Objective To systematically review the effectiveness and safety of intracoronary glycoprotein IIb/IIIa inhibitors (GPIs) undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) compared with intravenous administration. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 9, 2012), Ovid, CBM, CNKI and VIP were electronically searched for randomized controlled trials (RCTs) about intracoronary GPIs administration versus intravenous administration undergoing PCI for ACS from inception to September 30th, 2012. Meanwhile, domestic relevant papers published in recent 1 year were also retrieved manually. References of the included studies were retrieved, too. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed the methodologically quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results 10 RCTs involving 3 553 ACS patients were finally included. The results of meta-analysis showed that: compared with intravenous administration, intracoronary GPIs administration decreased the major adverse cardiovascular event (MACE) (OR=0.54, 95%CI 0.34 to 0.85, P=0.008). The incidences of re-infarction (MI), revascularization (TVR) and heart failure were (OR=0.62, 95%CI 0.39 to 0.97, P=0.04), (OR=0.59, 95%CI 0.36 to 0.97, P=0.04), (OR=0.52, 95%CI 0.32 to 0.84, P=0.008), respectively. But for the mortality, there were no significant differences between the two groups (OR=0.81, 95%CI 0.58 to 1.14, P=0.23). Intravenous administration and intracoronary administration were alike in the incidences of mild/serious bleeding (mild: OR=0.94, 95%CI 0.75 to 1.19, P=0.63; serious: OR=1.18, 95%CI 0.76, 1.84, P=0.47). Conclusion Compared with routine GPIs regimen of intravenous bolus, intracoronary administration with initial dosage showed significant benefits in clinical outcomes in ACS patients undergoing PCI, which could not increase the incidence of bleeding.
Objective To evaluate the early diagnostic value of ischemia modified albumin (IMA) for non-ST-segment elevation acute coronary syndromes (NSTEACS). Methods The study group consisted of 177 patients with suspected NSTEACS whose blood was collected within six hours after the onset of chest pain to determine cardiac troponin I (cTnI), and IMA was determined through the albumin cobalt binding (ACB) test. After standardized diagnosis and treatment and GRACE risk score, the patients then were divided into three groups according to the final diagnosis: the NSTEMI (non-ST-segment elevation myocardial infarction) group (n=34), the UA (unstable angina pectoris) group (n=56) and the NICP (non-ischemia chest pain) group (n=87). Meanwhile, 58 people taking the routine examination in the same hospital at that time were randomly selected as the control group. With the results of IMA, ROC curve analysis was used to determine the optimal cutoff of this assay for identifying patients with NSTEACS from those with NICP. Results of IMA, ECG and cTnI were correlated with final diagnosis, and their diagnostic sensitivity and specificity were evaluated for NSTEACS. Results The IMA concentration in the serum showed no significant difference between the NSTEMI group and the UA group, whereas there were significant differences between the former two groups and the NICP group. The sensitivity and specificity at a cutoff point 67.49 U/mL were 91.1% and 86.2%, respectively when the ROC curve area was 0.950. The correlation between the IMA concentration and GRACE risk score was negative. Conclusion IMA is an early sensitive indicator for NSTEACS and a useful predictor of prognosis.
