The mortality of acute myocardial infarction complicated with cardiogenic shock (AMI-CS) is very high, timely and effective circulatory support is essential to save the lives of patients. It is important to explore the clinical efficacy, complications and prognosis of combined auxiliary sequence of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pumps (IABP) in patients with AMI-CS.

To observe the effect of the auxiliary sequence of VA-ECMO and IABP on the therapeutic effect and prognosis of patients with AMI-CS in the combination of VA-ECMO and IABP, explore the causes and significance of changes in relevant indicators, compare the incidence of complications, analyze the factors affecting prognosis, so as to find a relatively safe and effective mechanical circulatory support (MCS) method for patients with AMI-CS.

AMI-CS patients who received VA-ECMO combined with IABP in the Department of Intensive Care Medicine of the Second Affiliated Hospital of Zhengzhou University and Fuwai Central China Cardiovascular Hospital from 2021 to 2022 were retrospectively included as the study objects, and all patients were treated with the combined auxiliary mode of VA-ECMO and IABP, and divided into the group A (IABP followed by VA-ECMO, n=42) and group B (VA-ECMO followed by IABP or VA-ECMO combined with IABP at the same time, n=40). Baseline data, clinical indicators, treatment status, related complications and prognosis before, 24 h and 72 h after combination therapy were collected by the electronic medical record system.

The results of two-factor repeated measures ANOVA showed that there were interactions of time and intergroup on mean arterial pressure (MAP), heart index (CI), arterial blood lactate (Lac), and troponin I (cTnI) (P<0.05). There was no interaction between time and groups on glomerular filtration rate (GFR) and brain natriuretic peptide (BNP) (P>0.05). The main effects of time on MAP, CI, GFR, Lac, cTnI and BNP were significant (P<0.05). The main intergroup effects on CI and GFR were significant (P<0.05) and not significant on MAP, Lac, cTnI and BNP (P>0.05). MAP, CI and GFR at 24 h and 72 h after treatment were higher than those before treatment, while Lac, cTnI and BNP were lower than those before treatment, the differences were statistically significant (P<0.05). CI at 72 h after treatment was higher than 24 h after treatment (P<0.05). Lac, cTnI and BNP at 72 h after treatment were lower than those at 24 h after treatment, the differences were statistically significant (P<0.05). MAP, CI and GFR of the group B were higher than those of group A at 24 h and 72 h after treatment, while Lac and cTnI were lower than those of group A, with significant differences (P<0.05). The proportions of norepinephrine and M-hydroxylamine use in group A were higher than group B (P<0.05). The proportion of acute kidney injury (AKI) in group A was higher than group B, with lower discharge survival rate (P<0.05) .

Compared to VA-ECMO followed by VA-ECMO, the combined auxiliary sequence of VA-ECMO followed by IABP (or the combination of ECMO and IABP at the same time) is superior in improving hemodynamics, cardiac function, renal function, and tissue perfusion levels, with less use of vasoactive drugs, lower incidence of complication of AKI, higher survival discharge rates, and improved clinical outcomes in patients with AMI-CS.

Important predictive value of platelet-lymphocyte ratio (PLR) for adverse outcomes of cardiovascular disease has been proved in previous studies, however, the predictive value of PLR for short-term prognosis in elderly patients with acute myocardial infarction (AMI) remains to be explored.

To determine the predictive ability of PLR for mortality risk during hospitalization in elderly patients with AMI.

The medical history data of 1 423 elderly patients with AMI treated in the Department of Cardiology of the Second Hospital of Dalian Medical University from December 2015 to December 2021 was retrospectively collected, mainly including gender, age, BMI, blood pressure classification, glycated hemoglobin, platelet count, neutrophil count, lymphocyte count, estimated glomerular filtration rate, lipid related indices, the combination of heart failure and diabetes, the use of statins and antiplatelet agents during hospitalization, with the final outcome defined as all-cause death during hospitalization. The included patients were divided into the non-death group (n=1 315) and death group (n=108) according to the occurrence of death. ROC curve was used to determine the predictive ability of PLR for in-hospital mortality risk in elderly patients with AMI, and the clinical application value of PLR and its combined indicators by decision curve analysis (DCA) .

There were significant differences in age, BMI, PLR, white blood cell count, neutrophil count, lymphocyte count, red blood cell count, hemoglobin, fasting blood glucose level, AST, TG, CTNI, eGFR grade, proportion of heart failure, proportion of antiplatelet drugs, and proportion of lipid-lowering drugs between the death group and the non-death group (P<0.05). The area under the ROC curve of PLR for predicting the risk of in-hospital mortality in elderly AMI patients was 0.661 (P<0.001) ; AUC when PLR was combined with CK-MB or CTNI was 0.705 and 0.779 (P<0.001), respectively. The results of decision curve analysis based on Bootstrap method showed that the risk threshold of PLR between 6% and 82% and the risk threshold of PLR combined with CTNI between 2% and 86% could produce large net benefits and have clinical application value.

