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Impact of liver cirrhosis on st-elevation myocardial infarction related shock and interventional management,a nationwide analysis

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World Journal of Hepatology 2022年第4期14卷 766-777页

作者： Sophia Haroon Dar Mehek Rahim Davood K Hosseini Khurram Sarfraz Internal Medicine Hackensack University Medical CenterHackensackNJ 07601United States

BACKGROUND Critical care is rapidly evolving with significant innovations to decrease hospital stays and costs.To our knowledge,there is limited data on factors that affect the length of stay and hospital charges in cirrhotic patients who present with stelevation myocardial infarction-related cardiogenic shock(SRCS).AIM To identify the factors that increase inpatient mortality,length of stay,and total hospital charges in patients with liver cirrhosis(LC)compared to those without LC.METHODS This study includes all adults over 18 from the National Inpatient Sample 2017 database.The study consists of two groups of patients,including SRCS with LC and without LC.Inpatient mortality,length of stay,and total hospital charges are the primary outcomes between the two groups.We used stATA 16 to perform statistical analysis.The Pearson's chi-square test compares the categorical variables.Propensity-matched scoring with univariate and multivariate logistic regression generated the odds ratios for inpatient mortality,length of stay,and resource utilization.RESULTS This study includes a total of 35798453 weighted hospitalized patients from the 2017 National Inpatient Sample.The two groups are SRCS without LC(n=758809)and SRCS with LC(n=11920).The majority of patients were Caucasian in both groups(67%vs 72%).The mean number of patients insured with Medicare was lower in the LC group(60%vs 56%)compared to the other group,and those who had at least three or more comorbidities(53%vs 90%)were significantly higher in the LC group compared to the non-LC group.Inpatient mortality was also considerably higher in the LC group(28.7%vs 10.63%).Length of stay(LOS)is longer in the LC group compared to the non-LC group(9 vs 5.6).Similarly,total hospital charges are higher in patients with LC($147407.80 vs$113069.10,P≤0.05).Inpatient mortality is lower in the early percutaneous coronary intervention(PCI)group(OR:0.79statistically significant.Both early Impella(OR:1.73<0.05)and early extracorporeal membrane oxygenation

关键词： Gastroenterology Hepatology Liver st-elevation myocardial infarction Cardiogenic Shock Percutaneous coronary intervention Impella Extracorporeal membrane oxygenation

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Effect of fibrinolytic therapy on st-elevation myocardial infarction clinical outcomes during the COVID-19 pandemic:A systematic review and meta-analysis

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World Journal of Cardiology 2023年第6期15卷 309-323页

作者： Anwar Khedr Hussam Al Hennawi Muhammed Khuzzaim Khan Mostafa Elbanna Abbas B Jama Ekaterina Proskuriakova Hisham Mushtaq Mikael Mir Sydney Boike Ibtisam Rauf Aalaa Eissa Meritxell Urtecho Thoyaja Koritala Nitesh Jain Lokesh Goyal Salim Surani Syed A Khan Department of Internal Medicine BronxCare Health SystemBronxNY 10457United States Department of Internal Medicine Jefferson Abington HospitalAbingtonPA 19001United States Department of Internal Medicine Dow University of Health ScienceKarachi 74200Pakistan Department of Internal Medicine Rochester Regional HealthRochesterNY 14621United States Department of Critical Care Mayo Clinic Health SystemMankatoMN 56001United States Department of Internal Medicine Mount Sinai HospitalChicagoIL 60608United States Department of Internal Medicine St.Vincent's Medical CenterBridgeportCT 06606United States Department of Medicine University of MinnesotaMinneapolisMN 55455United States Department of Medicine St.George's UniversitySchool of MedicineSt George SW170REGrenada Department of Medicine KFS UniversityKFS 33511Egypt Department of Medicine Robert D and Patricia E.Kern Center of Health Care DeliveryMayo ClinicRochesterMN 55905United States Department of Hospital Medicine Mayo Clinic Health SystemMankatoMN 56001United States Department of Medicine Mayo Clinic Health SystemMankatoMN 56001United States Department of Hospital Medicine Christus Sphon Hospital-shorelineCorpus ChristoTX 78404United States Department of Pulmonary Critical Care&Sleep MedicineTexas A&M UniversityCollege StationTX 77843United States Department of Critical Care Medicine Mayo Clinic Health SystemMankatoMN 56001United States

BACKGROUND st-elevation myocardial infarction(stEMI)is the result of transmural ischemia of the myocardium and is associated with a high mortality rate.Primary percutaneous coronary intervention(PPCI)is the recommended first-line treatment strategy for patients with stEMI.The timely delivery of PPCI became extremely challenging for stEMI patients during the coronavirus disease 2019(COVID-19)pandemic,leading to a projected steep rise in mortality.These delays were overcome by the shift from first-line therapy and the development of modern fibrinolytic-based reperfusion.It is unclear whether fibrinolytic-based reperfusion therapy is effective in improving stEMI endpoints.AIM To determine the incidence of fibrinolytic therapy during the COVID-19 pandemic and its effects on stEMI clinical outcomes.METHODS PubMed,Google Scholar,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials were queried from January 2020 up to February 2022 to identify studies investigating the effect of fibrinolytic therapy on the prognostic outcome of stEMI patients during the pandemic.Primary outcomes were the incidence of fibrinolysis and the risk of all-cause mortality.Data were meta-analyzed using the random effects model to derive odds ratios(OR)and 95%confidence intervals.Quality assessment was carried out using the Newcastle-Ottawa scale.RESULTS Fourteen studies including 50136 stEMI patients(n=15142 in the pandemic arm;n=34994 in the pre-pandemic arm)were included.The mean age was 61 years;79%were male,27%had type 2 diabetes,and 47%were smokers.Compared with the pre-pandemic period,there was a significantly increased overall incidence of fibrinolysis during the pandemic period[OR:1.80(1.18 to 2.75);I2=78%;P=0.00;GRADE:Very low].The incidence of fibrinolysis was not associated with the risk of all-cause mortality in any setting.The countries with a low-and middle-income status reported a higher incidence of fibrinolysis[OR:5.16(2.18 to 12.22);I2=81%;P=0.00;GRADE:Very low]and an increased risk of all-cause mortality i

