Correlation between C-reactive Protein to Albumin Ratio and Spontaneous Recanalization of Infarct-related Arteries in Patients with Acute ST-segment Elevation Myocardial Infarction
WANG Shunli，TANG Jianmin*，WANG Fengyun，SU Dongsheng，ZHU Yinchuan，WANG Tong
Cardiovascular Department，the Second Affiliated Hospital of Zhengzhou University，Zhengzhou 450014，China
*Corresponding author:TANG Jianmin，Chief physician；E-mail:mypmedical@163.com
Abstract: Background Multiple studies reported that there is spontaneous recanalization of infarct-related arteries（IRA） in some STEMI patients before emergency PCI，which may be associated with a better outcome.So it is very important to find a simple and effective predicative index for spontaneous recanalization of IRA.At present，there are few studies on the relationship between C-reactive protein/albumin ratio （CAR） and spontaneous recanalization of IRA in patients with acute STEMI at home and abroad.Objective To investigate the predictive value of CAR for spontaneous recanalization of IRA in patients with acute STEMI.Methods A retrospective study was conducted.271 acute STEMI patients who underwent emergency PCI in the Second Affiliated Hospital of Zhengzhou University from May 2016 to February 2019 were enrolled，and divided into spontaneous recanalization group （n=56） and non-spontaneous recanalization group（n=215） by the prevalence of spontaneous recanalization of IRA found in the surgery.Clinical baseline data and laboratory results of two groups were compared.Multivariate logistic regression analysis was applied to screen the influential factors of spontaneous recanalization of IRA.The receiver operating characteristic （ROC） curve was used to evaluate the value of CAR in predicting spontaneous recanalization of IRA.Results The leucocyte count，platelet/lymphocyte ratio （PLR），neutrophil/lymphocyte ratio （NLR），monocyte/high-density lipoprotein cholesterol ratio （MHR），and CAR in the spontaneous recanalization group were all lower than those in the non-spontaneous recanalization group （P<0.05）.Multivariate Logistic regression analysis showed that leucocyte count〔OR=0.856，95%CI（0.753，0.973）〕，NLR〔OR=0.368，95%CI（0.187，0.724）〕，MHR〔OR=0.947，95%CI（0.897，0.999）〕，and CAR〔OR=0.794，95% CI（0.732，0.862）〕 were influencing factors of spontaneous recanalization of IRA.ROC curve analysis showed that the AUC of CAR for predicting spontaneous recanalization of IRA was 0.768〔95%CI（0.705，0.832）〕when the cut-off point was determined as 11.99，with 67.9% sensitivity and 79.1% specificity，respectively.Conclusion The leucocyte count，NLR，MHR and CAR may independently influence spontaneous recanalization of IRA in patients with acute STEMI，and CAR had certain value in influencing spontaneous recanalization of IRA.
Effect of Different Chest Pain Management Models on Acute ST-segment Elevation Myocardial Infarction in Tianjin：a Comparative Study
CHEN Jinyu1，ZHAO Kun2，HUO Yong3，LI Chunjie4，SUI Binyan5*
1.China Health Economics Association，Beijing 100191，China
2.China National Health Development Research Center，Beijing 100044，China
3.Department of Cardiology，Peking University First Hospital，Beijing 100034，China
4.Tianjin Chest Hospital，Tianjin 300051，China
5.School of Social Development and Public Policy，Beijing Normal University，Beijing 100875，China
*Corresponding author：SUI Binyan；E-mail：suibinyan2001@163.com
Abstract: Background Since the establishment of the first chest pain center in Tianjin in 2014，the mortality rate of acute myocardial infarction in Tianjin residents decreased for three consecutive years. Evaluating the significance of the construction of chest pain center may have important practical guidance for further establishment of high-quality and efficient healthcare delivery system. Objective To compare the effect of acute ST-segment elevation myocardial infarction（STEMI） by different chest pain management models in Tianjin，providing suggestions for improving the construction of chest pain center，and offering evidence for the promotion of management model of chest pain center. Methods From October 2014 to February 2019，8 011 STEMI patients who underwent emergency percutaneous coronary intervention（PCI） in 33 chest hospitals in Tianjin were selected. They were divided into groups A，B and C according to the chest pain management model in the hospital they visited：group A received the chest pain management without chest pain center certification（n=915），group B received the chest pain management with chest pain center certification（standard level）（n=6 981），and group C received the chest pain management with chest pain center certification（primary level）（n=115）. Symptom-to-door（S2D） time，symptom-to-first medical contact（S2FMC） time，first medical contact-to-ECG（FMC2ECG） time，first medical contact-to-balloon（FMC2B） time，and door-to-balloon（D2B） time were compared among three groups. Moreover，the prevalence rates of intensive 24-hour statins treatment，use of β-blockers，post-PCI TIMI grade 3 flow，and post-discharge combined use of drugs（dual antiplatelet drugs，statins，β-blockers，RAS blockers） were compared. Results The median time of S2D，S2FMC，FMC2ECG，FMC2B and D2B in the participants were 117（147） min，100（128） min，2（2） min，76（47） min
and 67（32） min，respectively. There were significant differences in average median FMC2ECG time，FMC2B time，D2B time，as well as the prevalence rates of intensive 24-hour statins treatment，β-blocker use，post-PCI TIMI grade 3 flow，and post-discharge combined use of drugs among the three groups（P<0.05）. Further comparison showed that the prevalence rates of average median FMC2ECG time，FMC2B time，D2B time in group B were lower than those of group A（P<0.017），and post-PCI TIMI grade 3 flow in group B was higher than that of group A（P<0.017）；the prevalence rates of intensive 24-hour statins treatment，β-blocker use and post-discharge combined use of drugs in groups B and C were higher than those of group A（P<0.017）；Group C had lower average median FMC2ECG and D2B time and higher prevalence rate of intensive 24-hour statins treatment than group B（P<0.017）. From 2017 to 2019，the yearly median D2B time in group B was shorter than group A，and the prevalence rat of yearly median D2B time<90 min in group B was greater than group A. Conclusion The standard chest pain management may significantly shorten the reperfusion time，standardize the clinical medication and improve the prognosis of acute STEMI patients，but the pre-hospital emergency time could not be shortened. It is necessary to continue to promote the construction of regional chest pain centers to save more patients.
