Objective\ To analyze the experiences of emergent or urgent coronary artery bypass grafting(CABG) for patients with acute myocardial infarction(AMI). Methods\ From May, 1996 through December, 1999, 9 patients with AMI underwent emergent CABG including eight males and one female, with mean age 61 years, and year range 44 70. The localization of the AMI was anterior in 4 and inferior in 5. The interval between the onset of AMI and CABG was within 24 hours in 7 cases, 10 days in 1 case and 14 days in 1 case....
We reported a 65-year-old female who was admitted to our institute with "recurrent subxiphoid pain accompanied by dyspnea for more than 10 days". Electrocardiogram examination suggested acute extensive anterior ST segment elevation myocardial infarction. Preoperative transthoracic echocardiography suggested ventricular septal rupture. The patient was planned for the repair of ventricular septal rupture with cardiopulmonary bypass. The formation of left ventricular aneurysm was diagnosed by intraoperative transesophageal echocardiography (TEE). The surgeon decided to abdopt the modified incision of left ventricular approach guided by TEE, which greatly improved the prognosis of the patient. The surgery duration was 197 min, aortic cross-clamping time was 56 min, cardiopulmonary bypass time was 69 min, and the patient was safely admitted to ICU after the surgery. Extubation was performed on the first day postoperatively, and the intra-aortic balloon pump support was retreated on the second day postoperatively. Postoperative echocardiography showed that no obvious residual shunt was observed after ventricular septal repairment and ventricular aneurysm resection. The patient was discharged on the 12th day after the surgery. Additionally, the mental condition was good and daily activities were not limited within 6 months postoperatively.
Objective To summarize the efficacy and clinical experiences of emergent coronary artery bypass grafting (E-CABG) in patients with acute myocardial infarction (AMI) and to discuss the operative opportunity and procedures. Methods We retrospectively analyzed the clinical data of 21 patients with AMI undergoing E-CABG in Sun Yatsen Cardiovascular Disease Hospital between June 1999 and December 2009. Among the patients, there were 14 males and 7 females with their age ranged from 24 to 81 years (63.9±12.4 years). Six patients were operated within 6 hours after the onset of AMI, 7 patients were operated from 6 hours to 3 days after the onset of AMI, and 8 patients were operated from 3 days to 30 days after the onset of AMI. Eight patients had the cardiogenic shock after AMI, one had rupture of ventricular septum and cardiogenic shock, two had rupture of coronary artery after percutaneous transluminal coronary angioplasty, eight had unstable angina and frequent ventricular arrhythmia, one had ventricular fibrillation and cardiac arrest, and one had cardiac trauma. Ten patients were treated with intraaortic balloon pump (IABP). Conventional CABG was performed for 12 patients, off-pump CABG for 5 patients, and on-pump-beating CABG for 4 patients. Results Five patients died after E-CABG with a mortality of 23.8% which was obviously higher than the overall CABG mortality (23.8% vs. 3.1%, χ2=21.184, P＜0.05). There were respectively 2, 2 and 1 deaths with a mortality of 33.3%, 28.6% and 12.5% respectively for operations within 6 hours, 6 hours to 3 days and 3 to 30 days after the onset of AMI. The mortality of those patients who were operated within 3 days after AMI was obviously lower (P＜0.05). The primary causes of death were low cardiac output syndrome, perioperative acute myocardial infarction after CABG and sapremia. There was one death each for patients operated with off-pump and on-pump-beating CABG. Sixteeen patients were discharged from the hospital. The follow-up was from 6 months to 10 years. There were 6 late deaths among which 5 died of cardiac failure accompanied by pulmonary infection, one died of noncardiac factor. Ten patients survived at present, and the quality of life among 5 patients was unsatisfactory. Conclusion The mortality of E-CABG is obviously higher in patients operated within 3 days of AMI. With the support of IABP, if the operation can be carried out 3 days after the onset of AMI, the surgical success rate will be greatly improved by adopting proper offpump and onpumpbeating procedures.
