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.
Background Mortality and morbidity of acute myocardial infarction remains high. Intravenous magnesium started early after the onset of myocardial infarction is a promising adjunctive treatment that may limit infarct size, prevent serious arrhythmias, and reduce mortality. Several earlier trials and meta-analyses demonstrated a mortality rate reduction with magnesium treatment, but one mega trial found no benefit. Objective To examine the effect of intravenous magnesium versus control on early mortality and morbidity, stratified by time since onset of symptoms (lt;6 hours, 6+ hours), use of thrombolysis (used, not used), dose of magnesium used (lt;75 mmol, 75+ mmol). Search strategy We search the Cochrane controlled trial register (CCTR) of Cochrane Library, Medline and Embase. We also search Chinese Biomedical Disk (CBM disk) to identify the Chinese trials. Each database will be searched from its starting date to the first-half year of 2002. Selection criteria All randomized controlled trials that compared intravenous magnesium with placebo in the presence or absence of fibrolytic therapy in addition to routine treatment are eligible if they reported mortality and clinical events within 35 days of onset, regardless of language. Methods of review A data abstraction form will be specifically developed to extract information from the eligible articles. The quality assessment of RCT will be focused on method of treatment assignment, blinding of participants and investigators, control of selection bias after treatment assignment. The selection of studies, data extraction and assessment of methodological quality will be performed independently by two reviewers. Disagreements will be resolved through discussion, when necessary, in consultation with a third reviewer. Publication bias, heterogeneity and sensitivity analysis will be performed. The odds ratio (OR) will be used to pooling the effect if appropriate.
Objective To evaluate the feasibility and efficacy of emergency percutaneous coronary intervention( PCI) under mechanical ventilation for the treatment of patients with acute myocardial infarction complicated with acute pulmonary edema. Methods The clinical data of 15 patients admitted to the emergency ward for acute pulmonary edema caused by acute myocardial infarction from 2007 to 2009 were retrospectively analyzed. These patients received emergency PCI under mechanical ventilatory support.Parameters involved changes of symptoms, arterial blood gas, left ventricular ejection fraction( LVEF) , plasma concentrations of B-type natriuretic peptide( BNP) , and high sensitivity reactive protein( hs-CRP) . Results All patients showed significant improvements in dyspnea, artery blood gas parameters after PCI( P lt;0. 01) .LVEF increased significantly after PCI compared with before weaning [ ( 37. 36 ±0. 02) % vs ( 47. 41 ±0. 02) % , F =461. 47, P lt; 0. 05] . The concentrations of BNP and hs-CRP returned to lower level 4 weeks after PCI [ ( 99. 34 ±5. 15) fmol /mL vs ( 430. 50 ±96. 08) fmol /mL, ( 8. 35 ±2. 49) ng/mL vs ( 89. 50 ±9. 30) ng/mL, both P lt;0. 01] . Conclusion Emergency PCI under mechanical ventilatory support is a feasible and effective approach for patients with acute myocardial infarction complicated with acute pulmonary edema.
Objective To investigate appropriate treatment strategy and timing for patients with subacute myocardial infarction and severe ischemic mitral regurgitation （IMR）. Methods A total of 89 patients with subacute myocardial infarction and severe IMR underwent surgical treatment from January 2005 to December 2011 in Beijing Anzhen Hospital. There were 66 male patients and 23 female patients with their mean age of 64 （55-73） years. All the patients received only coronary artery bypass grafting （CABG） after 3 months of medication treatment without specific management for their IMR. Echocardiography was examined before medication treatment，preoperatively and 6 months after CABG to analyze their IMR degree and measure left ventricular end-systolic dimension （LVESD），left ventricular end diastolic dimension （LVEDD） and left ventricular ejection fraction （LVEF）. Results There was no surgery-related death，perioperative myocardial ischemia or other severe postoperative complication. Eighty-one patients （91.0%） were followed up for 6-60 months. At 6 months after CABG，mitral regurgitation area （3.1±1.3 cm2 vs. 5.6±2.3 cm2），LVEDD （51.3±4.2 mm vs. 54.3±5.5 mm） and LVESD （31.7±3.9 mm vs. 34.6±4.3 mm） were significantly decreased than preoperative values （P＜0.05），but LVEF was not statistically different from preoperative value （59.1%±3.9% vs. 58.9%±5.6%，P＞0.05）. From the third year during follow-up，all the patients received annual CT examination of their coronary artery，and no significant graft stenosis （graft stenosis＞50%） was found. Conclusion With appropriately delayed CABG and right medication treatment，patients with subacute myocardial infarction and severe IMR may no longer need concomitant surgical management for their IMR， which can decrease surgical risks and reduce treatment cost.
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.
Abstract: Ventricular septal rupture is a rare complication of acute myocardial infarction, but it can easily lead to such complications as acute heart failure and cardiac shock with sinister prognosis. Surgical treatment is a fundamental measure to improve the prognosis, and the selection of operation time is a key factor. The basic guiding principles of operation timing are as follows. Those patients who have acute heart failure and/or cardiac shock soon after the onset of ventricular septal rupture, and can not be controlled by nonsurgery therapy and are also unable to tolerate surgery, will die soon. For them, surgery treatment cannot be implemented because they have missed the optimal operation time. For those whose perforation was so small that they can be stably controlled by nonsurgery therapy, surgery treatment can be postponed for 1 to 4 weeks. However, emergency operation should be performed in time once the condition of the patients becomes unstable. For others, no matter in what state they are, surgical treatment should be implemented immediately.