PLR can effectively predict the risk of in-hospital death in elderly patients with AMI, and this predictive ability is significantly improved after combined CTNI.

Early reperfusion therapy for acute myocardial infarction (AMI) is an effective approach to reduce mortality in AMI patients. Percutaneous coronary intervention (PCI) is one of the reperfusion therapy modalities, and contrast-induced acute kidney injury (CI-AKI) after PCI has become one of the common causes of AKI.

To investigate the risk factors for the development of CI-AKI in AMI patients after PCI, establish a risk prediction model for CI-AKI based on risk factors and evaluate its validity.

The clinical data of 1 274 patients who attended the Affiliated Hospital of Xuzhou Medical University diagnosed of AMI and treated with PCI were collected consecutively from 2019 to 2021. According to the chronological order of admission, the included patients were divided into the training group (January 2019 to March 2021, 900 cases) and validation group (April 2021 to December 2021, 374 cases) in a ratio of approximately 7∶3; and divided into the CI-AKI and non-CI-AKI groups according to the diagnostic criteria of CI-AKI. Independent risk factors were screened using univariable Logistic regression analysis, Lasso regression, cross-validation, multivariable Logistic regression analysis, and a nomogram for predicting the risk of CI-AKI was plotted. Their discriminatory power, calibration ability, and clinical application value were evaluated by calculating concordance statistic (C-statistic), plotting calibration curve and decision curve.

Among the 900 patients in the training group, 109 patients (12.1%) developed CI-AKI after PCI; among the 374 patients in the validation group, 27 patients (7.2%) developed CI-AKI. Multivariable Logistic regression analysis showed that LVEF〔OR=0.903, 95%CI (0.873, 0.934) 〕, platelet distribution width〔OR=1.158, 95%CI (1.053, 1.274) 〕, MPVLR〔OR=1.047, 95%CI (1.016, 1.079) 〕, NHR〔OR=1.072, 95%CI (1.021, 1.124) 〕, Scr〔OR=1.006, 95%CI (1.002, 1.011) 〕, and diuretics〔OR=2.321, 95%CI (1.452, 3.709) 〕 were independent influencing factors for CI-AKI after PCI in AMI patients (P<0.05). A prediction model containing 6 risk factors of LVEF, platelet distribution width, MPVLR, NHR, Scr and diuretics was constructed and a nomogram for predicting the risk of CI-AKI was plotted. The C-statistic was 0.794〔95%CI (0.766, 0.820) 〕 for the training group and 0.799〔95%CI (0.774, 0.855) 〕 for the validation group, and the calibration plots showed good consistency between the predicted and actual results; the decision curve and clinical impact curve showed clinical application value of nomogram.

The CI-AKI risk prediction model including LVEF, platelet distribution width, MPVLR, NHR, Scr, and diuretics has good discrimination and accuracy, which can intuitively and independently screen high-risk population and has high predictive value for the development of CI-AKI after PCI in AMI patients.

Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been shown to have significant predictive value for cardiovascular disease in previous studies, however, whether the combination of NLR and PLR can enhance the predictive value for in-hospital mortality risk in patients with acute myocardial infarction (AMI) has not been investigated.

To investigate the combined predictive value of NLR and PLR in the short-term prognosis of AMI patients.

The case data of 3 246 AMI patients hospitalized in the Department of Cardiology of the Second Hospital of Dalian Medical University from December 2015 to December 2021 were included, with the final outcome of all-cause death during hospitalization, who were divided into in-hospital death and non-death groupsand matched 1∶1 using propensity score matching (PSM). Receiver operating characteristic (ROC) curves were plotted for the predictive value of NLR+PLR, NLR, and PLR for the risk of in-hospital death in AMI patients. In order to better evaluate the predictive value of NLR+PLR for in-hospital mortality risk in patients with different types of AMI, patients were divided into NSTEMI and STEMI groups, and the predictive values of NLR+PLR, NLR, and PLR for in-hospital mortality risk in patients with NSTEMI and STEMI groups were analyzed.