Value of Hematological Parameters in Predicting Major Adverse Cardiovascular Events after PCI in Patients with Acute STEMI
CHEN Xinsen，SHAO Meng，ZHANG Tian，ZHANG Hongyan，MENG Youbao，HAI Hua，LI Guihua*
Department of Emergency Medicine，First Affiliated Hospital，School of Medicine，Shihezi University，Shihezi 832002，China
*Corresponding author：LI Guihua，Chief physician；E-mail：lgh169@126.com
Abstract: Background Monocyte to lymphocyte ratio（MLR），mean platelet volume to lymphocyte ratio（MPVLR），neutrophil to lymphocyte ratio（NLR） are all new markers of inflammatory response，which are related to the adverse outcomes in patients with acute ST segment elevation myocardial infarction（STEMI）.However，few studies at home and abroad have been found to explore the relationship between these hematological parameters，and the clinical value of the combination of them in predicting the prognosis of acute STEMI patients.Objective To investigate the clinical value of hematological parameters in predicting major adverse cardiovascular events（MACE） after percutaneous coronary intervention（PCI） in patients with acute STEMI.Methods A total of 524 patients who were diagnosed with acute STEMI and who underwent emergency PCI for the first time at the First Affiliated Hospital，School of Medicine，Shihezi University from August 2017 to February 2019 were enrolled.They were divided into MACE group and non-MACE group according to whether MACE occurred during the follow-up period.Baseline characteristics were collected，including age，proportions of males，smokers，diabetes，hypertension，and hyperlipidemia，Killip class of post-admission acute myocardial infarction-induced heart failure，admission GRACE score，pre-PCI clinical indicators〔fasting blood glucose，creatine kinase isoenzyme（CK-MB） peak，peak troponin T（TnT），total cholesterol，triacylglycerol，low-density lipoprotein，high-density lipoprotein，left ventricular ejection fraction，C-reactive protein（CRP），N-terminal brain natriuretic peptide precursor（NT-proBNP），white blood cell count，neutrophil count，lymphocyte count，hemoglobin，platelet count，monocyte count，MPV，MLR，MPVLR，NLR，red blood cell distribution width，platelet distribution width〕and culprit vessels detected by coronary angiography，number of stents，time from symptom onset to PCI，no-reflow prevalence，and medical treatment.Cox regression analysis was used to investigate the influencing factors of MACE in STEMI patients after PCI.The receiver operating characteristic curve was plotted to evaluate the predictive value of MLR，MPVLR and NLR，alone and in double-combination forms，for MACE after PCI in patients with acute STEMI.Results In this study，a total of 56 patients developed MACE during the follow-up period，including 23 cases of cardiogenic or all-cause death，15 cases of heart failure，7 cases of recurrent angina pectoris，5 cases of malignant arrhythmia，4 cases of recurrent myocardial infarction and 2 cases of stroke.Compared to those without MACE，MACE patients had greater mean age，higher mean admission GRACE score，peak TnT，CRP，NT-proBNP，neutrophil count，monocyte count，MPV，MLR，MPVLR，and NLR，and also a higher proportion of admission Killip class ≥Ⅱ.Moreover，MACE patients had lower levels of lymphocyte count as well as LVEF（P<0.05）.And they had a higher no-reflow prevalence（P<0.05）.Multivariate Cox regression analysis showed that lymphocyte count〔HR=0.884，95%CI（0.817，0.966），P<0.001〕，monocyte count〔HR=1.169，95%CI（1.104，1.463），P=0.009〕，MPV〔HR=1.333，95%CI（1.005，1.752），P=0.039〕，MLR〔HR=1.701，95%CI（1.332，2.172），P<0.001〕，MPVLR〔HR=1.372，95%CI（1.196，1.443），P<0.001〕and NLR〔HR=1.428，95%CI（1.037，1.576），P=0.015〕were the influencing factors of MACE in acute STEMI patients after PCI.MLR was positively correlated with NLR（rs=0.195，P<0.001） and MPVLR（rs=0.210，P<0.001）.NLR was positively correlated with MPVLR（rs=0.483，P<0.001）.MLR+NLR，MLR+MPVLR，or NLR+MPVLR was better than MLR，NLR，or MPVLR in predicting MACE after PCI in acute STEMI patients（P<0.05）.Conclusion Hematological parameters such as MLR，MPVLR，and NLR shortly after admission are related to the prognosis of acute STEMI patients.And combined application of these hematological parameters can more effectively identify high-risk patients and predict the occurrence of MACE.
Electrocardiograms with de Winter syndrome of acute ST-segment elevation myocardial infarction during the whole period of treatment
CHU Qingmin1，TANG Na2，JIN Zheng1，LI Rong1*
Department of Cardiology，the First Affiliated Hospital of Guangzhou University of Chinese Medicine，Guangzhou 510405，China 2.Baiyun District Sanyuanli Subdistrict Community Health Center，Guangzhou 510406，China *Corresponding author：LI Rong，Chief physician；E-mail：15916372@qq.com
Abstract: The de Winter electrocardiogram（ECG） pattern is considered as the ECG manifestation for acute ST-segment elevation myocardial infarction （STEMI），based on the evidence of clinical coronary angiography suggested severe proximal stenosis or complete occlusion of the anterior descending branch，and its intrinsic relationship with the typical four-stage ECG findings of STEMI is not clear.In this paper，we analyzed the changes on the ECGs with de Winter pattern of a case of acute STEMI during the whole period of treatment，and reviewed relevant studies，then assessed the relationship between acute STEMI and de Winter ECG，in order to provide new ideas for the further understanding of de Winter ECG.
Effect of Metabolic Syndrome on Long-term Prognosis of Patients with ST-segment Elevation Myocardial Infarction
CHEN Hairong*，LI Minglan，PAN Biyun，CHEN Xunchun，LU Shijuan，WANG Yanying
Department of General Medicine，Central South University Xiangya School of Medicine Affiliated Haikou Hospital，Haikou 570208，China
*Corresponding author： CHEN Hairong，Associate chief physician；E-mail： rhaichen@163.com
Abstract: Background Metabolic syndrome（MetS） is a collection of conditions，which increases the risk for cardiovascular and cerebrovascular diseases.Its influence on long-term prognosis of ST-segment elevation myocardial infarction（STEMI） patients is rarely reported.Objective To evaluate the impact of MetS on long-term prognosis of STEMI patients.Methods We enrolled 507 STEMI patients treated with PCI from Cardiovascular Department，Central South University Xiangya School of Medicine Affiliated Haikou Hospital from March 2014 to March 2015，including 217 with coexisting MetS（MetS group），and 290 without（non-MetS group）．We collected their general clinical data，and information about severity of conditions，length of stay，incidence of complications during hospitalization，pharmacological treatment within one-month follow-up，and major adverse cardiovascular events（MACE） and death within four-year follow-up.We performed a multivariate analysis of the impact of MetS on MACE and death using the Cox proportional hazard regression model.Results Both groups showed significant differences in sex ratio，mean age，prevalence of history of smoking，hypertension，diabetes，hyperlipidemia，low HDL cholesterol，central obesity，distribution of BMI，and multi-vessel lesions，as well as mean SYNTAX score（P<0.05）．Also，MetS group showed longer mean length of stay than non-MetS group （P<0.05）.At one-month follow-up，the rates of using ACEIs/ARBs，calcium channel blockers，and hypoglycemic agents in MetS group were higher than those of non-MetS group（P<0.05）．During the four-year follow-up，MetS group had higher incidence of angina pectoris，and target vessel revascularization，and lower incidence of receiving repeat PCI/coronary artery bypass grafting than no-MetS group（P<0.05）．The death rate differed significantly by the number of MetS components（P<0.05）．The incidence of MACE also varied significantly by the number of MetS components（P<0.05）．Multivariate analysis with the Cox proportional hazards regression model showed that age 〔HR=1.057，95%CI（1.022，1.090）〕，renal insufficiency 〔HR=3.025，95%CI（1.180，7.759）〕，previous myocardial infarction〔HR=2.430，95%CI（1.488，5.151）〕，left ventricular ejection fraction 〔HR=0.958，95%CI（0.923，0.995）〕，Killip class≥Ⅱ 〔HR=4.641，95%CI（2.188，9.825）〕 were independent risk factors for death in STEMI patients（P<0.05）；age 〔HR=1.029，95%CI（1.006，1.054）〕，renal insufficiency 〔HR=2.826，95%CI（1.229，6.496）〕，left ventricular ejection fraction 〔HR=0.960，95%CI（0.934，0.987）〕，SYNTAX score 〔HR=2.138，95%CI（1.281，3.567）〕，Killip class≥Ⅱ 〔HR=2.098，95%CI（1.131，3.893）〕 and MetS 〔HR=1.833，95%CI（1.162，2.896）〕were independent risk factors for MACE in STEMI patients（P<0.05）．MetS was independently associated with TVR 〔HR=2.204，95%CI（1.273，3.815），P=0.005〕.Conclusion STEMI patients with MetS had longer length of stay and higher long-term MACE incidence after PCI.MetS is not associated with long-term death of STEMI patients，but is independently associated with MACE，especially with TVR.
