRP levels in the NSTEMI subjects. However, PAI-1 and CRP levels could explain the lack of a significant relationship between them in control and STEMI subjects.The frequencies of 4G/4G genotype in the AMI group were higher than those in the control group and higher in patient with STEMI than in patient with NSTEMI. Plasma levels of PAI-1 in subjects with 4G/4G genotype were significantly increased as compared to those in subjects with 4G/5G and 5G/5G genotype. Conclusions Plasma PAI-1 levels were associated with different myocardial infarction type, and PAI-1 promoter 4G/5G polymorphisms and CRP may be related to plasma PAI-1 levels展开更多
文摘Background: Approximately 70% patients with acute myocardial infarction (AMI) presented without ST-segment elevation on electrocardiogram. Patients with non-ST segment elevation myocardial infarction (NSTEMI) often presented with atypical symptoms, which may be related to pre-hospital delay and increased risk of mortality. However, up to date few studies reported detailed symptomatology of NSTEMI, particularly among Asian patients. The objective of this study was to describe and compare symptoms and presenting characteristics of NSTEMI vs. STEMI patients. Methods: We enrolled 21,994 patients diagnosed with AMI from China Acute Myocardial Infarction (CAMI) Registry between January 2013 and September 2014. Patients were divided into 2 groups according to ST-segment elevation: ST-segment elevation (STEMI) group and NSTEMI group. We extracted data on patients' characteristics and detailed symptomatology and compared these variables between two groups. Results: Compared with patients with STEMI (N=16,315), those with NSTEMI (N=5679) were older, more often females and more often have comorbidities. Patients with NSTEMI were less likely to present with persistent chest pain (54.3% vs.71.4%), diaphoresis (48.6% vs.70.0%), radiation pain (26.4% vs.33.8%), and more likely to have chest distress (42.4% vs.38.3%) than STEMI patients (all P<0.0001). Patients with NSTEMI were also had longer time to hospital. In multivariable analysis, NSTEMI was independent predictor of presentation without chest pain (odds ratio: 1.974, 95% confidence interval:1.849-2.107). Conclusions: Patients with NSTEMI were more likely to present with chest distress and pre-hospital patient delay compared with patients with STEMI. It is necessary for both clinicians and patients to learn more about atypical symptoms of NSTEMI in order to rapidly recognize myocardial infarction.
文摘Background：There remains significant debate as to the relationship between fragmented QRS （fQRS） complexes on electrocardiogram （ECG） and acute myocardial infarction （AMI）.Few studies have reported on this relationship in non-ST elevated AMI （NSTEMI）,and thus,we attempt to assess this relationship and its potential short-term prognostic value.Methods：This was a single-center,observational,retrospective cohort study.A total of 513 consecutive patients （399 men,114 women） with NSTEMI within 24 h who underwent coronary angiography at our department,between January 1,2014,and December 31,2014.Patients were divided into 2 groups according to the presence or absence of fQRS complex on the admission ECG.fQRS complexes were defined as the existence of an additional R＇ or crochetage wave,notching in the nadir of the S wave,RS fragmentation,or QS complexes on 2 contiguous leads.All patients were followed up for 6 months,and all major adverse cardiac events （MACE） were recorded.Results：In this study,there were 285 patients with fQRS ECG in the 513 patients with NSTEMI.The number of patients with 0-2 coronary arteries narrowed by ≥50% in fQRS group were less while patients with 3 narrowed arteries were more than in the non-fQRS group （P =0.042）.There were fewer Killip Class Ⅰ patients in the fQRS group （P =0.019）,while Killip Class Ⅱ,Ⅲ,and Ⅳ patients were more in the fQRS group than in the non-fQRS group （P =0.019）.Left ventricular ejection fraction levels were significantly lower in the fQRS group （P =0.021）.Baseline total cholesterol,low-density lipoprotein,creatinine,creatine kinase,homocysteine,high-sensitivity C-reactive protein （CRP）,and red blood cells distribution width levels were significantly higher in the fQRS group.Total MACE （MACE,P =0.028）,revascularization （P =0.005）,and recurrent angina （P =0.005） were also significantly greater in the fQRS group.On final logistic regression analysis,after adjusting for baseline variables,the following