(1) Patients who died during hospitalization were matched based on PSM in a 1∶1 ratio, with 115 patients in each group. There was no significantly different in matching variables between the two groups after matching (P>0.05). (2) The area under the ROC curve of NLR + PLR for predicting the risk of in-hospital mortality in AMI patients (AUC=0.754) was greater than NLR (AUC=0.731) and PLR (AUC=0.577) (P<0.05). (3) NLR+PLR had a higher predictive ability for in-hospital mortality risk in STEMI patients (AUC=0.797) than in NSTEMI patients (AUC=0.739) .

Compared with NLR or PLR alone, the combination of NLR and PLR can better predict the risk of in-hospital mortality in AMI patients, especially with better efficacy in STEMI patients.

Dyslipidemia is closely related to the occurrence of acute myocardial infarction (AMI) and affects the prognosis of patients. Understanding blood lipid changes in patients with AMI is of great significance for improving lipid-lowering treatments for these patients.

To explore the evolution of blood lipid levels in patients with AMI during hospitalization and post-discharge follow-up.

This study consecutively selected 457 cases of AMI who were hospitalized in Department of Cardiology, Peking University People's Hospital from January 1, 2015 to February 28, 2018. They were monitored for blood lipid levels during hospitalization and the first post-discharge follow-up. The patient's medication status was recorded.

The low-density lipoprotein cholesterol (LDL-C) level in AMI patients varied statistically significantly by the measurement time point (P<0.05). Specifically, LDL-C showed a decreasing trend within 24 h after the onset of AMI, then reached (2.21±0.63) mmol/L at about 24 h after the onset, which decreased by (0.98±0.34) mmol/L on average compared with the admission level. After that, the level of LDL-C gradually stabilized. The total cholesterol (TC) level differed statistically significantly across measurement time points (P<0.05). To be specific, it decreased by an average of (1.34±0.46) mmol/L at about 24 h after the onset of the disease, and then stabilized. There were statistically significant differences in the high-density lipoprotein cholesterol (HDL-C) level of AMI patients at different time points (P<0.05). The HDL-C level of patients decreased within 12 h after onset, and then stabilized. There were statistically significant in triglyceride (TG) levels of AMI patients at different time points (P<0.05). After the onset of the disease, the TG level of the patients increased within 12 h and decreased after 24 h, and then stabilized. In terms of lipid-regulating therapy, 36.8% (168/457) of AMI patients received lipid-regulating therapy before the hospitalization. Among those who were not engaged in lipid-regulating treatment prior to hospitalization, 28.2% (129/457) had already suffered from arteriosclerotic cardiovascular disease. During the hospitalization, 99.2% (453/457) of the patients were treated with lipid-regulating therapy, mainly statins at medium doses. By one year after discharge, only 59.3% (271/457) of patients still regularly took lipid-regulating drugs. In the follow-up period after discharge, 43.7% (200/457) of patients met the standard of blood lipids.

At about 24 h after the onset of AMI, the LDL-C of AMI patients dropped to the bottom, and the trend of decline was more obvious in those who received no lipid-lowering drugs before hospitalization. The lipid-lowering treatment for them was mainly based on medium-dose statins, and the in-hospital statin usage rate reached 99.2%, but the rate of patients meeting the target LDL-C level during follow-up period was 43.7%, which may be enhanced by improving patient compliance.

Global population epidemiology research shows that by 2019, there were 1.28 billion hypertensive patients, and about 59.7 million patients with atrial fibrillation (AF) worldwide. Hypertension greatly increases the risk of AF. And in older hypertensive patients, the incidence of AF will be higher than 60%. Moreover, AF increases the risk of ischemic stroke, heart failure, myocardial infarction, chronic kidney disease and dementia. However, there are few studies on whether AF increases the risk of new-onset myocardial infarction, and whether the risk interacts with age is still unclear in large hypertensive populations.

To examine whether AF increases the risk of new-onset myocardial infarction in hypertensive patients.

Individuals with hypertension were selected as subjects from the employees of Kailuan Group who underwent the medical check-up in Tangshan Gongren Hospital and Kailuan General Hospital from June 2006 to October 2007. General data and laboratory test results of subjects were collected. And all of them were regularly followed up until 2020-12-31. The endpoint event was new-onset myocardial infarction. The finally enrolled cases (n=42 833) included 270 with AF diagnosed by baseline ECG (AF group) and 42 563 without (non-AF group) . The cumulative incidence of myocardial infarction was calculated by the life table method. The survival curve for the cumulative incidence of new-onset myocardial infarction was plotted by Kaplan-Meier method. The difference of the cumulative incidence of myocardial infarction between AF and non-AF groups was compared by Log-rank test. Multivariate Cox proportional hazards regression model was used to investigate the effect of AF on new-onset myocardial infarction in hypertension.