Application of Intra-hospital + Home-based Continuous Cardiac Rehabilitation Model in Patients with Acute Myocardial Infarction after Emergency Coronary Intervention
ZHAO Dongjing*，TANG Wei，CAO Shujun，SUN Pengyu，HU Shuoqiang，TONG Zichuan
Department of Cardiovascular Medicine，Daxing Teaching Hospital of Capital Medical University，Beijing 102600，China
*Corresponding author：ZHAO Dongjing，Attending physician；E-mail：e54zdj@qq.com
Abstract: Background At present，the participation rates of phaseⅡ outpatient cardiac rehabilitation both at home and abroad are low.Foreign studies have shown that the clinical benefits of home-based cardiac rehabilitation are equivalent to that of outpatient cardiac rehabilitation，and are reliable and safe.However，there are few researches on home-based cardiac rehabilitation in China.Objective To explore the effect of intra-hospital+home-based continuous cardiac rehabilitation model on patients with acute myocardial infarction after percutaneous coronary intervention（PCI）.Methods From June in 2018 to February in 2019，80 patients with acute myocardial infarction who were hospitalized in the Department of Cardiovascular Medicine of Daxing Teaching Hospital of Capital Medical University and underwent emergency PCI were selected as the study objects.The subjects were divided into observation group（n=40） and control group（n=40） according to the method of random number table.The observation group adopted intra-hospital+home-based continuous cardiac rehabilitation model for three months，and the control group was intervened by routine intervention for three months.The body mass index（BMI），blood pressure，total cholesterol（TC），low-density lipoprotein cholesterol（LDL-C），6-minute walk distance（6MWD），left ventricular ejection fraction（LVEF） and smoking status were compared between the two groups at admission and three months after intervention.According to the results of 6-min walk test before discharge，the patients in the observation group and the control group were divided into 6MWD≥400 m group and 6MWD<400 m group，and the 6MWD before and after the intervention was further compared between the two groups.Results There was no significant difference in blood pressure，TC，LDL-C，LVEF and BMI between the two groups at admission（P>0.05）.There was no significant difference in 6MWD between the two groups before discharge（P>0.05）.The systolic blood pressure，diastolic blood pressure，TC，LDL-C and BMI in the observation group after three months of intervention were lower than those before the intervention，6MWD in the observation group after three months of intervention was higher than those before the intervention.The TC，BMI in the control group after three months of intervention were lower than those before the intervention，6MWD in the control group were longer than those before the intervention（P<0.05）.After three months of intervention，TC，LDL-C and 6MWD in the observation group were higher than those in the control group with a statistically significant difference（P<0.05）.The difference value of TC，LDL-C，BMI and 6MWD in the observation group before and after the intervention were higher than those in the control group（P<0.05）.The rate of quitting smoking was 70.6%（24/34） in the observation group and 39.4%（13/33） in the control group after three months of intervention，and the difference was statistically significant（P=0.010）.There was no significant difference in 6MWD between 6MWD≥400 m groups in the observation group and the control group at discharge and three months after intervention（P>0.05）.The 6MWD in the two groups increased significantly after three months of intervention（P<0.05）.The 6MWD between 6MWD<400 m groups in the observation group and the control group after three months of intervention was significantly longer than that at discharge（P<0.05）.The 6MWD in the observation group was significantly longer than that in the control group after three months of intervention（P<0.05）.Conclusion The intra-hospital and home-based continuous cardiac rehabilitation model is beneficial for patients with acute myocardial infarction after PCI to control risk factors（blood pressure，blood lipid，smoking and BMI），change behavior and improve daily physical activity ability，especially for patients in the 6MWD<400 m groups.
Relationship between Acute-to-chronic Glycemic Ratio and Poor Short-term Prognosis in Patients with Acute Myocardial Infarction
DU Fawang，LI Ling，WU Qiang，CHEN Dandan，WU Yueting，WANG Jiren，CHEN Baolin*
Cardiovascular Department，Guizhou Provincial People's Hospital，Guiyang 550002，China
*Corresponding author：CHEN Baolin，Chief physician；E-mail：mymailrs@126.com
Abstract: Background Elevated levels of acute glycemia at hospital admission are common among patients with acute myocardial infarction（AMI）.It has been found that in clinical practice，AMI patients are often combined with a variety of complex clinical factors，which may cause acute hyperglycemia.Acute-to-chronic glycemic ratio may be a predictor of poor short-term prognosis in such patients，but relevant studies are still lacking in China.Objective To study the relationship between acute-to-chronic glycemic ratio and poor short-term prognosis in patients with AMI.Methods We enrolled 272 inpatients with ST-elevation and non-ST-elevation AMI from CCU，Guizhou Provincial People's Hospital between January 2017 and January 2018.The primary end point of the study was mortality within a 30-day follow-up.Venous plasma glycemia and glycosylated hemoglobin（HbA1c） levels were measured at hospital admission，then the chronic glycemia was estimated based on HbA1c，and acute-to-chronic glycemic ratio was calculated further.Factors associated with poor short-term prognosis were analyzed.The ROC curve of acute-to-chronic glycemic ratio in predicting poor short-term prognosis of AMI was plotted，and the optimal cutoff value was estimated.Kaplan-Meier method was used for survival analysis.The incidence of adverse cardiovascular events was explored by acute-to-chronic glycemic ratio.Results By the survival status，the patients were divided into the survival group（n=256） and the death group （n=16）.Multivariate Logistic regression analysis showed that Killip classⅡ-Ⅲ，three-vessel coronary artery lesions and elevated acute-to-chronic glycemic ratio were independent risk factors associated with poor short-term prognosis（OR=23.110，0.073，35.885，P<0.05）.Patients were divided into acute-to-chronic glycemic ratio >1.01 group（n=138） and≤1.01 group（n=134）by the cutoff value，and the former group had much lower short-term cumulative survival rate（90.3% vs 97.8%）（χ2=6.932，P=0.008）showed by survival analysis.Further subgroup analysis by diabetes indicated that，those without diabetes and acute-to-chronic glycemic ratio >1.01 had a significantly reduced short-term cumulative survival rate compared with those with diabetes and acute-to-chronic glycemic ratio≤1.01（92.3% vs 97.5%）（χ2=4.465，P=0.035）those with diabetes and acute-to-chronic glycemic ratio >1.01 had a significantly reduced short-term cumulative survival rate compared with those with diabetes and acute-to-chronic glycemic ratio≤1.01（86.0% vs 100.0%）（χ2=5.658，P=0.017）.Acute pulmonary edema，cardiogenic shock，atrial tachycardia，and ventricular tachycardia were significantly increased in acute-to-chronic glycemic ratio >1.01 group （P<0.05）.Conclusion Elevated acute-to-chronic glycemic ratio is an independent risk factor for poor short-term prognosis in patients with AMI，and is closely related to adverse cardiovascular events.Elevated acute-to-chronic glycemic ratio is also associated with lower short-term cumulative survival rate and poorer short-term prognosis in AMI patients with or without diabetes.Its value is more valuable to predict the poor short-term prognosis in those with diabetes.Acute-to-chronic glycemic ratio >1.01 may be used as the optimal cutoff value to predict the poor short-term prognosis of patients with AMI.Above this level，cardiovascular adverse events may increase significantly and the short-term prognosis of patients may be poor.