Objective To determine the benefits of an invasive compared to a conservative strategy for treating unstable anguba (UA)/ non-ST-elevation myocardial infarction (NSTEMI). Methods We searched The Cochrane Library (Issue 4, 2009), MEDLINE (1996 to September 2009), EMbase (1974 to September 2009), CBM (1989 to 2009), CNKI (1997 to 2009), and VIP (1989 to 2009). The quality of the included studies was critically evaluated. Data analyses were performed using the Cochrane Collaboration’s RevMan 5.0 software. Results Seven randomized controlled trials involving 11 394 patients met the inclusion criteria. The results meta-analyses showed the incidence of all-cause mortality at six months follow-up was lower in the early invasive group compared with the conservative group (RR=0.75, 95%CI 0.61 to 0.92, P=0.007); the relative risk of myocardial infarction was significantly decreased in the early invasive group (RR=0.74, 95%CI 0.63 to 0.87); there was a reduction in rehospitalization for unstable angina in the invasive group (RR=0.66, 95%CI 0.61 to 0.73, Plt;0.000 01); the invasive strategy was associated with a two-fold increase in the relative risk of PCI-related myocardial infarction (as variably defined). There was not a significant increase in bleeding by an invasive strategy at six months follow-up, but, a routine invasive strategy was associated with a significantly higher bleeding rate at 1-year follow-up (RR=2.22, 95%CI 1.55 to 3.17, Plt;0.000 1). Patients with elevated cardiac biomarker levels at baseline benefited more from routine intervention, with no significant benefit observed in patients with negative baseline marker levels. Conclusion An early invasive strategy is preferable to a conservative strategy in the treatment of UA/NSTEMI, especially higher-risk patients with elevated cardiac biomarker benefit more from invasive strategy. In addition, complications such as procedure-MI and bleeding must be paid great attention to.
Objective To evaluate the cardiac protection function of high thoracic epidural anesthesia (HTEA) for patients with acute coronary syndrome or heart failure. Methods A literature search was conducted with computerized database on PubMed, EBSCO, Springer, Ovid, and CNKI from 1990 to May 2010. Further searches for articles were conducted by checking all references describing cardiac protection studies with HTEA. All included articles were assessed and data were extracted according to the standard of Cochrane review. The homogeneous studies were pooled using RevMan 4.2.10 software. Results A total of 28 articles involving 1 041 patients were included. The results of meta-analyses showed that, a) cardiac function: HTEA could significantly improve ejection fraction of left ventricle (WMD= – 10.28, 95%CI – 14.14 to – 6.43) and cardiac output (WMD= – 1.26, 95%CI – 1.63 to – 0.89), contract left ventricular diastolic dimension (WMD= 5.02, 95%CI 3.72 to 6.32), increase E peak (WMD= – 17.50, 95%CI – 29.40 to – 5.59) and decrease A peak (WMD= 27.36, 95%CI 24.46 to 30.26); b) ischemic degree for patients with heart failure: the change of NST-T (WMD= 1.45, 95%CI 1.12 to 1.78) and ∑ST-T (WMD= 1.02, 95%CI 0.78 to 1.26) got significantly decreased after HTEA; c) ischemic degree for patients with acute coronary syndrome: HTEA could obviously lessen the times (WMD= 4.24, 95%CI 0.48 to 8.00) and duration (WMD= 23.29, 95%CI 4.66 to 42.11) of myocardial ischemia, decrease the times of heart attack (WMD= 3.44, 95%CI 0.92 to 5.97), and decrease the change of NST-T (WMD= 1.10, 95%CI 0.84 to 1.36) and ∑ST-T (WMD= 1.33, 95%CI 1.01 to 1.65); d) hemodynamic change for patients with acute coronary syndrome: HTEA could obviously decrease heart beat (WMD= 8.44, 95%CI 3.81 to 13.07) and systolic arterial pressure (WMD= 2.07, 95%CI 0.81 to 3.34), but not decrease the diastolic blood pressure (WMD= 2.06, 95%CI – 0.52 to 4.64) so as to avoid influencing the infusion of coronary artery; and e) influence on Q-T interval dispersion: HTEA could significantly decrease Q-Td (WMD= 9.51, 95%CI 4.74 to 14.27), Q-Tcd (WMD= 11.82, 95%CI 5.55 to 18.09), and J-Td (WMD= 9.04, 95%CI 2.30 to 15.79). Conclusions High thoracic epidural anesthesia can obviously improve the systolic and diastolic function of left ventricle, decrease the heart beat and stabilize hemodynamic change, lessen the times and duration for myocardial ischemia, reserve the ST segment change, contract Q-T interval dispersion, which has to be further proved with more high quality studies.