AF group had greater mean age, and lower mean levels of diastolic blood pressure, total cholesterol, triglyceride, low-density lipoprotein cholesterol than non-AF group (P<0.05) . There were also statistically differences in the incidence of myocardial infarction and cumulative incidence of new-onset myocardial infarction between the two groups (P<0.05) . After age-stratification, it was found that the differences in the incidence of new-onset myocardial infarction and cumulative incidence of myocardial infarction were statistically significant between those aged ≤60 years with AF and without AF (P<0.05) , but were insignificant between those aged > 60 years with and without AF (P>0.05) . Adjusted multivariate Cox proportional hazards regression analysis showed that AF was a risk factor for new-onset myocardial infarction in hypertensive population〔HR=2.89, 95%CI (1.74, 4.82) , P<0.01〕, and also in hypertensive population aged ≤60 years old〔HR=4.72, 95%CI (2.11, 10.56) , P<0.01〕.

AF is a risk factor for new-onset myocardial infarction in hypertensive population, especially in those ≤60 years old. Active control of blood pressure and treatment of AF are important prevention and treatment measures for new-onset myocardial infarction.

Culprit-only revascularization and complete revascularization are two major treatments for acute myocardial infarction (AMI) with multivessel disease. Many systematic reviews have compared the efficacy and safety of the two treatments, but the review results are inconsistent and cannot be directly applied to clinical practice.

To perform an overview of the systematic reviews of the efficacy and safety of complete revascularization versus culprit-only revascularization for AMI with multivessel disease.

PubMed, Cochrane Library, Embase and PROSPERO databases were searched from inception to February, 2022 for systematic reviews/meta-analyses about complete revascularization versus culprit-only revascularization for AMI with multivessel disease regardless of the language and status of publication. Two researchers independently evaluated the methodological quality and evidence quality of included studies using the AMSTAR 2 and GRADE, respectively.

A total of 25 systematic reviews or meta-analyses were included. The methodological quality of the included studies was generally low, with one being of high quality, two being of moderate quality, and 22 being of critical low quality. Eight outcomes and 135 evidence bodies (eight were of high quality, 17 were of moderate quality, and the rest were of low or very low quality according to the GRADE classification) were identified in the studies in total.

Compared with culprit-only revascularization, complete revascularization can partially improve clinical outcomes in patients with AMI with multivessel disease, but its safety needs to be further evaluated by high-quality, large-sample clinical studies.

Acute myocardial infarction (AMI) can be found in some patients with normal serum lipids although abnormal lipid metabolism is a major risk of AMI. The association of AMI with two unconventional lipid parameters, namely residual lipoprotein-cholesterol (RLP-C) and atherogenic index of plasma (AIP), has been studied rarely, and the predictive value of RLP-C and AIP for first-time AMI in young adults still needs to be explored.

To assess the value of RLP-C and AIP in predicting first-time AMI in young adults.

A total of 1 201 inpatients aged 18-45 years old with an initial diagnosis of coronary heart disease (CHD) were selected from Northern Jiangsu People's Hospital from November 2014 to November 2021, including 627 with first-time AMI and 574 without. General demographics, triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and other indicators were collected, and RPL-C and AIP were calculated according to the formula for statistical analysis. Logistic regression analysis was used to explore the influencing factors of first-time AMI. Receiver operating characteristic (ROC) analysis was used to evaluate the predictive value of RLP-C and AIP for first-time AMI.

CHD patients with and without first-time AMI had significant differences in male ratio, smoking history, hypertension history, and average levels of TG, TC, HDL-C, LDL-C, RLP-C and AIP (P<0.05). Multivariate Logistic regression analysis showed that smoking history〔OR=2.541, 95%CI (1.824, 3.538) 〕, TC≥5.17 mmol/L〔OR=2.787, 95%CI (1.405, 5.531) 〕, RLP-C≥0.6 mmol/L〔OR=3.786, 95%CI (2.648, 5.413) 〕 and AIP≥0.2〔OR=3.427, 95%CI (2.106, 5.576) 〕independently increased the risk for first-time AMI (P<0.05), while HDL-C≥1.19 mmol/L〔OR=0.049, 95%CI (0.025, 0.093) 〕independently decreased the risk of first-time AMI (P<0.05). In ROC analysis, the performance of RLP-C and AIP predicting first-time AMI was as follows: RLP-C had an AUC of 0.851〔95%CI (0.830, 0.873) 〕, with 0.535 mmol/L as the optimal cut-off value, 0.848 sensitivity and 0.699 specificity; AIP had an AUC of 0.813〔95%CI (0.789, 0.837) 〕, with 0.122 as the optimal cut-off value, 0.852 sensitivity and 0.660 specificity.