Analysis of the Utilization of Medical Resources in Different Treatments of Acute ST-Segment Elevation Myocardial Infarction Inpatients
CHEN Aiming1，TIAN Lin1，QIU Hengjia2，3*
1.Department of Pharmacy，the Fifth Affiliated Hospital of Sun Yat-Sen University，Zhuhai 519000，China.
2.Institute for Hospital Management，Tsinghua University，Shenzhen 518055，China
3.School of Public Health，the Johns Hopkins University，Baltimore Maryland MD4321，USA
*Corresponding author:QIU Hengjia，Professor；E-mail:chiuhc@sz.tsinghua.edu.cn
Abstract: Background In 2012，the World Health Organization announced that ischemic heart disease was the leading cause of death worldwide.In addition，it is also one of the most common causes of death in China.Acute ST-segment elevation myocardial infarction（STEMI） is one of the most common types of ischemic heart disease.Its treatment methods include traditional drug therapy and interventional therapy.However，the quantification of medical resources utilized for both therapy methods has not been elucidated，to some extent，which limits the effective allocation of medical resources.Objective To investigate the utilization of medical resources of traditional drug therapy and interventional therapy in hospitalized patients with acute STEMI and the related influencing factors.Methods Patients with acute STEMI admitted for traditional drug therapy or interventional therapy in the Fifth Affiliated Hospital of Sun Yat-Sen University from 10 October，2014 to 31 December，2016 were enrolled by retrospective analysis.The demographic information，disease and treatment characteristics of patients were captured.As traditional drug therapy and interventional therapy were the main predictors，the hospitalization days and the total hospitalization expenses were used as indicators to evaluate the utilization of medical resources and the main influencing factors were analyzed by multivariate linear regression.Results A total of 315 patients were enrolled，including 67（21.3%） patients in traditional drug therapy group and 248（78.7%） patients in interventional therapy group.There were significant differences between the two groups in age，infarct site，Killip grade，time distribution of SO-to-FMC，admission form，death，CCU or ICU occupancy，total hospitalization expenses，and western charges（P<0.05）．The multifactor linear regression results showed that females（β=4.03），the 50-59 years old（β=3.71），and interventional therapy（β=3.63） were the influencing factors of the increase of length of stay（P<0.05）．Clinical pathway（β=-3.18） and death（β=-4.87） were the influencing factors of the decrease of length of stay（P<0.05）．The 50-59 years old（β=12 483.39），medical insurance（β=7 769.88），interventional therapy（β=36 703.60），and stayed in CCU or ICU before（β=13 539.14） were the influencing factors for the increase of hospitalization expenses，while death（β=-13 347.59） was the influencing factor of the decrease of hospitalization expenses（P<0.05）．Conclusion The interventional therapy utilizes more medical resources than the traditional drug therapy.Female，the 50-59 years old，and interventional therapy are all correlated to an increased length of stay，while the implementation of clinical pathway can shorten the length of stay.The 50-59 years old，medical insurance and interventional therapy are main influencing factors of the increasing total hospitalization expenses.
Effect of the Regional Cooperative Treatment System on the Treatment Efficiency and Short-term Prognosis of Patients with Acute ST-segment Elevation Myocardial Infarction
CAO Mengzhu1，QIAO Zengyong2*
1.School of Medicine，Anhui University of Science and Technology，Huainan 232000，China
2.Department of Cardiovascular Medicine，South Campus of the Sixth People's Hospital，Shanghai Jiao Tong University，Shanghai 201400，China
*Corresponding author：QIAO Zengyong，Chief physician，Professor；E-mail：qiaozy666@sina.com
Abstract: Background Delayed treatment of acute ST-segment elevation myocardial infarction（STEMI） usually leads to prolonged total ischemia time and increased mortality.Regional cooperative rapid treatment system can shorten the treatment time of acute myocardial infarction and reduce the occurrence of adverse cardiovascular events.Objective To explore the effect of the regional cooperative treatment system on the treatment efficiency and short-term prognosis of patients with acute STEMI.Methods This study relied on the treatment data of patients with acute STEMI before and after the operation of the regional cooperative treatment system with the South Campus of the Sixth People's Hospital，Shanghai Jiao Tong University as the treatment center，and the treatment data were retrospectively analyzed.Patients who received emergency PCI therapy for acute STEMI were selected as the control group from April 2017 to March 2018（n=84），and the patients with acute STEMI from April 2018 to March 2019 were selected as the experimental group（n=122）.Patient's clinical data，from onset to the first medical contact（S-FMC） time，from first medical contact to balloon dilatation（FMC2B） time，from onset to balloon dilatation（S2B） time，from entering hospital door to balloon dilatation（D2B） time，standard-reaching rate of FMC2B time，standard-reaching rate of D2B time，whether combined with adverse cardiovascular events rate were collected and compared.Results There was no significant difference in gender，age，history of coronary heart disease，history of previous PCI，history of cerebral infarction，history of angina pectoris before infarction，history of hypertension，history of diabetes，history of smoking，BNP，blood lipid index and distribution of criminal vessels between the two groups（P>0.05）.S-FMC and FMC2B were positively correlated with S2B〔rs =0.947，95%CI（0.924，0.963），P<0.001；rs=0.496，95%CI（0.381，0.591），P<0.001〕.S-FMC，FMC2B and D2B were positively correlated with S2B in self-admission group and calling ambulance group（P<0.05），while only S-FMC and FMC2B were positively correlated with S2B in non-PCI hospital referrals（P<0.05）.The time of S-FMC，FMC2B，S2B and D2B in the experimental group were shorter than those in the control group，while the proportion of ECG transmission through WeChat was higher，and the rates of adverse cardiovascular events were lower（P<0.05）.Conclusion The regional cooperative treatment system can shorten the treatment time of acute myocardial infarction，improve the treatment efficiency，and reduce the occurrence of adverse cardiovascular events，which should be vigorously promoted.