文摘BACKGROUND Cardiac injury may occur after acute pathology of central nervous system(CNS)without any evidence of primary cardiac diseases.The resulting structural and/or functional changes are called cerebrocardiac syndrome(CCS).The great majority of studies have been performed in patients with subarachnoid hemorrhage(SAH),while CCS data after intracerebral hemorrhage(ICH)are rare.It may cause diagnostic and therapeutic pitfalls for the clinician due to a lack of specific clinical manifestations and diagnostic methods.Understanding the underlying pathophysiological and molecular mechanism(s)following cerebrovascular incidents will help to implement prevention and treatment strategies to improve the prognosis.CASE SUMMARY A 37-year-old man with a history of hypertension presented to our department on an emergency basis because of a sudden dizziness and left limb weakness.Cerebral computed tomography(CT)suggested ICH in the occipital and parietal lobes,and the chosen emergency treatment was hematoma evacuation.Left ventricular(LV)dysfunction occurred after the next 48 h and the electrocardiogram(ECG)showed non-ST elevation myocardial infarction.CCS was suspected first in the context of ICH due to the negative result of the coronary CT angiogram.CONCLUSION Misinterpretation of ischemic-like ECGs may lead to unnecessary or hazardous interventions and cause undue delay of rehabilitation after stroke.Our objective is to highlight the clinical implications of CCS and we hope the differential diagnoses will be considered in patients with acute CNS diseases.
文摘BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular free wall rupture(FWR)occurs in approximately 2%of AMI patients and is notably rare in patients with non-STEMI.Types of cardiac rupture include left ventricular FWR,ventricular septal rupture,and papillary muscle rupture.The FWR usually leads to acute cardiac tamponade or electromechanical dissociation,where standard resuscitation efforts may not be effective.Ventricular septal rupture and papillary muscle rupture often result in refractory heart failure,with mortality rates over 50%,even with surgical or percutaneous repair options.CASE SUMMARY We present a rare case of an acute non-STEMI patient who suffered sudden FWR causing cardiac tamponade and loss of consciousness immediate before undergoing coronary angiography.Prompt resuscitation and emergency open-heart repair along with coronary artery bypass grafting resulted in successful patient recovery.CONCLUSION This case emphasizes the risks of AMI complications,shares a successful treatment scenario,and discusses measures to prevent such complications.
文摘BACKGROUND GRACE and SYNTAX scores are important tools to assess prognosis in non-STelevation acute coronary syndrome(NSTE-ACS).However,there have been few studies on their value in patients receiving different types of therapies.AIM To explore the value of GRACE and SYNTAX scores in predicting the prognosis of patients with NSTE-ACS receiving different types of therapies.METHODS The data of 386 patients with NSTE-ACS were retrospectively analyzed and categorized into different groups.A total of 195 patients who received agents alone comprised the medication group,156 who received medical therapy combined with stents comprised the stent group,and 35 patients who were given agents and underwent coronary artery bypass grafting(CABG)comprised the CABG group.General information was compared among the three groups.GRACE and SYNTAX scores were calculated.The association between the relationship between GRACE and SYNTAX scores and the occurrence of major adverse cardiovascular events(MACEs)was analyzed.Pearson’s correlation analysis was used to determine the factors influencing prognosis in patients with