Some patients with acute ST-segment elevation myocardial infarction (STEMI) still experience major adverse cardiovascular events (MACEs) despite undergoing emergency percutaneous coronary intervention (PCI) and receiving standard secondary preventive medications. The lactate dehydrogenase-to-albumin ratio (LAR), as a prognostic marker, has shown good performance in predicting the prognosis of patients with cancer and sepsis. However, studies related to STEMI are scarce, and its predictive value for MACEs in patients with acute STEMI after PCI remains to be investigated.
To explore the correlation between LAR and the prognosis of patients with STEMI undergoing emergency PCI.
A retrospective study was conducted on 370 patients diagnosed with STEMI and undergoing emergency PCI at Subei People's Hospital from January 2021 to June 2023. Baseline data and the first fasting biochemical test results at admission were collected. The enrolled patients were followed up for one year through phone calls, outpatient visits, questionnaires, and re-admissions, with the occurrence of MACEs as the endpoint. After follow-up, patients were divided into the MACEs group (n=76) and the non-MACEs group (n=294) based on the occurrence of MACEs. Univariate and multivariate Cox proportional hazards regression models were used to analyze the factors influencing the occurrence of MACEs. Receiver operating characteristic (ROC) curves were plotted to evaluate the value of LAR in predicting MACEs, and the area under the ROC curve (AUC) was calculated. Kaplan-Meier survival curves were plotted to compare the differences in cumulative survival rates during follow-up between groups, with the Log-rank test used for intergroup comparisons.
Comparisons of baseline data between the MACEs and non-MACEs groups showed that the MACEs group had higher levels of hemoglobin, neutrophil count, low-density lipoprotein, alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), LAR, and Gensini score, as well as a lower left ventricular ejection fraction (LVEF) than the non-MACEs group (P<0.05). Multivariate Cox proportional hazards regression analysis revealed that increased AST (HR=1.001, 95%CI=1.000-1.002, P=0.007), increased Gensini score (HR=1.014, 95%CI=1.006-1.022, P<0.001), and increased LAR (HR=1.067, 95%CI=1.045-1.090, P<0.001) were risk factors for MACEs. The ROC curve analysis showed that the AUC for LAR in predicting MACEs after PCI in patients with acute STEMI was 0.804 (95%CI=0.747-0.861, P=0.001), with an optimal cut-off value of 22.58. The study population was divided into high and low LAR groups based on the optimal cut-off value calculated from the ROC curve. Kaplan-Meier survival curves were plotted, showing that the cumulative survival rate was higher in the low LAR group than in the high LAR group (P=0.01) .
There is a significant correlation between LAR levels and the occurrence of MACEs in patients with acute STEMI after PCI. Higher LAR values are associated with a higher risk of MACEs, indicating its predictive value and warranting clinical application.
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been proven to effectively improve the prognosis of patients with heart failure, chronic kidney disease, and diabetes in the context of cardiovascular-renal-endocrine coordinated management. However, the clinical benefits of SGLT2i in patients with acute myocardial infarction (AMI) remain controversial.
To investigate the impact of SGLT2i on the incidence of major cardiovascular adverse events (MACEs) in AMI patients after percutaneous coronary intervention (PCI) .
Relevant studies on the use of SGLT2i in AMI patients post-PCI were identified through a search of the PubMed, Web of Science, and Embase databases. Two researchers independently screened the studies, extracted data, and assessed the risk of bias. Meta-analysis was conducted using STATA 16.0 software.
A total of 8 studies involving 16 643 AMI patients were included in this analysis. Compared to conventional secondary prevention after PCI, the addition of SGLT2i did not reduce the all-cause mortality (OR=0.88, 95%CI=0.61-1.29, P=0.052), cardiovascular mortality (OR=1.04, 95%CI=0.83-1.30, P=0.735), all-cause readmission rate (OR=1.00, 95%CI=0.91-1.14, P=0.952), or the incidence of revascularization (OR=0.87, 95%CI=0.58-1.30, P=0.486). However, it significantly reduced the rate of heart failure-related readmission in AMI patients (OR=0.71, 95%CI=0.60-0.83, P<0.01) and did not increase the incidence of severe drug-related adverse reactions (OR=0.99, 95%CI=0.91-1.09, P=0.903) .
The addition of SGLT2i can safely and effectively reduce the incidence of heart failure-related readmission in AMI patients post-PCI. However, its impact on other MACEs still requires further high-quality randomized controlled trials for validation.
Previous studies have found that increased neutrophil and monocyte counts and decreased high-density lipoprotein cholesterol are associated with ST-segment elevation myocardial infarction (STEMI), however, the correlation of Neutrophil-to-lymphocyte ratio (NLR) and Monocyte count-to-high-density lipoprotein cholesterol ratio (MHR) with the occurrence of contrast nephropathy (CIN) in emergency percutaneous coronary intervention (PCI) has been less well studied.