The risk of first-time AMI in young adults may be increased by smoking history, TC≥5.17 mmol/L, RLP-C≥0.6 mmol/L and AIP≥0.2, and decreased by HDL-C≥1.19 mmol/L. RLP-C and AIP may partially predict first-time AMI.

As one exercise program of cardiac rehabilitation, the role of high-intensity interval training (HIIT) in improving myocardial infarction is still controversial, and the mechanism is unclear.

To investigate the effect of HIIT on improving the cardiac structure and function in a rat model of myocardial infarction.

An experiment was conducted from September 2020 to October 2021. From a random sample of 78 3-month-old male SD rats, 56 were eventually included, and 14 of them were randomly selected as sham-surgery group (Sham group) , and the remaining 42 rats were equally randomized into MI-sedentary group (MI-SED group) , MI-HIIT group (MI-HIIT group) , and MI-medium-intensity continuous training (MI-MICT group) after being used for preparing a model of acute myocardial infarction (AMI) . Sham group and MI-SED group were not trained, MI-HIIT group received high-intensity and medium-intensity training alternately, MI-MICT group received medium-intensity continuous training. After 1 week of AMI modeling, MI-HIIT and MI-MICT groups received 8 weeks of training. At the end of 4 weeks of training, 7 rats in each of the 4 groups were randomly selected for detecting cardiac ultrasound, and weighing body weight, then were sacrificed, and their heart weight and serum tumor necrosis factor (TNF-α) were measured, cardiac mass index was calculated, and heart tissues were measured using H&E staining, Masson's Trichrome staining and immunohistochemical staining. At the end of 8 weeks of training, the same operation was performed on the remaining 7 rats in each of the groups.

After 4 weeks of training, the standardized cardiac mass index of MI-HIIT group was higher than that of each of the other three groups (P<0.05) . The sham group had higher ejection fraction (EF) , fractional shortening (FS) and left ventricular end-systolic posterior wall thickness (LVPWs) than MI-HIIT and MI-MICT groups (P<0.05) . MI-SED group had lower EF, FS, and LVPWs, and higher left ventricular end-systolic diameter (LVESD) than MI-HIIT and MI-MICT groups (P<0.05) . After 8 weeks of training, MI-HIIT group had lower body weight than sham and MI-SED groups, higher heart weight than sham, MI-SED and MI-MICT groups, and higher standardized cardiac mass index than sham and MI-MICT groups (P<0.05) . MI-HIIT group demonstrated higher EF, LVESD, left ventricular end-diastolic diameter (LVEDD) , left ventricular end-systolic anterior wall thickness (LVAWs) than sham and MI-SED groups (P<0.05) . Moreover, MI-HIIT group also showed higher FS and LVPWs than MI-SED group (P<0.05) . HE staining results showed that MI-HIIT group had significantly improved inflammatory changes of heart tissue and more closely arranged myocardial cells at the end of the 8th week of training compared with at the end of 4 weeks of training. Masson's Trichrome staining results showed that after 8 weeks of training, the proportion of myocardial fibrillar collagen in myocardial tissues of MI-SED group was higher than that of MI-HIIT and MI-MICT groups. Immunohistochemical results showed that MI-HIIT group had more newly formed blood vessels in cardiac tissues than sham and MI-SED groups after 4 and 8 weeks of training, so did the MI-MICT group. The number of newly formed blood vessels in cardiac tissues of MI-HIIT group was more than that in MI-MICT group after 8 weeks of training. MI-HIIT group had higher serum TNF-α than MI-SED group after 4 weeks of training. After 8 weeks of training, the serum TNF-α in MI-HIIT group was higher than that in MI-MICT group.

HIIT performed in the early stage of AMI could improve cardiac mass index, induce early inflammatory response in myocardial tissue, reduce myocardial fibrosis, promote angiogenesis and ventricular remodeling. HIIT had better overall effect than MICT.

Risk stratification for acute myocardial infarction (AMI) is important for clinical decision-making and prognosis evaluation. As changes have been found in clinical characteristics and management of AMI, the current existing clinical risk score for AMI may be inapplicable to clinical practice. To effectively implement strategies of individualized management for AMI patients, it is necessary to improve the prediction accuracy of long-term major adverse cardiovascular events (MACEs) in AMI after percutaneous coronary intervention (PCI) .

To develop a predictive model for long-term MACEs in AMI patients after PCI.