ObjectiveTo investigate the influencing factors of serum NT-proBNP level in elderly patients with acute myocardial infarction (AMI) after PCI, and to analyze its predictive value for the short-term prognosis of patients. MethodsA total of 98 elderly patients with AMI in Zhengzhou central hospital from May 2020 to August 2022 were selected, all of whom underwent PCI. The level of serum NT-proBNP before and after PCI was detected. The level of serum NT-probNP after PCI was ≥125 pg/mL, and the level of serum NT-probNP after PCI was normal. Univariate analysis of the general data of the elevated NT-proBNP group and the normal group, Lasso regression model was used to screen the screening variables, and Logistic regression was used to analyze the influencing factors of serum NT-proBNP level in elderly AMI patients after PCI. The prognosis recovery of patients with different NT-proBNP and the level of NT-proBNP in patients with different prognosis were compared and analyzed. ROC curve was drawn to analyze the predictive value of NT-proBNP level in patients with short-term prognosis after PCI. ResultsLogistic regression analysis showed that the time from onset to PCI, age, left ventricular ejection fraction (LVEF), stroke, number of stents implanted, no recirculation and stent diameter were the influencing factors of serum NT-proBNP level in elderly AMI patients after PCI. The incidence of adverse cardiovascular events (MACE) was 21.43% (21/98) in 98 patients followed up 6 months after surgery, and the incidence of NT-proBNP increased group was 68.00% (17/25), which was significantly higher than that of normal group (5.48% (4/73) (P<0.05). The level of NT-proBNP in the group with MACE was significantly higher than that in the group without MACE (P<0.05). ROC curve showed that AUC was 0.813 (95%CI 0.721 to0.884), sensitivity and specificity were 80.95% and 79.22%, respectively, suggesting that serum NT-proBNP level after PCI had certain predictive value for short-term prognosis of patients. ConclusionSerum NT-proBNP level in elderly AMI patients after PCI has a good ability to predict the short-term prognosis of patients. Comprehensive consideration of the number of stents inserted, the presence of stroke, the presence of reflow and age and other factors to strengthen the monitoring of NT-proBNP level is helpful to prevent and control the occurrence of MACE, so as to improve the prognosis of patients.
Objective To evaluate the effectiveness of nicorandil for reperfusion of acute myocardial infarction (AMI), so as to provide high quality evidence for formulating the rational AMI therapy. Methods Databases including The Cochrane Library (Issue 3, 2012), PubMed, EMbase, HighWire, CBM, and CNKI were searched to collect randomized controlled trials (RCTs) on nicorandil in AMI reperfusion published before March 2012. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and evaluated the methodological quality of the included studies. Then the meta-analysis was conducted using RevMan5.1 software. Results A total of 11 trials involving 1 027 patients were included. The results of meta-analyses showed that: for AMI reperfusion, nicorandil could decrease the non-reflow or slow flow rate (RR=0.34, 95%CI 0.19 to 0.61, P=0.000 3), improve the left ventricular ejection fraction (MD=5.49, 95%CI 4.51 to 6.47, Plt;0.000 01), reduce the left ventricular end-diastolic volume (MD=–14.38, 95%CI –17.31 to –11.45, Plt;0.000 01), and decrease the incidence of cardiac adverse events (RR=0.34, 95%CI 0.25 to 0.46, Plt;0.000 01), readmission rate (RR=0.33, 95%CI 0.17 to 0.63, P=0.000 8) and mortality rate (RR=0.40, 95%CI 0.16 to 0.97, P=0.04). Conclusion Current evidence shows that nicorandil used as an adjuvant for AMI reperfusion can increase coronary microcirculation, improve prognosis, and decrease the incidence of cardiac adverse events, readmission and mortality rate. Due to the limited quality and quantity of the included studies, this conclusion still needs to be further proved by performing more large-scale and high quality RCTs, so we suggest clinician should adopt rational therapies based on patient’s conditions.
Objective To evaluate the diagnostic value of human heart-type fatty acid-binding protein for early detection of acute myocardial infarction (AMI). Methods Studies involving this biomarker were identified from MEDLINE, EMbase, CBM and VIP (1970 to 2006). Relevant journals (1980 to 2006) were also handsearched. The quality of the included studies was assessed using the QUADAS tool. Data extraction and analysis were conducted by software of EXCEL2003 and Metadisc. Results We included 13 studies, which were heterogeneous (P=0, I2=58.5%). Five studies (n=396) included in the group assessed the test at the first three hours after chest pain onset. These studies were homogeneous (P= 0.49, I2=0). The pooled sensitivity was 0.86 ( 95%CI 0.80 to 0.91), the pooled specificity was 0.76( 95%CI 0.80 to 0.91), and the area under the curve was 0.88 (SE=0.032 3). In the group of 0 to 6 hours after chest pain onset, 10 included studies (n=1 175) were heterogeneous (P=0, I2=69%). The pooled sensitivity was 0.86 (95%CI 0.83 to 0.89), the pooled specificity was 0.79 (95%CI 0.76 to 0.82), and the area under the curve was 0.92 (SE=0.019). In the group of 6 to 12 hours after chest pain onset, 4 included studies (n=215) were homogeneous (P=0.56, I2=0). The pooled sensitivity was 0.97 (95%CI 0.91 to 0.99), the pooled specificity was 0.52 (95%CI 0.42 to 0.61), and the area under the curve was 0.810 with (SE=0.152 2). In the group of 0 to 12 hours after chest pain, 11 included studies (n=1 352) were heterogeneous (P=0.56, I2=59%). The pooled sensitivity was 0.88 (95%CI 0.84 to 0.89), the pooled specificity was 0.75 (95%CI 0.71 to 0.78), and the areas under the curve was 0.91 (SE=0.016 4). Conclusions In this systematic review, we found that H-FABP has an acceptable diagnostic accuracy within 3 hours after the onset of symptoms, and within 12 hours after the onset of symptoms, H-FABP has a high diagnostic efficacy. So H-FABP may be a new symbol for the early diagnosis of AMI.