Objective To analyze the electrocardiogram (ECG) and troponin (cTnI) in patients with acute coronary syndrome (ACS), so as to assess their value in diagnosing the extent of vascular lesions. Methods The results of ECG, cTnI and coronary angiography (CAG) were analyzed in 37 patients with ACS. Chi-square test and a logistic regression model were used for statistical analysis. Results In patients with positive ECG or cTnI, the results of Chi-square test showed that the incidences of coronary occlusion (P=0.016, 0.003, respectively) and coronary stenosis (P=0.121, 0.013, respectively) were significantly higher than for those with negative ECG or cTnI. The results of logistic regression analysis indicated that only cTnI was significantly correlated with coronary occlusion (P=0.013) and moderate to severe coronary stenosis (P=0.021). ECG has significant consistency with cTnI (Kappa=0.617, Plt;0.001). Conclusion Both ECG and the qual itative cTnI test can reflect the extent of vascular lesions in patients with ACS.
ObjectiveTo systematically review the therapeutic effects and safety of new platelet inhibition regimens targeting P2Y12-receptors (prasugrel/ticagrelor) in patients with acute coronary syndrome (ACS). MethodsSuch databases as PubMed (1980 to 2013.7), EMbase (1980 to 2013.5), The Cochrane Library (Issue 7, 2013), CBM (1990 to 2013.7), CNKI (1994 to 2013.7), VIP (1989 to 2013.7) and WanFang Data (1980 to 2013.7) were electronically searched to collect the randomized controlled trials (RCTs) about comparing prasugrel/ticagrelor with clopidogrel in treating patients with ACS. Two reviewers screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then meta-analysis was performed using RevMan 5.2 software. ResultsFive studies involving 43 452 patients were finally included. The results of meta-analysis showed that:compared with standard clopidogrel, prasugrel/ticagrelor reduced the incidences of myocardial infarction (OR=0.83, 95%CI 0.77 to 0.89, P < 0.000 01), cardiovascular death (OR=0.86, 95%CI 0.78 to 0.94, P=0.002), and stent thrombosis (OR=0.61, 95%CI 0.38 to 0.97, P=0.04); while no advantage was found in reducing the incidences of stroke (OR=1.06, 95%CI 0.88 to 1.26, P=0.54), intracranial hemorrhage (OR=1.18, 95%CI 0.81 to 1.71, P=0.39), and severe bleeding after thrombolysis due to myocardial infarction (OR=1.17, 95%CI 0.94 to 1.47, P=0.16). ConclusionNew platelet inhibition regimens targeting P2Y12-receptors for ACS could effectively decrease the incidences of myocardial infarction, cardiovascular death, and stent thrombosis events. However, compared with clopidogrel, it could not improve the clinical outcomes of patients with stroke and intracranial hemorrhage. Additionally, due to the increased risk of non-CABG related bleeding, more attention should be paid to the application of new platelet inhibition regimens.
ObjectiveTo systematically review the effectiveness and safety of domestic tirofiban for Chinese population with non ST-elevation acute coronary syndromes (NSTE-ACS) in non-interventional therapy. MethodsWe searched databases including The Cochrane Library (Issue 11, 2013), PubMed, EMbase, CBM, CNKI, VIP and WanFang Data from 1994 to 2014 to collect randomized controlled trials (RCTs) about domestic tirofiban for NSTE-ACS patients in non-interventional therapy. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Meta-analysis was then conducted using RevMan 5.2 software. ResultsA total of 23 RCTs were enrolled involving 2 425 patients. The results of meta-analysis showed that:a) the effectiveness of tirofiban in the trial group was significantly better than that in the control group (OR=3.62, 95%CI 2.33 to 5.63, P<0.000 01); b) ST segment down improvement in the trial group was better than that in the control group (WMD=0.39, 95%CI 0.30 to 0.49, P<0.000 01); c) improvement of platelet aggregation in the trial group was better than that in the control group (WMD=27.89, 95%CI 25.45 to 30.34, P<0.000 01); d) the incidences of cardiovascular events of composite endpoints in the trial group were lower than that in the control group (during 36 h:OR=0.20, 95%CI 0.12 to 0.31, P<0.000 01; and after 30 days:OR=0.31, 95%CI 0.23 to 0.42, P<0.000 01); and e) the incidence rate of bleeding in the trial group was higher than that in the control group (OR=1.53, 95%CI 1.09 to 2.15, P=0.02). ConclusionCompared with routine drugs used alone, tirofiban has better therapeutic effects in non-interventional therapy for Chinese population with NSTE-ACS, but the incidence of bleeding is relatively high.