Among the 1 130 AMI patients treated with PCI in Beijing Anzhen Hospital from January 1 to July 31, 2019, 962 eligible cases were enrolled, and their clinical data and laboratory examination indices were collected. Follow-up of the patients was performed via telephone interviews at a median of 2.4 years. The primary endpoint was a composite of all-cause mortality, non-fatal myocardial infarction, non-fatal stroke, malignant arrhythmia, new heart failure or readmission due to exacerbated heart failure, and unplanned revascularization. Patients were divided into event (122 cases) and non-event (840 cases) groups according to the prevalence of MACEs during the follow-up period. Lasso regression was conducted to identify candidate risk factors of long-term MACEs. Multivariate Logistic regression analysis was used to construct the prediction model and the nomograms. The receiver operating characteristic curve was used to evaluate the discrimination ability of the prediction model. The efficacy of the predictive model was assessed by comparing with that of the Global Registry of Acute Coronary Events (GRACE) score in terms of the net reclassification improvement (NRI) and the integrated discrimination improvement (IDI) .

The prevalence of MACEs was 12.7% (122/962) . Five predictive variables were identified by Lasso regression, which included ST-segment deviation, diabetes history, hemoglobin (Hb) , left ventricular ejection fraction (LVEF) , and estimated glomerular filtration rate (eGFR) . The algorithm of the prediction model developed using multivariate Logistic regression was: logit (P) =3.596-0.023×X1-0.014×X2-0.036×X3+0.726×X4+1.372×X5 (X1-X5 indicate Hb, eGFR, LVEF, diabetes, and ST-segment deviation, respectively) . ST-segment deviation, diabetes, LVEF, and Hb were associated with MACEs in AMI patients after PCI (P<0.05) . ST-segment deviation, diabetes, eGFR and Hb were associated with MACEs in ST-segment elevation myocardial infarction (STEMI) patients after PCI (P<0.05) . ST-segment deviation, diabetes, and Hb were associated with MACEs in non-STEMI patients after PCI (P<0.05) . The prediction model exhibited an area under the curve (AUC) of 0.774〔95%CI (0.710, 0.834) 〕 for the training cohort, and an AUC of 0.751〔95%CI (0.686, 0.815) 〕for the testing cohort. The NRI estimated by the predictive model in AMI, STEMI, and non-STEMI patients was 0.493〔95%CI (0.303, 0.682) 〕, 0.459〔95%CI (0.195, 0.724) 〕, and 0.455〔95%CI (0.181, 0.728〕, respectively. The IDI estimated by the predictive model in AMI, STEMI, and non-STEMI patients was 0.055〔95%CI (0.028, 0.081) 〕, 0.042〔95%CI (0.015, 0.070〕, and 0.069〔95%CI (0.022, 0.116) 〕, respectively. The predictive efficiency of the predictive model in the three groups was significantly better than that of the GRACE score (P<0.05) . The predictive model was significantly better than the GRACE score in all participants 〔ΔAUC=0.050, P=0.015; IDI=0.055, 95%CI (0.028, 0.081) , P<0.001; NRI=0.493, 95%CI (0.303, 0.682) , P<0.001) 〕.

Our predictive model containing five factors (ST-segment deviation, diabetes, LVEF, eGFR and Hb) may be useful for early risk stratification and long-term prognosis prediction in patients with AMI after PCI.

Active and effective coping is contributive to the prevention of disease recurrence and delay the development of complications. It has been reported that more than 50% of young and middle-aged patients with acute myocardial infarction (AMI) adopt a negative response to the disease, which negatively influences their prognosis and quality of life. But the underlying personal and sociocultural factors associated with the choice of disease coping styles in this population are still unclear. Self-regulation theory has been extensively used in studies of behaviors, comprehensive intervention, and health promotion in patients with stroke, chronic heart failure, or chronic obstructive pulmonary disease. Currently, there is a lack of research on disease coping style and its influencing factors in young and middle-aged patients with first AMI using the framework of this theory.

To explore disease coping styles in young and middle-aged patients with first AMI using the four-component framework of self-regulation theory.

Purposive sampling was used to recruit young and middle-aged patients with first AMI from the First Affiliated Hospital of Jinan University from January to June 2021. They were invited to attend an individual, semi-structured interview guided using an outline determined based on our research team members and experts' consensuses on the analysis results of a relevant pre-interview. The interview was conducted till data saturation, and the interview results were analyzed using Colaizzi's phenomenological methodology.

Altogether, the study included 15 cases. Two themes arose from the results of interview with them: (1) the coexistence of positive coping (adjustment of mentality, emotional control, positive attitude towards AMI, self-motivation, lifestyle change, exploring a new way to achieve psychological balance) and negative coping (tolerance, avoidance, reluctant acceptance, submission, concealment) ; (2) influencing factors of coping styles (social support, prognosis estimation, behavioral benefit acquisition, and the powder of role models) .