Quality Evaluation and Content Analysis of Lifestyle and Dietary Guidelines/Consensus on Secondary Prevention of Myocardial Infarction
LI Wenjiao1，CHENG Lyu1，ZHAO Mengzhu2，RAO Chang3，JIN Changde4，JIN Yinghui5，LI Yan4*
1.Graduate College，Tianjin University of Traditional Chinese Medicine，Tianjin 301617，China
2.Department of Cardiovascular Medicine，First Teaching Hospital of Tianjin University of TCM，Tianjin 300193，China
3.Acupuncture Department，First Teaching Hospital of Tianjin University of TCM，Tianjin 300193，China
4.School of Nursing，Tianjin University of Traditional Chinese Medicine，Tianjin 301617，China
5.Center for Evidence-based and Translational Medicine，Zhongnan Hospital of Wuhan University/Center for Evidence-based and Translational Medicine，Wuhan University/Teaching and Research Section of Evidence-based Medicine and Clinical Epidemiology，Second Clinical College of Wuhan University，Wuhan 430071，China
*Corresponding author：LI Yan，Lecturer；E-mail：22019036@qq.com
Abstract: Background As an important part of secondary prevention of myocardial infarction，a healthy lifestyle and diet can effectively reduce the risk of recurrent myocardial infarction，and improve the prognosis of patients with myocardial infarction.It is necessary to summarize the high-quality evidence，so as to promote the clinical practice of secondary prevention of myocardial infarction.Objective To systematically retrieve and screen the evidence-based practice guidelines/consensus on lifestyles and dietary for secondary prevention of myocardial infarction at home and abroad and evaluate rigorously the quality of included guidelines/consensus，and to extract，analyze and summarize relevant recommendations in order to provide a theoretical basis for promoting the clinical transformation of evidence.Methods Guidelines/consensus on myocardial infarction，or guidelines/consensus on lifestyle or dietary guidelines for myocardial infarction prevention，were electronically retrieved in the website of Guidelines International Network（GIN），National Institute for Health and Care Excellence（NICE），Scottish Intercollegiate Guidelines Network（SIGN），National Guideline Clearinghouse（NGC），Australian Clinical Practice Guidelines（ACPG），New Zealand Guidelines Group（NZGG），and World Health Organization（WHO），and databases，such as PubMed，CNKI，WanFang Data，and VIP from January 1 in 2013 to December 31 in 2018，and the search was completed in June of 2019.In addition，relevant guidelines/consensus were recommended by cardiovascular experts，and the references of related guidelines/consensus were also searched to supply the guidelines/consensus.Appraisal of Guidelines for Research & Evaluation Ⅱ Instrument（AGREE Ⅱ） was used to evaluate the quality of guidelines/consensus，and then the recommendations for lifestyles and dietary were summarized.Results A total of 10 guidelines/consensus were included from the United States，the United Kingdom，Australia，New Zealand，and China.For the overall quality，one of them was grade A，seven of them were grade B，and two of them were grade C.Finally，49 items of recommendations were summarized including six parts of lifestyles in smoking cessation，alcohol control，weight management，sleep management，emotional management，and physical exercise，and dietary recommendations covering dietary habits，nutritional structure，dietary patterns and dietary goals.Conclusion The overall quality of the included guidelines/consensus is high，but the formulation and reporting process of the guidelines/consensus still needs to be further standardized.The lifestyle and dietary recommendations in guidelines/consensus for myocardial infarction cover a wide range providing evidence for clinical practice.It is recommended that clinical practice should be based on the best evidence，and clinical staff should fully integrate the research evidence into the provision of health care.After considering the promotion and hindrance of evidence application，and patient values and preferences，then the best evidence for clinical practice could be selected.The makers of guidelines/consensus should further consider the opinions of patients and other stakeholders，and then refine the recommendations in a more targeted way to ultimately improve patient outcomes.
Effect of Cilostazol on Cardiac Function in Acute Myocardial Infarction Patients with Congestive Heart Failure and Aspirin Intolerance
HE Mei1，2，LI Feng1，HU Houxiang3，LIU Fu1，2*
1. Department of Pharmacy，Affiliated Hospital of North Sichuan Medical College，Nanchong 637000，China
2. School of Pharmaceutical Sciences，North Sichan Medical College，Nanchong 637000，China
3. Department of Cardiovascular，Affiliated Hospital of North Sichan Medical College，Nanchong 637000，China
*Corresponding author：LIU Fu，Chief pharmacist；E-mail：nclf91@163.com
Abstract: Background Aspirin is the cornerstone for treating acute myocardial infarction，but about 2%-9% of patients can develop aspirin intolerance. Cilostazol may be used as an alternative to aspirin，but its cardiovascular safety is unclear. Objective To investigate the safety of cilostazol in acute myocardial infarction patients with congestive heart failure and aspirin intolerance. Methods Patients with a primary diagnosis of acute myocardial infarction and congestive heart failure who were hospitalized in three hospitals（Affiliated Hospital of North Sichan Medical College，Pengan County People's Hospital，Changan Branch，the First Affiliated Hospital of Xi'an Jiaotong University） from January 2018 to August 2019 were retrospectively included. All were treated according to the diagnosis and treatment criteria of myocardial infarction. Specifically，those with aspirin intolerance received cilostazol and clopidogrel （cases），and the other received aspirin and clopidogrel（controls），and the two groups were matched based on propensity scores in a 1∶1 ratio. Outcomes were compared between the groups in terms of 1-year cardiac death，1-year readmission for heart failure，left ventricular diastolic diameter，and ejection fraction measured by echocardiography before and after treatment. Multivariate Logistic regression analysis was used to explore factors associated with 1-year cardiac death and heart failure readmission. Results Of the 5 244 hospitalized cases in the period，3 893 who met the inclusion and exclusion criteria were finally included. After matching，the cases and controls had no statistically notable differences in left ventricular diastolic diameter，and ejection fraction（P>0.05）. But the cases had higher rates of 1-year cardiac death and heart failure readmission（P<0.05）. Multivariate Logistic regression analysis showed that NYHA class ⅢandⅣ，and combined with diabetes were associated with 1-year cardiac death （P<0.05）. NYHA class ⅢandⅣ，diabetes，and cilostazol treatment for more than 90 days were recognized as the influencing factors of heart failure readmission （P<0.05）. Conclusion It may be safe to use cilostazol in acute myocardial infarction patients with NYHA class Ⅰ and Ⅱ. Given increased safety risks，cilostazol is not recommended for those with NYHA classⅢandⅣ，and combined with diabetes. Moreover，cilostazol is not suggested to be used for more than 90 days，due to increased potential risks of heart failure readmission.