ObjectiveTo systematically review the effect of compound Danshen dripping pills combined with Western medicine on inflammatory factors and cardiac function after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction.MethodsDatabases including CNKI, WanFang Data, VIP, CBM, PubMed, Web of Science, EMbase and The Cochrane Library were searched for randomized controlled trials of compound Danshen dripping pills combined with Western medicine in the treatment of acute myocardial infarction after PCI. The retrieval time was from the establishment of the databases to June 11th, 2020. Two reviewers independently screened literature, extracted data and evaluated the risk bias of included studies. RevMan 5.3 software was used for meta-analysis.ResultsA total of 16 studies were included, involving 2 069 patients. The results of the meta-analysis showed that the combination of compound Danshen dripping pills could increase the left ventricular ejection fraction (MD =−4.74, 95%CI 4.07 to 5.42, P<0.01), decrease the B-type natriuretic peptide (SMD=−3.81, 95%CI −5.06 to −2.57, P<0.01), the level of interleukin-6 (SMD=−3.20, 95%CI −4.54 to −1.86, P<0.01) and level of tumor necrosis factor-a (SMD=−4.96, 95%CI −7.03 to −2.89, P<0.01).ConclusionsCurrent evidence suggests that the combination of compound Danshen dropping pills has potential benefits in inhibiting inflammation and improving cardiac function after PCI. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
ObjectiveTo explore the application of cardiac enhanced MRI in acute myocardial infarction with normal result of coronary angiography. MethodsOn October 18, 2013, a male patient underwent coronary angiography under the local anesthesia. Mild coronary stenosis both in left and right side were found in the surgery, but the results of dynamic cardiogram and myocardial markers were abnormal, which accorded with the clinical procedure of myocardial infarction. The patient underwent cardiac enhanced MRI at the 6th day and was finally diagnosed as acute myocardial infarction. We reviewed the database to find out the significance of cardiac enhanced MRI in diagnosis of acute myocardial infarction. ResultsAlthough coronary angiography was the gold standard for the diagnosis of coronary diseases, it had limitations in the diagnosis of coronary eccentric stenosis, branch vascular stenosis and coronary spasm. Cardiac enhanced MRI had the advantages of accurate measurement of the attenuation of myocardium and exhibition of functional changes of ischemic myocardium. ConclusionCardiac enhanced MRI is important for the diagnosis of myocardial infarction with normal result of coronary angiography.
Objective To investigate the correlation between glycosylated hemoglobin A1c (HbA1c) and severity of coronary artery lesions in young men with acute myocardial infarction (AMI). Methods Total 278 young men with AMI less than 45 years old were retrospectively studied, and all of them were admitted to hospital from January 2009 to December 2011, and had undergone coronary angiography. According to the results of coronary angiography, the patients were divided into three groups based on the number of artery lesions: the single group (156 cases), the double group (64 cases) and the triple group (58 cases). The relationship between the severity of coronary artery lesions and the following factors were observed: HbA1c, systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin (Hb), serum uric acid (UA), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), body mass index (BMI), smoking history, drinking history and family history of early coronary artery disease. Results a) HbA1c levels were gradually raised in all the three groups, but the single group (6.39±1.67%) was significantly lower than the double group (6.91±1.63%) and the triple group (7.41±2.12%), with significant differences (Plt;0.05); the HbA1c level of the single group was significantly lower than the triple group in both the ST-segment elevation AMI (6.42±1.68% vs. 7.17±1.86%, Plt;0.05) and the non-ST-segment AMI (5.57±0.37% vs. 8.56±2.83%, Plt;0.05); the HbA1c level of the single group was significantly lower than the triple group in patients with diabetes millitus (8.31±1.83% vs. 8.59±2.02%, Plt;0.05) and in patients without diabetes millitus (5.56±0.33% vs. 5.74±0.37%, Plt;0.05); b) There were significant differences in SBP, TC, HDL-C, LDL-C and drinking history between the single group and the other two groups (all Plt;0.05), and there were significant differences in DBP and TG between the single group and the double group (all Plt;0.05); and c) The results of logistic regression analysis showed that, LDL-C (OR=1.790), HbA1c (OR=1.287) and SBP (OR=1.042) were the independent risk factors (all Plt;0.05) for multiple lesions in coronary arteries of young men with AMI. Conclusion Glycosylated hemoglobin A1c is an independent risk factor for multiple lesions in coronary arteries of young men with AMI.