Both positive and negative methods for coping with first AMI were found in the young and middle-aged patient population, and the negative coping cannot be overlooked. To improve the physical and mental recovery of these patients via reducing patients' negative coping styles and increasing their positive coping styles, medical workers should guide the patients and their families to make full use of the social support system, provide them with individualized health education and education on benefits of healthy behaviors through multiple ways, and set a good example of leadership, motivation and supervision.

Acute myocardial infarction (AMI) complicated with cardiogenic shock (CS) is a common emergency and severe disease in the department of cardiology. Timely and effective hemodynamic support is one of the important means to save the lives of such patients. Research on intraaortic balloon pumping (IABP) combined with extracorporeal membrane oxygenation (ECMO) had important clinical significance for the efficacy of these patients.

To explore the efficacy of IABP combined with ECMO in patients with AMI and CS and the inflencing factor of the need for ECMO support in patients with AMI and CS.

A total of 91 patients with AMI and CS treated with IABP in the Coronary Care Unit (CCU ward) of the First Affiliated Hospital of Zhengzhou University from October 2014 to October 2020 were collected and divided into IABP group (n=65) and IABP+ECMO group (n=26) according to the use of ECMO. The clinical data of the patients in both groups were collected and analyzed. The 12-months survival rate of patients discharged from hospital was followed up. The inflecting factors of AMI patients complicated with CS treated with IABP needed ECMO support by Multivariate logistic regression analysis.

Rate of cardiac arrest after IABP, VIS level at 24 h, survival rate at 12 months after discharge and proportion of continuous renal replacement therapy (CRRT) , tracheal intubation, pulmonary infection, lower extremity ischemia, acute kidney injury and gastrointestinal bleeding, 12-month survival rate after discharge, the use ratio of epinepHrine and norepinepHrine in IABP group were lower than those in IABP+ECMO group (P<0.05) . And the duration of CCU hospitalization in IABP group was shorter than that of IABP+ECMO group (P<0.05) . Age in IABP group was higher than that of IABP+ECMO group (P<0.05) . The results of two-factor repeated measures Anova showed that the group and time had no significant interaction effects on systolic blood pressure, diastolic blood pressure and heart rate (P>0.05) . The group and time had significant interaction effects on lactic acid and pH (P<0.05) . The main effect of time on systolic blood pressure, diastolic blood pressure, lactic acid and pH was significant (P<0.05) . The main effect of time on heart rate was not significant (P>0.05) . The main effect of group on systolic blood pressure, diastolic blood pressure, heart rate, lactic acid and pH was not significant (P>0.05) . Systolic blood pressure, pH at 24 h after treatment and 72 h after treatment were higher than that before treatment in both groups (P<0.05) . The level of lactic acid at 24 h after treatment and 72 h after treatment was lower than that before treatment in both groups (P<0.05) . Systolic blood pressure, pH at 72 h after treatment were higher than that at 24 h after treatment in both groups (P<0.05) . The level of lactic acid at 72 h after treatment was lower than that at 24 h after treatmen in both groups (P<0.05) . Systolic blood pressure of IABP+ECMO group was higher than IABP group at 72 h after treatment (P<0.05) . The diastolic blood pressure at 24 h and 72 h after treatment in the IABP group was higher than that before the machine treatment (P<0.05) . The IABP+ECMO group had a lower lactate level 24 hours after treatment than that in the IABP group, the pH value was higher than that in the IABP group (P<0.05) . Multivariate logistic regression analysis showed that age, VIS level at 24 h after treatment, and cardiac arrest after IABP could predict whether AMI patientscomplicated with CS treated with IABP needed ECMO support (P<0.05) .

IABP combined with ECMO can improve the hemodynamic indexes and survival rate of patients with AMI complicated with CS at 12 months after discharge. Age, 24 h VIS and cardiac arrest after IABP could predict whether AMI patients complicated with CS treated with IABP needed ECMO support.

There may be sex-specific differences in the treatment and outcome of elderly people with acute myocardial infarction (AMI) . However, few studies have reported sex-specific differences in management and prognosis of older Chinese people with AMI.

To assess the sex-specific differences in management strategies, in-hospital mortality and cardiovascular mortality within one year after discharge in older Chinese people with AMI.

We consecutively enrolled 1 579 elderly (>60 years of age) patients with AMI admitted to 11 tertiary general hospitals in Chengdu between January 2017 and June 2019, including 1 056 men and 523 women. Sex-specific analysis of clinical characteristics, management strategies and 1-year outcome were performed. Kaplan-Meier estimator was used to describe the incidences of cardiovascular death within one year after discharge between men and women and the associated factors were explored using multivariate Cox proportions hazards regression analysis.