Association between Discharge Destination and Medium-term Mortality in Elderly Patients with ST-segment Elevation Myocardial Infarction
WANG Qi*，LIN Zhen，CHEN Hairong，ZHOU Yanhui
Department of General Practice，Haikou People's Hospital/Haikou Affiliated Hospital of Central South University Xiangya School of Medicine，Haikou 570100，China
*Corresponding author：WANG Qi，Associate chief physician；E-mail：wangqi8247@163.com
Abstract: Background Population ageing has led to an increase in the number of elderly patients with ST-segment elevation myocardial infarction（STEMI） receiving percutaneous coronary intervention（PCI）. Coexistence of diseases，frailty，impaired immunity，poor nutritional status and other conditions may occur in elderly patients，which may have an impact on their recovery and return to their families. There is a lack of a comprehensive assessment on the relationship between this group's discharge destination and prognosis. Objective To assess the relationship between discharge destination and medium-term mortality in 80-year-old STEMI survivors receiving PCI. Methods A retrospective analysis was conducted on STEMI patients undergoing PCI in Haikou People's Hospital from December 2015 to December 2018，with the following information collected，including general data〔age，gender，BMI，hospital stays，major medical histories （heart failure，myocardial infarction，PCI，coronary artery bypass grafting，stroke，gastrointestinal bleeding，peripheral arterial disease，dyslipidemia，diabetes，hypertension，smoking，chronic kidney disease，systolic pressure，diastolic pressure，heart rate，Killip classification），proportion of left ventricular ejection fraction（LVEF） <40%〕，laboratory findings〔hemoglobin，albumin，white blood cell count，C-reactive protein，blood glucose，peak CK during hospitalization〕，pathological features of coronary artery〔left main coronary artery（LMCA），left anterior descending artery（LADA），left circumflex artery（LCXA），right coronary artery （RCA），number of patients with 2-vessel disease and time from symptom onset to reperfusion〕，post-discharge medication （aspirin，clopidogrel or ticagrelor，warfarin，new oral anticoagulants，statins，ACEI/ARB，calcium receptor antagonist，β-receptor blocker） and severe debilitating condition. The follow-up started at discharge and ended in December 2020，with the terminal event of being all-cause death. Logistic regression analysis was used to explore the influencing factors of all-cause death. Results In all，2 450 patients completed thefollow-up，including 2 090 who were discharged to home （home discharge group） and 360 to other facilities （non-home discharge group）. During the follow-up period，370 patients（17.5%） died after discharge，and the most common cause of death was infection（21.6%，80/370），followed by sudden death（18.9%，70/370） and heart failure（16.2%，60/370）. The cardiovascular death rate of the homedischarge group was higher than that of the non-homedischarge group（P<0.05）. Two groups showed significant differences in the cumulative mortality curve（P<0.05）. Univariate Logistic regression analysis showed that non-home discharge，previous heart failure，lesions in the LADA，serum albumin <35 g/L，LVEF<40% may be the risk factors of all-cause death during follow-up （P<0.05）. Further multivariate Logistic regression analysis showed that LVEF<40%〔OR=3.161，95%CI（1.564，6.389），P=0.001〕，previous heart failure〔OR=4.899，95%CI（1.835，13.078），P=0.002〕，non-homedischarge〔OR=2.617，95%CI（1.188，5.765），P=0.049〕，lesions in the LADA〔OR=2.210，95%CI（1.137，4.295），P=0.019〕，albumin level<35 g/L〔OR=2.147，95%CI（1.064，4.330），P=0.033〕 were all risk factors of death during follow-up period. Conclusion There is a relationship between non-family discharge and an increased risk of medium-term mortalityin STEMI patients over the age of 80. Active searching for causes of non-homedischarge and early delivering targeted interventions may reduce the medium-term mortality in thesepatients.
Interventional Therapy Prevalenceand Influencing Factors in Patients Aged 75 and over with Acute Non-ST Segment Elevation Myocardial Infarction
LYU Xiao1，LI Shuren2*，SHEN Zexue1，HAO Xiao2，CHEN Jialun1，MENG Yang3，LUO Fei1，BAI Yuhao1，YUAN Zhihui3
1. Graduate School，North China University of Science and Technology，Tangshan 063210，China
2. No. 1 Cardiovascular Department，Hebei General Hospital，Shijiazhuang 050051，China
3. Graduate College，Hebei Medical University，Shijiazhuang 050017，China
*Corresponding author：LI Shuren，Professor，Chief physician，Master supervisor；E-mail：lsr64@126.com
Abstract: Background Older age is an independent risk factor of the onset and poor prognosis of acute non-ST-segment elevation myocardial infarction （NSTEMI） patients. Although older age is not alimitingfactor for reperfusion therapy theoretically，the prevalence of reperfusion therapy in Chinese older NSTEMI patients is far lower than that of those in developed countries，so it is necessary to analyze the factors associated with inability to receive reperfusion therapy in such patients. Objective To analyze the prevalence and associated factors of invasive therapy in patients aged 75 and over with NSTEMI.Methods Five hundred and thirty-sixcases with an admission diagnosis of NSTEMI were selected from Hebei General Hospital from November 2016 to August 2019. The following variables were collected，including age，sex，Killip class >Ⅱ，admission blood pressure and heart rate，medical history （including history of old myocardial infarction，PCI history，grade 2-3hypertension，diabetes，hyperlipidemia，chronic kidney disease，anemia），smoking，drinking，GRACE score，left ventricularejection fraction，white blood cell count，hemoglobin，platelet count，albumin，fasting blood glucose，serum creatinine，glomerular filtration rate，total cholesterol，triglyceride，high-density lipoprotein，low-density lipoprotein and treatment strategies. The differences between patients under 75 years of age and those aged 75 and over were compared after being matched using the propensity score. Subgroup differences were analyzed between those with interventional therapy and with conservative treatment in the 75-and-over age group. Multivariate Logistic regression analysis was used to explore the influencing factors of invasive treatment. Results After propensity-score matching，it was found that patients under 75 years of age had higher prevalence of interventional therapy （P<0.05）. Compared with conservative treatment subgroup，interventional therapy subgroup had decreased GRACE score and serum creatinine，and elevated total cholesterol and albumin（P<0.05）. Multivariate logistic regression analysis showed systolic blood pressure〔OR=1.022，95%CI（1.002，1.044），P=0.034〕，GRACE score 〔OR=1.015，95%CI（1.001，1.030），P=0.031〕，albumin level〔OR=0.86，95%CI（0.763，0.969），P=0.013〕，serum creatinine level〔OR=1.018，95%CI（1.000，1.035），P=0.044〕 were associated with interventional therapy. Conclusion The rate of interventional therapy in elderly patients（age≥75 years old）with NSTEMI is lower. The possibility of receiving invasive therapy may be increased with lower blood pressure and higher albumin，and may be reduced with higher GRACE score and serum creatinine level.
Risk Factors and Predictive Scoring System for Long-term Adverse Cardiovascular Events in Patients with Acute Non-ST Segment Elevation Myocardial Infarction
LYU Xiao 1，LI Shuren2*，LI Wenjing3，CHEN Jialun1，LIU Ran1，MENG Yang3，YUAN Zhihui3，HAO Xiao2，BAI Yuhao1，LUO Fei1
1. Graduate School，North China University of Science and Technology，Tangshan 063210，China
2. No. 1 Cardiovascular Department，Hebei General Hospital，Shijiazhuang 050051，China
3. Graduate College，Hebei Medical University，Shijiazhuang 050017，China
*Corresponding author：LI Shuren，Professor，Chief physician，Master supervisor；E-mail：lsr64@126.com
Abstract: Background The risk prediction scoring systems for acute coronary syndrome （ACS） have been extensively used for assessing the long-term prognosis of patients with acute non-ST-segment elevation myocardial infarction （NSTEMI）. Both STEMI and NSTEMI belong to ACS，but NSTEMI shows an increasing percentage in ACS，with a possible trend of exceeding the percentage of STEMI. Moreover，they have significant differences in incidence，mortality risk during the acute phase，and long-term prognosis. However，there is no literature about tools for effectively predicting long-term prognosis of patients with NSTEMI. Objective To identify the risk factors for long-term major adverse cardiovascular events（MACEs） in discharged patients with NSTEMI，and based on this，to develop a predictive scoring system. Methods Three hundred and twenty-four patients with an admission diagnosis of NSTEMI were recruited from Hebei General Hospital from January 2017 to August 2018. Clinical data were obtained，including age，sex，Killip class，systolic and diastolic blood pressure，heart rate，cardiac function at admission，past medical history（history of old myocardial infarction，PCI，coronary artery bypass grafting，thrombolysis，hypertension，diabetes，hyperlipidemia，chronic kidney disease，old cerebral infarction，cerebral hemorrhage，anemia），smoking，drinking，incidence of in-hospital heart failure，in-hospital medication，GRACE score，left ventricular ejection fraction，hemoglobin，white blood count，lymphocytes，platelet count，alanine aminotransferase，aspartate transaminase，total protein，globulin，albumin，serum creatinine，glomerular filtration rate，electrolytes，blood lipids，and treatment strategies. All cases were followed up till 2020-09-01，during which the incidence of MACEs and all-cause death were recorded. The risk factors of out-of-hospital MACEs were identified，and used to construct a predictive scoring system. Results （1） Compared with patients without MACEs，those with MACEs had older mean age，higher mean higher prevalence of grade 2-3 hypertension，in-hospital betamethasone treatment，in-hospital heart failure，and non-revascularization treatment，lower prevalence of smoking，as well as lower mean levels of glomerular filtration rate，low-density lipoprotein，lymphocyte count，and hemoglobin（P<0.05）. （2） Multivariate Logistic regression analysis showed lymphocyte count〔OR=0.621，95%CI（0.408，0.946），P=0.026〕，hemoglobin〔OR=0.983，95%CI（0.969，0.996），P=0.013〕，non-revascularization 〔OR=2.030，95%CI（1.153，3.573），P=0.014〕，and the cut-off value of total protein〔OR=2.412，95%CI（1.244，4.675），P=0.009〕were associated with out-of-hospital MACEs in NSTEMI patients.（3） A regression equation based on these risk factors of MACEs was developed：logit（P）=3.98-0.476X1-0.018X2+0.88X3+0.708X4（X1-X4 stand for lymphocyte count，hemoglobin，total protein，and non-revascularization，respectively）. Combined with the risk coefficient β of each factor，a scoring system with a total score of 21 points and a predictive threshold of 9 points was constructed，with an AUC value of 0.704. Conclusion Long-term MACEs were common in patients with acute NSTEMI，which may be associated with lymphocyte count，hemoglobin，total protein and non-revascularization. Our predictive scoring system for long-term MACEs with a total score of 21 points and a predictive threshold of 9 points，and has good predictive capability.