ObjectiveTo systematically review the association between H type hypertension and acute coronary syndromes in China. MethodsWe electronically searched databases including PubMed, Web of Science, CNKI, CBM, VIP and WanFang Data databases to collect case-control studies about the association between H type hypertension and acute coronary syndromes among the Chinese population from inception to May, 2015. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.2 software. ResultsA total 6 studies involving 992 patients were included. Among these cases, 438 cases were in the acute coronary syndromes group (case group) and 554 were in the control group. The results of metaanalysis showed that: proportion of H type hypertension patients in the case group was significantly higher than that in the control group (OR=3.32, 95%CI 2.21 to 4.98, P<0.000 01). ConclusionCurrent evidence shows that, H type hypertension may be associated with acute coronary syndromes in the Chinese population. Due to the limited quantity and quality of included studies, more high quality studies are needed to verify the above conclusion.
Objectives To evaluate the clinical outcomes and identify its associated factors in patients with acute coronary syndromes (ACS) in Tianjin city. Methods Data were obtained from Tianjin urban employee basic medical insurance database. Adult patients who were discharged alive after the first ACS-related hospitalization (the index hospitalization) during January, 2012 to December, 2014 and without malignant tumor were included. Clinical outcomes were measured by subsequent major adverse cardiovascular events (MACE) including hospitalization for myocardial infarction (MI) or stroke, all-cause death, or their composite endpoint. Cox model was used to explore the factors associated with MACE. Results 22 041 patients were identified, in which 9.5% experienced MACE during follow-up with a mean number of 1.3 MACEs. 3.1% of patients had MI, 5.7% had stroke and 1.4% had all-cause death. Among patients who experienced MACEs, the average time from index discharge to the 1st MACE was 143.2 days. Patients being older, male or had higher Charlson Comorbidity Index (CCI) were more likely to experience MACE. Patients who had prior stroke and prior all-cause hospitalization were also more likely to experience MACE, whereas patients who had prior angina, prior β-blockers utilization and received percutaneous coronary intervention (PCI) during index event were less likely to experience MACE. Conclusion Stroke is the most common type of MACE among ACS patients in Tianjin, China. Almost half of the 1st MACE occur within the 3 months after ACS. Patients who are older, male, have higher CCI or have prior stroke are at higher risk of MACE.
ObjectiveTo investigate the influence of hemoglobin level on in-hospital outcome of elderly patients with acute coronary syndrome (ACS).MethodsThis study retrospectively collected 262 elderly patients with ACS in the First Hospital of Tsinghua University from January 2015 to August 2019. Patients were divided into 4 groups according to the hemoglobin level. Patients with hemoglobin level≤121.75 g/L were classified into group A (n=65), patients with hemoglobin level between 121.76 and 132.50 g/L were classified into group B (n=66), patients with hemoglobin level between 132.51 and 144.00 g/L were classified into group C (n=69), and patients with hemoglobin level≥144.01 g/L were classified into group D (n=62). The primary endpoints of this study were in-hospital major adverse cardiovascular events, including all-cause death, reinfarction, acute or subacute stent thrombosis and cardiac arrest. Logistic regression analysis was used to explore the effect of hemoglobin on the in-hospital prognosis of elderly patients with ACS.ResultsLogistic regression analysis showed that the odds ratio of hemoglobin level in the major adverse cardiovascular events assessment was 0.971, the 95% confidence interval was (0.946, 0.996) and the P value was 0.024, while the odds ratio of hemoglobin level in the all-cause death assessment was 0.957, the 95% confidence interval was (0.929, 0.987) and the P value was 0.005.ConclusionLow hemoglobin level is a risk factor for in-hospital adverse events in the elderly patients with ACS.