Female patients had lower prevalence of smoking, and alcohol consumption, history of percutaneous coronary intervention and chronic obstructive pulmonary disease, typical symptoms including chest pain and chest tightness, and use of dual antiplatelet agents and statins, and lower mean creatinine levels than male patients (P<0.05) . Moreover, female patients had older mean age, diabetes, and higher mean heart rate, greater prevalence of Killip class≥Ⅱ, and higher mean level of total cholesterol, longer mean symptom-onset-to-balloon time and first medical contact to balloon dilation time, and higher in-hospital mortality rate (P<0.05) . Furthermore, the cardiovascular mortality rate within one year after discharge was higher in women (P<0.05) . Multivariate Cox proportions hazards regression analysis showed sex〔HR=1.830, 95%CI (1.029, 3.255) , P=0.040〕, age〔HR=1.063, 95%CI (1.031, 1.095) , P<0.001〕, ST-segment elevation myocardial infarction〔HR=2.382, 95%CI (1.380, 4.113) , P=0.002〕, cardiogenic shock〔HR=2.474, 95%CI (1.259, 4.859) , P=0.009〕, creatinine〔HR=1.004, 95%CI (1.001, 1.006) , P=0.003〕 and PCI〔HR=0.228, 95%CI (0.135, 0.386) , P<0.001〕 were associated with cardiovascular death within one year after discharge.

The rates of reperfusion treatment in older women and men with AMI were similar, but there were differences in treatment efficiency and outcome. Older women with AMI had lower in-hospital treatment efficacy, longer total myocardial ischemia time, lower prevalence of pharmacological treatment, and higher in-hospital all-cause mortality and cardiovascular mortality within one year after discharge.

Atrial fibrillation is the most obvious arrhythmia in medical practice. Atrial fibrillation has been listed as one of the eight fastest-growing causes of death since 1990. Epidemiological investigation shows that the highest incidence of atrial fibrillation is 9% in people over 65 years old and 17% in people over 80 years old; more than 60% of patients with hypertension will develop atrial fibrillation after the age of 60. Atrial fibrillation increases the risk of ischemic stroke, heart failure, chronic kidney disease, cognitive impairment and dementia, but it is unclear whether it increases the risk of new onset myocardial infarction.

To investigate whether atrial fibrillation increases the risk of new onset myocardial infarction.

From June 2006 to October 2007, 96 750 employees of Kailuan Group in Tangshan, Hebei Province (Kailuan population) were selected for the study, including 458 patients with atrial fibrillation (atrial fibrillation group) and 96 292 patients without atrial fibrillation (non atrial fibrillation group) . The general information of patients was recorded, including age, gender, personal history (smoking history, drinking history) , past medical history (hypertension, coronary heart disease, diabetes, dyslipidemia) , anthropometric parameters (weight, height, blood pressure, etc.) . Total cholesterol (TC) , triglyceride (TG) , high density lipoprotein cholesterol (HDL-C) , low density lipoprotein cholesterol (LDL-C) and fasting blood glucose (FPG) were collected. The patients were followed up every 2 years, respectively, that was from 2008 to 2009, 2010 to 2011, 2012 to 2013, 2014 to 2015, and 2016 to 2017. The median follow-up was 10 years, and the end point was new onset myocardial infarction. Multivariate Cox regression model was used to analyze the effect of atrial fibrillation on new onset myocardial infarction.

(1) There were significant differences in age, body mass index (BMI) , systolic blood pressure (SBP) , LDL-C, FPG, diabetes, smoking, drinking and new onset myocardial infarction between atrial fibrillation group and non atrial fibrillation group (P<0.05) . (2) Multivariate Cox regression analysis showed that atrial fibrillation increased the risk of new onset myocardial infarction compared with non atrial fibrillation〔RR=1.841, 95%CI (1.118, 2.869) , P<0.05〕. After adjusting for age and gender (male) , atrial fibrillation increased the risk of new onset myocardial infarction compared with non atrial fibrillation〔RR=1.635, 95%CI (1.049, 2.547) , P<0.05〕, after further adjustment for BMI, SBP, LDL-C, FPG, smoking and drinking, atrial fibrillation increased the risk of new onset myocardial infarction compared with non atrial fibrillation〔RR=1.381, 95%CI (1.087, 1.573) , P<0.05〕; drinking was the protective factor of new onset myocardial infarction 〔RR=0.664, 95%CI (0.572, 0.770) , P<0.05〕.

Atrial fibrillation is an independent risk factor of new onset myocardial infarction.