Predictive Value of Glycogen Protein 125 Combined with Brain-Derived Neurotrophic Factor for Acute Heart Failure in Elderly Patients with Acute Myocardial Infarction
WANG Yating1，YAO Jie1，GUAN Shihe1*，CHENG Cheng2
1.Department of Laboratory，the Second Affiliated Hospital of Anhui Medical University，Hefei 230601，China
2.Department of Cardiology，the Second Affiliated Hospital of Anhui Medical University，Hefei 230601，China
*Corresponding author：GUAN Shihe，Professor，Senior technologlist；E-mail：ypfang2003@126.com
Abstract: Background Acute myocardial infarction （AMI） is currently an important clinical cause of sudden cardiac death in patients. The occurrence of AMI in general patients can easily lead to myocardial damage，which can lead to acute heart failure （AHF）. Early diagnosis of AHF in AMI patients has positive significance for improving the prognosis of patients and reducing the risk of death. At present，the main clinical diagnosis of AHF is based on brain natriuretic peptide （BNP），but there are many related factors which can affect BNP，and when BNP reaches a diagnostically meaningful value，AHF has occurred in the patient，which may seriously affect the prognosis and survival of the patient. Therefore，a more accurate diagnosis method is needed to predict the occurrence of AHF in the early stage of AMI. Objective To explore the diagnostic value of glycogen protein 125 （CA-125） combined with brain-derived neurotrophic factor （BDNF） in predicting the occurrence of AHF in elderly patients with AMI. Methods 144 patients with AMI admitted to the Department of Cardiology of The Second Affiliated Hospital of Anhui Medical University from September 2017 to March 2020 were enrolled. The clinical data of all patients were collected at the time of admission and their fasting venous blood was drawn after admission to measure serum CA-125 and BDNF levels by an automatic immunoassay analyzer. The enrolled patients were divided into heart failure group （42 cases） and control group （102 cases） according to whether AHF occurred within 1 week after coronary reperfusion therapy. The clinical data of the two groups were compared，and the multivariate logistic regression was used to analyze the independent risk factors that affect the occurrence of AHF in AMI patients. Receiver operating characteristic （ROC） curve was drawn to analyze the predictive value of CA-125 combined with BDNF for AHF in elderly patients with AMI. Results The patients in the heart failure group had higher cardiac troponin （cTnI）. BNP，CA-125，BDNF，and higher number of diseased branches than the control group （P<0.05）. Multivariate Logistic regression analysis showed that elevated levels of BNP 〔OR=1.015，95%CI （1.003，1.026）〕，CA-125 〔OR=23.228，95%CI （4.095，131.748）〕and BDNF 〔OR=1.455，95%CI （1.148，1.845）〕 were independent risk factors for AHF in AMI patients （P<0.05）. The ROC curve shows that the area under the ROC curve of CA-125 combined with BDNF in prediction of AHF in AMI patients is higher than that of CA-125 and BDNF alone （P<0.05），with a diagnostic sensitivity of 78.57% and a specificity of 89.22%. Conclusion Monitoring serum CA-125 and BDNF levels can effectively predict the risk of AHF in elderly patients with AMI.
ST-elevation Myocardial Infarction Patients with Failed Thrombolysis with Recombinant Human Prourokinase: Clinical Characteristics and Influencing Factors of Thrombolysis Failure
WANG Yanbo，DIAO Jingchao，ZHI Wei，WANG Qing，FU Yang，JIANG Yunfa，HAO Guozhen*，FU Xianghua
No.5 Cardiovascular Department，the Second Hospital of Hebei Medical University，Shijiazhuang 050000，China
*Corresponding author：HAO Guozhen，Chief physician，Professor；E-mail：172754447@qq.com
Abstract: Background Intravenous thrombolysis is still a major reperfusion therapy for ST-segment elevation myocardial infarction（STEMI）patients in China's rural primary care，but some patients have failed recanalization after using thrombolysis with recombinant human prourokinase（RHP）.Objective To analyze the clinical characteristics of patients with STEMI with failed thrombolysis with RHP and influencing factors of thrombolysis failure.Methods From January 2018 to October 2019，a total of 131 STEMI inpatients treated by early interventional therapy following thrombolysis with RHP were selected from No.5 Cardiovascular Department，the Second Hospital of Hebei Medical University，and divided into recanalization and non-recanalization groups by coronary angiographic findings in infarct-related arteries.The general clinical data，reperfusion parameters，as well as clinical events during hospitalization were recorded and compared between the two groups.Multivariate Logistic regression was used to analyze the related factors of failed thrombolysis.Results Thirty-two cases had failed thrombolysis，accounting for 24.4%，the other 99 had successful thrombolysis.Compared with patients in recanalization group，those in non-recanalization group had younger age，larger average body mass index and body surface area，shorter average APTT and higher platelet aggregation rate after thrombolysis（P<0.05）.Moreover，non-recanalization group had higher rates of using thrombus aspiration and stents，higher average peak values of creatine kinase and creatine kinase isoenzyme and lower average left ventricular ejection fraction（P<0.05）.Multivariate Logistic regression analysis found that age，body surface area，levels of APTT were associated with failed thrombolysis with RHP（P<0.05）.Conclusion The clinical characteristics of STEMI patients with failed thrombolysis with RHP were including being younger age，large body surface area，shorter APTT after thrombolysis，large myocardial infarction area and poor cardiac function.Younger age，larger body surface area and shorter APTT after thrombolysis may be risk factors for failed thrombolysis with RHP in STEMI patients.