NSTE-ACS.Univariate and multivariate analyses were conducted to analyze the predictive value of GRACE and SYNTAX scores for predicting prognosis in patients with NSTE-ACS using the Cox proportional-hazards model.RESULTS The incidence of MACE increased with the elevation of GRACE and SYNTAX scores(all P<0.05).The incidence of MACE was 18.5%,36.5%,and 42.9%in the medication group,stent group,and CABG group,respectively.By comparison,the incidence of MACE was significantly lower in the medication group than in the stent and CABG groups(all P<0.05).The incidence of MACE was 6.2%,28.0%and 40.0%in patients with a low GRACE score in the medication group,stent group,and CABG group,respectively(P<0.05).The incidence of MACE was 31.0%,30.3%and 42.9%in patients with a medium GRACE score in the medication group,stent group,and CABG group,respectively(P>0.05).The incidence of MACE was 16.9%,46.2%,and 43.8%in patients with a high G
文摘BackgroundFew studies have compared change in the health-related quality of life （HRQL） following treatment of non-ST-elevation acute coronary syndrome （NSTE-ACS） with either percutaneous coronary intervention （PCI） or coronary artery bypass grafting （CABG）. This study is tocompare changes in HRQL six months after hospital discharge between NSTE-ACS pa-tients who underwent either PCI or CABG.Methods HRQL was assessed using the Seattle angina questionnaire at admission and six months after discharge in 1012 consecutive patients with NSTE-ACS. To assess associations of PCI and CABG with HRQL changes, logistic regression models were constructed treating changes in the score of each dimension of the Seattle angina question-naire as dependent variables.Results Although both the PCI and CABG groups experienced angina relief and other improvements at 6-month follow-up （P〈0.001）, the CABG relative to PCI group showed more significant improvements in angina frequency （P= 0.044） and quality of life （P= 0.028）. In multivariable logistic analysis, CABG also was an independent predictor for both im-provement of angina frequency （OR： 1.62, 95%CI： 1.09-4.63,P= 0.042） and quality of life （OR： 2.04, 95%CI： 1.26-6.92,P= 0.038） relative to PCI.Conclusions In patients with NSTE-ACS, both PCI and CABG provide great improvement in disease-specific health status at six months, with that of CABG being more prominent in terms of angina frequency and quality of life.
文摘Background Antithrombotic and antiplatelet therapies have been proposed to treat non-ST elevation acute coronary syndrome （NSTEACS）, yet limited information is available about their applications from a multicenter ＂real-world＂ clinical procedure, especially in China. This study was undertaken to characterize the use of antithrombotic and antiplatelet agents in relation to the risk levels of the NSTEACS patients who were enrolled in Sino-Global Registry of Acute Coronary Events （GRACEs） registry study. Methods We analyzed the data from 618 Chinese NSTEACS patients stratified into low-（n=151）, intermediate-（n=233）, and high-risk groups （n=-234） based on GRACE risk scores. The baseline characteristics, clinical presentations, antithrombotic and antiplatelet agents were recorded and compared among the three groups. Results The administration rates of low-molecular-weight heparins （LMWHs） （86.08%） and thienopyridines （85.92%） were higher whereas the administration rate of glycoprotein Ⅱb/Ⅲa inhibitor （1.78%） was much lower than those reported previously. Meanwhile, within the first 24 hours of admission, the use of heparin/LMWHs in the high-risk group was more than that in the intermediate- and low-risk groups （73.50% vs 63.09% vs 55.63%, P=0.001）. Furthermore, the combination of antithrombotic and antiplatelet medications showed no significant differences in all groups. Conclusions In the ＂real world＂ practice of China, the antithrombotic and antiplatelet therapies on NSTEACS are well adherent to the current guidelines except for several gaps, such as the very low use of glycoprotein Ⅱb/Ⅲa inhibitor. Moreover, these antithrombotic and antiplatelet treatments usually tend to be underused for the high-risk ones.