Objective To study the influence of autologous bone mesenchymal stem cells (BMSCs) on myocardial structure and cardiac function after being implantated into acute infarcted myocardial site. Methods Bone marrow was aspirated from the posterosuperior iliac spine of Guizhou Xiang swine. After being isolated, cultured and co cultured with 5 azacytidine, either autologous BMSCs (total cells 2×10 6, experimental group, n =12), or a comparable volume of culture medium (control group, n =12), was injected into the left anterior descending(LAD) branch of coronary artery just distal to the ligation site of the LAD. The same volume of BMSCs or culture medium was injected into several spots in the infarcted myocardium. Echocardiographic measurements were performed three or six weeks after implantation to assess the myocardial structure and cardiac function. Results Left ventricular function, including eject fraction(EF), fractional shortening and wall thickening, were higher in experimental group when compared with control group. The thickness of the ventricular wall and septum was also found increased while the left ventricular chamber size was smaller in experimental group. Conclusion Implantation of BMSCs into the infarcted myocardium is believed to attenuate the remodeling process, inhibit the extent of wall thinning and dilatation of the ventricular chamber. BMSCs implantation may also improve the contractile ability of the myocardium and cardiac function.
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....
Objective To investigate the effects of tissue inhibitor-3 of matrix metalloproteinases(TIMP-3) genetransfected vascular smooth muscle cells(VSMCs) transplantation on heart structure after acute myocardial infarction (AMI) in rats and to explore the potential mechanisms. Methods Sixty-one female Wistar rats were produced AMI models by ligating the descending left coronary artery. Fifty-four rats were survived and divided into 3 groups randomly(n=18): 0.5 ml PBS containing 1×106 TIMP-3 gene-transfected VSMCs(group A), 1×106 VSMCs(group B) or 0.5 ml PBS without cell(group C) were injected into the ischemic myocardium immediately. Ischemic myocardium samples were harvested at 1 weekafter operation. The heart structure was observed through the tissue morphologic examination. The activity of TIMP-3 gene-transfected VSMCs were measured by immunohistochemical method. Proteins of TIMP-3 and matrix metalloproteinase 9(MMP-9) were determined by Western blot. Results VSMCs were cultivated and had a high purity(98%). TIMP-3 gene was transfected into VSMCs successfully. One week after operation in groups A, B and C, the average percentage of infarction myocardium size 〖KG6〗and left ventricle free wal area were 28.73%±1.56%, 39.63%±1.84% and 46.32%±2.16% separately.Group A was significantly lower than groups B and C(P＜0.01), group B was significantly lower than group C(P＜0.01). In groups A, B and C the averageleft ventricle volume indexes were 5.27±0.21 mm3／g, 6.69±0.34 mm3／g and 9.67±0.88 mm3／g respectively. Group A was significantly smaller than groups B and C(P＜0.01), group B was significantly smaller than group C(P＜0.01). The immunohistochemical observation confirmed that the implanted VSMCs and TIMP-3 gene were survival in ischemic area. The protein content of TIMP-3 in ischemicmyocardium was significantly higher in group A (300 704.8±3 692.8) than in groups B and C(195 548.8±3 014.2，177 991.1±2 502.1)(P＜0.01), the protein content of MMP-9 in ischemic myocardium was significantly lower in group A(594 827.4±5 708.5) than in groups B and C(921 461.4±8 887.4，1 044 445.0±8 788.6)(P＜0.01). Conclusion Implanted TIMP3 gene transfected VSMCs in ischemic myocardium can conspicuously reduce the myocardium remodeling after AMI.
Objective To establish an effective model of myocardial infarction in black goat so as to provide a safe, convenient and credible model of myocardial infarction for treatment and research. Methods Sixteen black goats were made chronic myocardial infarction by ligation of far end of left anterior descending coronary artery through incision below xiphoidprocess. Electrocardiogram(ECG) and serum myocardial enzymes were investigated before and after occlusion. Echocardiographic measurements were performed, and left coronary artery angiography was performed with digital subtraction angiography (DSA) before infarction and 6 weeks after infarction. The myocardial ultrastructure were observed. Results All goats survived more than 6 weeks. ECG showed ambulatory change, ST-segment elevated half an hour after occlusion and pathologic Q waves 6 weeks after infarction, CK-MB significantly increased. Echocardiographic indexes showed significant decrease of maximal peak A, percent wall thickening(WHT) and ejecting fraction (EF), increase ofend-systolic volume (ESV), end-diastolic volume (EDV), and dilation of left ventricle. DSA showed block or decrease of perfusion of far end of left anterior descending coronary artery. Conclusion It is safe, convenient and credible to establish model of myocardial infarction by ligation of far end of left anterior descending coronary artery through incision below xiphoidprocess in black goat.