Effect of Intracoronary and Intravenous Bivalirudin Administration of on No-reflow during PCI and Short-term Outcome in Acute ST-segment Elevation Myocardial Infarction Patients
LI Xiufen，XIE Yang，PA Erhati?Tuerxun，JIANG Shubin*
Cardiology Center，Xinjiang Medical University Affiliated TCM Hospital，Urumqi 830001，China
*Corresponding author：JIANG Shubin，Chief physician；E-mail：121327a@sina.com
Abstract: Background Coronary no-reflow is an important factor associated with the effect of emergency PCI in patients with acute ST-segment elevation myocardial infarction （STEMI），which is also a prognostic factor as it increases the risk of death.So it is essential to identify effective drug treatment to improve the effect of PCI and reduce the possibility of developing coronary no-reflow.Objective To perform a comparative analysis of intracoronary with intravenous administration of bivalirudin and intravenous administration of bivalirudin in patients with acute STEMI in terms of safety and effects on no-reflow during PCI and short-term outcome.Methods Participants were 110 inpatients who were diagnosed with acute STEMI and underwent PCI within 12 hours of symptom onset in Xinjiang Medical University Affiliated TCM Hospital from June 2017 to January 2019.They were evenly randomized into observation group with intracoronary with intravenous administration of bivalirudin，and control group with intravenous administration of bivalirudin.Intraoperative and postoperative observation indices（number of diseased coronary artery vessels，infarct-related artery（IRA），preoperative TIMI flow grade of target vessel，Gensini score，door-to-balloon time，number of thrombus aspiration cases，number of implanted stents，rate of poststenotic dilation，rate of postoperatively using ACEIs or ARBs，rate of postoperatively usingβ-blockers），therapeutic evaluation indices〔corrected TIMI frame count（CTFC） of the IRA measured immediately after stent implantation，and rate of coronary no-reflow during PCI，degree of ST-segment depression within four hours after PCI，serum CK-MB and LVEF at 24 hours after PCI〕，and major adverse cardiovascular events（MACE） within 30 days after PCI were compared between the two groups.Multivariate logistic regression analysis was used to investigate the effect of intracoronary and intravenous bivalirudin bolus administration during PCI on some therapeutic indices.Results There were no significant differences in intraoperative and postoperative observation indices between the two groups（P>0.05）.The CTFC of the IRA measured immediately after stent implantation，rate of coronary no-reflow and degree of ST-segment depression within four hours after PCI differed significantly between the two groups（P<0.05）.Multivariate Logistic regression analysis showed that intracoronary and intravenous bivalirudin bolus administration during PCI was associated with reduced number of CTFC of the IRA measured immediately after stent implantation 〔OR=0.423，95%CI（0.321，0.656），P=0.005〕，reduced possibility of developing coronary no-reflow 〔OR=0.431，95%CI（0.262，0.812），P=0.002〕，and greater degree of ST-segment depression within four hours after PCI〔OR=1.532，95%CI（0.627，2.517），P=0.003〕.Conclusion The results of this study demonstrate that intracoronary and intravenous bivalirudin administration during PCI could reduce the incidence of coronary no-reflow and the risks of acute heart failure and all-cause death，and improve short-term clinical outcome in acute STEMI patients with good safety.
Circadian and Workday and Off-day Variations of Treatment of Patients with Acute Myocardial Infarction
CHENG Lianchao1，ZHOU Minggang1，HE Dan2，TONG Lan1，ZHANG Cui1，WANG Yanfeng1，CAI Lin1*
1.Cardiovascular Department，Affiliated Hospital of Southwest Jiaotong University/the Third People's Hospital of Chengdu，Chengdu 610031，China
2.Dujiangyan Medical Center，Chengdu 611830，China
*Corresponding author：CAI Lin，Chief physician；E-mail：cailinwm@163.com
Abstract: Background Patients presented to hospital during off-hours may experience poorer quality of care and clinical outcomes.However，in China，few studies examined the variations in clinical processes and outcomes across presentation times and days in patients with acute myocardial infarction（AMI）.Objective This study aimed to comparatively analyze the impact of daytime and nighttime presentations and workday and off-day presentations on treatment efficiency and in-hospital mortality in AMI patients.Methods We consecutively enrolled 2 109 AMI patients admitted to 11 tertiary general hospitals in Chengdu with accreditation as chest pain centers during January 2017 to June 2019.Patients were stratified into daytime group （n=1 235） and night-time group （n=874） according to admission time，while were divided into workday group （n=1 442） and off-day group （n=667） according to admission date.Clinical characteristics，treatment efficiency of STEMI patients with emergent PCI （including S-to-B time，S-to-D time，FMC-to-B time，D-to-B time，compliance rate of FMC-to-B time and D-to-B time），and in-hospital mortality were investigated between different groups.Multivariate regression analysis was used to analyze the influencing factors of in-hospital mortality.Results Compared to STEMI patients with emergent PCI in daytime group，those in nighttime group had dramatically longer average S-to-B，FMC-to-B and D-to-B time，and much lower compliance rates of D-to-B and FMC-to-B time（P<0.05），while there was no obvious difference in the treatment efficiency between such patients in workday group and off-day group（P>0.05）.In-hospital mortality of AMI patients，non-STEMI patients，and STEMI patients underwent emergent PCI in nighttime group was significantly higher than that of those in daytime group （P<0.05）.But the in-hospital mortality was similar in AMI patients in workday and off-day groups，and so was that in non-STEMI patients，STEMI patients，and STEMI patients with and without emergent PCI in the two groups（P>0.05）.Multivariate Logistic regression analysis revealed that age 〔OR=1.051，95%CI（1.023，1.080）〕，diagnosis〔OR=2.820，95%CI（1.163，6.841）〕，cardiogenic shock 〔OR=7.463，95%CI（4.066，13.697）〕，sudden cardiac arrest 〔OR=5.729，95%CI（1.616，20.314）〕，multi-vessel disease 〔OR=1.889，95%CI（1.080，3.303）〕，and nighttime presentation 〔OR=1.788，95%CI（1.036，3.087）〕 were influencing factors of in-hospital death in AMI patients.Conclusion It was proved that there was circadian difference but not workday and off-day difference in the treatment of AMI patients in Chengdu in our study.AMI patients admitted at night-time had more in-hospital treatment delays，longer total ischemic time，and higher in-hospital mortality when compared with those admitted during daytime.
Advances in Etiology and Prognosis of Myocardial Infarction with Non-obstructive Coronary Arteries
ZHANG Yiman，HUANG Baotao，SHI Ruijuan，CHEN Mao*
Department of Cardiology，West China Hospital，Sichuan University，Chengdu 610000，China
*Corresponding author：CHEN Mao，Professor，Chief physician，Doctoral supervisor；E-mail：hmaochen@vip.sina.com
Abstract: Myocardial infarction with non-obstructive coronary arteries（MINOCA）is a syndrome with multiple causes，which accounts for 5%-25% of acute myocardial infarction and arouses widespread concern in clinical practice in recent years.As the global definition of myocardial infarction has changed，the etiology of MINOCA may have also changed.Meanwhile，the prognosis of MINOCA remains unclear due to the influence of different causes.In this review，according to the Fourth Universal Definition of Myocardial Infarction and recent accumulating evidence on MINOCA，the etiology and diagnostic algorithm of MINOCA were further summarized，and the short-term middle-term and long-term prognosis of MINOCA were analyzed.We suggested that patients diagnosed with MINOCA should be evaluated to uncover the potential cause as far as possible for improving the prognosis，and hoped that further research would be carried out to explore the impact of different causes on the prognosis of MINOCA.