文摘<strong>Background: </strong><span style="font-family:;" "=""><span style="font-family:Verdana;">The diagnosis of Non-ST Elevated Myocardial Infarction (NSTEMI) is dependent on elevation of high sensitivity troponin (Hs-troponin). The current cutoff point for Hs-troponin is highly sensitive but not specific for obstructive coronary artery disease (CAD). This study aims to determine the best cutoff point for diagnosing CAD in patients presented with NSTEMI. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">Our study included all patients admitted as NSTEMI that underwent coronary angiography (CAG). They were grouped into two groups</span></span><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> A and B. Group A has obstructive CAD of 70% or more stenosis and group B with non-obstructive CAD. Patients were assessed for their demographics, clinical history, laboratory and imaging results. Using SPSS version 22, the pooled cohort of patients were analyzed at significant level <</span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.05 and the data were tested for significant correlations between two predetermined groups. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Group A comprised 87.6% of the patients and both groups had a median age of 53 years. In Group A, 91% were males, 54% diabetics, 54% hypertensives, and median Hs-troponin was 145 ng/L. While in group B, 88% were males, 39% diabetics, 60% hypertensives, and median Hs-troponin was 54 ng/L. There was significant correlation between the two groups in the percentage of diabetes and median troponin level (p < 0.05). A ROC curve has identified a level of 127 ng/dL as the best cutoff of Hs-troponin in detecting obstructive CAD (p = 0.03). Interestingly, 60% of patients in group B had alternative diagnoses. </span><b><span style="font-family:Verdana;">Conclusion: </span
文摘Coronary ostial stenosis after surgical aortic valve replacement (SAVR) is a rare but potentially fatal complication. Surgeons must have a high level of vigilance regarding the presentation of acute myocardial ischemia, arrhythmia, and heart failure after AVR. According to most reports, this event can be time-dependent divided into two groups;early acute phase that mostly happens intraoperative during weaning of CPB or in early ICU stay, and late presentation usually appears 1 - 6 months post surgery. Here, we describe an unusual subacute presentation of right coronary ostial stenosis 12 days after SAVR, which was treated successfully with redo beating heart coronary artery bypass grafting (CABG).
文摘Objectives To analyze the clinical characteristics of 216 patients with non-ST segment elevation myocardial infarction （NSTEMI）. Methods A retrospective analysis was used. Two hundred and sixteen NSTEMI patients were divided into two groups： （1） according to the age： age 〈65 years group and age ≥65 years group; （2） according to thrombolysis in myocardial ischemia trial （TIMI） lib risk stratification scoring system： score 〈4 group and ≥4 group; （3） according to serum creatinine （sCr） level： sCr level ≤ 178 μmol · L^-1 group and 〉 178 μmol · L^-1 group. Seven hundred and eighty six acute myocardial infarction （AMI） patients during the same period were divided into ST segment elevation myocardial infarction （STEMI） group and NSTEMI group. Clinical characteristics of the patients in the two groups were compared. Results （1） The number of NSTEMI patients in age ≥65 years group is significantly greater than that in age 〈 65 years group. Study revealed that the patients in age ≥ 65 years group were without chest pain, had hypertension, dyslipidemia, atrial fibrillation, cardiac and renal dysfunction （sCr 〉 178 μmol· L^-1 ）and triple vessel disease. Fewer patients in this group received coronary artery angiography （CAG）, percutaneous coronary intervention （PCI） and coronary artery bypass graft （CABG）. More number of deaths in this group compared with the age 〈 65 years group. （2） The number of NSTEMI patients in TIMI score 〉 4 group is significantly greater than that in TIMI score 〈 4 group. Four major complications such as acute left ventricular failure, cardiogenic shock, serious arrhythmia and deaths, increased significantly in TIMI score 〉 4 group comparing with TIMI score ≤〈4 group. （3） Obviously, more number of elderly patients, non-insulin dependant diabetes mellitus （NIDDM）, patients with cardiac troponin T （CTnT） 〉3.0 ng· L^-1 and deaths occurred in sCr 〉 178 μmol · L^-1 group.（4） STEMI a
基金National Natural Science Foundation of China(国家自然科学基金项目,81573796,81503440)%Shanghai Shenkang Hospital Development Center:Three-year Plan for Promoting Clinical Skills and Innovations in Municipal Hospitals(上海申康医院发展中心-促进市级医院临床技能与临床创新能力三年行动计划,16CR1031B)%Shanghai Clinical Cooperation Pilot Project of Chinese and Western Medicine(上海市中西医临床协作试点建设项目,ZY (2018-2020)-FWTX-1011)
文摘Acupuncture anesthesia is a technique by partially or completely replacing anesthetics with acupuncture in surgery based on the traditional acupuncture analgesia mechanism.It emerged in the 1950s,went viral in the 1970s and then gradually fell into decline.In the recent years,this technique has regained attention and further research.Acupuncture anesthesia can be classified as either pure acupuncture anesthesia or acupuncture-medication combined anesthesia.To expand the application of this technique,a patient with non-ST elevation acute coronary syndrome in urgent need of percutaneous coronary intervention (PCI) received pure acupuncture anesthesia because of an allergy to lidocaine,and the operation went successfully.This is the first time that pure acupuncture anesthesia and coronary arteriography were combined,which is of great significance in further study and development of acupuncture anesthesia.