To investigate the predictive value of NLR, MHR, and the combination of both on CIN after emergency PCI in STEMI patients.
437 STEMI patients who underwent emergency PCI at Northern Jiangsu People's Hospital Affilated to Yangzhou University from 2019 to 2022 were selected for the study, and the enrolled patients were divided into the CIN group (65 patients) and the non-CIN group (372 patients) according to whether they developed CIN after surgery. The general data and laboratory examination indexes of patients were collected, the values of NLR and MHR were calculated, and the clinical data of patients in the 2 groups were compared. Univariate and multivariate Logistic regression analyses were used to screen the independent risk factors for the development of CIN after PCI in STEMI patients. The working characteristics (ROC) curves of subjects with NLR, MHR and both in combination were plotted to predict the occurrence of CIN after PCI in STEMI patients, and the area under the ROC curve (AUC) was calculated to assess the predictive efficacy of NLR, MHR and both in combination for the occurrence of CIN.
Patients in the CIN group had higher levels of history of type 2 diabetes, diuretic use, leukocyte counts, neutrophil counts, monocyte counts, fasting glucose, NLR, and MHR than those in the non-CIN group, and lower levels of hemoglobin, lymphocyte counts, and creatinine than those in the non-CIN group (P<0.05). The results of multivariate Logistic regression analysis showed that the history of type 2 diabetes (OR=1.997, 95%CI=1.063-3.751, P=0.032), monocyte count (OR=2.372, 95%CI=1.060-5.310, P=0.036), NLR (OR=1.311, 95%CI=1.171-1.468, P<0.001), and elevated levels of MHR (OR=7.075, 95%CI=1.893-26.439, P=0.004) as independent risk factors for postoperative CIN after emergency PCI in patients with STEMI. The results of the ROC curves showed that the NLR, MHR, and the combination of the two predicted postoperative CIN after emergency PCI in patients with STEMI with an AUC were 0.733 (95%CI=0.669-0.796, P<0.001), 0.706 (95%CI=0.633-0.779, P<0.001), and 0.796 (95%CI=0.740-0.852, P<0.001), respectively; and the sensitivities were 66.2%, 60.0%, and 69.2%, respectively; The specificity was 71.8%, 75.3%, and 73.1%, respectively.
History of type 2 diabetes, elevated monocyte count, NLR, and MHR levels are independent risk factors for the development of CIN after emergency PCI in STEMI patients; NLR, MHR, and the combination of both can be used as early biomarkers to effectively identify the development of CIN after emergency PCI in STEMI patients.
In clinical practice, some primary hospitals lack the facilities to perform percutaneous coronary intervention (PCI). For patients with acute myocardial infarction (AMI), direct PCI is often challenging. Cardiopulmonary resuscitation (CPR) is considered a relative contraindication for thrombolytic therapy. Whether thrombolysis should be administered to AMI patients who experience cardiac arrest remains controversial.
To investigate the clinical efficacy, feasibility, and necessity of recombinant human pro-urokinase thrombolysis after CPR in AMI patients with cardiac arrest.
We retrospectively analyzed 117 patients with AMI and cardiac arrest who underwent CPR and were admitted to the emergency departments of the Second Hospital of Hebei Medical University, Ningjin County Hospital of Hebei Province, Xinle People's Hospital of Shijiazhuang, and Fengrun District People's Hospital of Tangshan from February 2015 to December 2021. Patients were divided into two groups based on the treatment received: the non-thrombolytic group (17 patients) and the thrombolytic group (100 patients). The non-thrombolytic group received comprehensive supportive treatment, including respiratory and circulatory support, anticoagulation, vasodilation, antiarrhythmia, and anti-shock therapies. The thrombolytic group received recombinant human pro-urokinase thrombolysis in addition to the treatments provided to the non-thrombolytic group. All thrombolytic treatments were administered within the therapeutic time window. Clinical data and outcomes were collected from the electronic medical record system and compared between the two groups.
All 17 patients in the non-thrombolytic group died despite resuscitation efforts. In the thrombolytic group, 15 patients (15.0%) died, while 85 patients (85.0%) survived. Among the 85 surviving patients, 17 did not undergo PCI or were evaluated with enhanced CT scans and were discharged after medical treatment. Nineteen patients underwent PCI, and no thrombi or vascular occlusions were found in the coronary arteries on imaging, thus no stents were implanted. Forty-six patients underwent PCI and were found to have significant stenosis in the vascular lumen, requiring stent implantation to dilate the vessels. Three patients in the thrombolytic group experienced thrombolysis-related complications, all of which were gingival bleeding, with no gastrointestinal bleeding or intracranial hemorrhage observed.
Intravenous thrombolysis with recombinant human pro-urokinase after CPR in AMI patients with cardiac arrest is associated with better outcomes compared to non-thrombolytic treatment. For hospitals without PCI facilities, intravenous thrombolysis remains a preferred treatment option for AMI patients with cardiac arrest following CPR.