基金supported by Medical Research Fund Project of Guangdong Province(No.C2017054)
文摘Background Whether glycated hemoglobin(HbA1c)implicates as a prognosis predictor in patients with coronary artery diseaseremains controversial. We investigated whether HbA1 c is an independent predictor of mid-term mortality in non-ST segment elevation acute coronary syndrome(NSTEACS)patients undergoing percutaneous coronary intervention(PCI). Methods In a single-center study,1075 patients undergoing PCI were included. HbA1 c was measured at admission,along with other standard laboratory values. The outcome was all-cause mortality during a 1.48-year median follow-up period. Results Kaplan-Meier curve showed that HbA1c≥6.5% was associated with all-cause mortality. According to multivariate analysis(after adjusting for potential confounding factors),HbA1c≥6.5% predicted mid-term mortality(hazard ratio:2.02;95% CI:1.03-3.98;P=0.041). The other risk factors for mortality were hemoglobin,low-density lipoprotein cholesterol,and triglyceride. Conclusions InNSTEACS patients undergoing PCI,HbA1c≥6.5% is associated with mid-term mortality.
文摘Objective To investigate the relationship between CRP, plasminogen activator inhibitor type 1 （PAI-1） levels, PAI-1 gene promoter 4G/5G polymorphism and the type of acute myocardial infarction （ST elevation myocardial infarction, STEMI vs the non-ST elevation Myocardial infarction, NSTEMI）. Methods One hundred seventy-six consecutive patients with AMI were included for the study, of whom 60 had STEMI and 56 had NSTEMI, and 60 adults without cardiovascular and cerebrovascular disease were selected as controls. Blood samples were obtained from patients within 6 h of AMI and the plasma PAI-1, CRP, and the gene polymorphism were measured. Results Plasma levels of PAI- 1 and CRP were higher in AMI groups, compared those in the control group, and plasma levels of PAI-1 were significantly higher in patients with STEMI compared to those with NSTEMI （80.12ng/ml VS.73.01ng/ml, P 〈0.01）, while CRP levels were not significantly different between patient with STEMI and NSTEMI （3.87 ± 0.79 mg/ml VS.4.01 ±0.69mg/ml, P〉0.05）. PAI-1 levels presented a significant correlation with CRP levels in the NSTEMI subjects. However, PAI-1 and CRP levels could explain the lack of a significant relationship between them in control and STEMI subjects.The frequencies of 4G/4G genotype in the AMI group were higher than those in the control group and higher in patient with STEMI than in patient with NSTEMI. Plasma levels of PAI-1 in subjects with 4G/4G genotype were significantly increased as compared to those in subjects with 4G/5G and 5G/5G genotype. Conclusions Plasma PAI-1 levels were associated with different myocardial infarction type, and PAI-1 promoter 4G/5G polymorphisms and CRP may be related to plasma PAI-1 levels