关键词： st-elevation myocardial infarction myocardial infarction Thrombolytic therapy Fibrinolysis COVID-19 Pandemics

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Role of Soluble st2 Levels and Beta-Blockers Dosage on Cardiovascular Events of Patients with Unselected st-Segment elevation myocardial infarction

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Chinese Medical Journal 2018年第11期131卷 1282-1288页

作者： Wei-Ping Huang Xuan Zheng Lei He Xi Su Cheng-Wei Liu Ming-Xiang Wu Department of Cardiology Wuhan Asia Heart Hospital Wuhan Hubei 430022 China

Background： Serum soluble st2 （sst2） levels are elevated early after acute myocardial infarction and are related to adverse left ventricular （LV） remodeling and cardiovascular outcomes in st-segment elevation myocardial infarction （stEMI）. Beta-blockers （BB） have been shown to improve LV remodeling and survival. However, the relationship between sst2, final therapeutic BB dose, and cardiovascular outcomes in stEMI patients remains unknown. Methods： A total of 186 stEMI patients were enrolled at the Wuhan Asia Heart Hospital between January 2015 and June 2015. All patients received standard treatment and were followed up for 1 year. Serum sst2 was measured at baseline. Patients were divided into four groups according to their baseline sst2 values （high 〉56 ng/ml vs. low ≤56 ng/ml） and final therapeutic BB dose （high ≥47.5 mg/d vs. low 〈47.5 mg/d）. Cox regression analyses were performed to determine whether sst2 and BB were independent risk factors for cardiovascular events in stEMI. Results： Baseline sst2 levels were positively correlated with heart rate （r = 0.327, P = 0.002）, Killip class （r = 0.408, P = 0.000）, lg N-terminal prohormone B-type natriuretic peptide （r = 0.467, P = 0.000）, lg troponin I （r = 0.331, P = 0.000）, and lg C-reactive protein （r = 0.307, P = 0.000） and negatively correlated to systolic blood pressure （r = ？0.243, P = 0.009） and LV ejection fraction （r = ？0.402, P = 0.000）. Patients with higher baseline sst2 concentrations who were not titrated to high-dose BB therapy （P 〈 0.0001） had worse outcomes. Baseline high sst2 （hazard ratio [HR]： 2.653; 95% confidence interval [CI]： 1.201–8.929; P = 0.041） and final low BB dosage （HR： 1.904; 95% CI, 1.084–3.053; P = 0.035） were independent predictors of cardiovascular events in stEMI. Conclusions： High baseline sst2 levels and final low BB dosage predicted cardiovascular events in stEMI. Hence, sst2 may be a useful biomarker in cardiac pathophysiology.

关键词： Adrenergic Beta-Antagonists Prognosis st-elevation myocardial infarction st2

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Comparative effects of percutaneous coronary intervention for infarct-related artery only or for both infarct- and non-infarct- related arteries in patients with st-elevation myocardial infarction and multi-vessel disease

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Chinese Medical Journal 2008年第23期121卷 2384-2387页

作者： HAN Ya-ling WANG Bin WANG Xiao-zeng LI Yi WANG Shou-li JING Quan-min WANG Geng MA Ying-yan LUAN Bo Department of Cardiology Shenyang General Hospital of PLA Shenyang Liaoning 110016 China

Background Rapid recanalization of infarct-related artery （IRA） has become the major target during primary percutaneous coronary intervention （PCI） for patients with st-elevation myocardial infarction （MI）, but strategy for treatment of non-IRA lesions in this setting remains unclear. This study aimed to compare long-term effects between PCI for IRA only and that for both IRA and non-IRA in st-elevation MI patients with multi-vessel disease.Methods A total of 242 eligible patients with st-elevation MI and at least two diseased coronary arteries （luminal narrowing 〉70%） undergoing primary PCI were included. Of them, 149 patients underwent primary PCI for IRA only （group 1）, and 93 received primary PCI for IRA followed by elective PCI for non-IRA 7 to 15 days after acute myocardial infarction （AMI）（group 2）. Drug-eluting stents （DESs） were deployed in more than 90% of the patients. Results The two groups did not differ with respect to baseline clinical and angiographic characteristics. No significant differences were observed in 12-month clinical follow-up results regarding major adverse cardiac events （11.5% vs 15.1%, P 〉0.05） and target lesion revascularization （8.1% vs 7.6%, P 〉0.05） between the two groups. However, patients in group 1 had higher rates of recurrent angina （10.1% vs 2.1%, P 〈0.05） and depressed left ventricular ejection fraction evaluated by echocardiography （0.56±0.22 vs 0.63±0.25, P 〈0.05）. Conclusion With the use of DESs, complete revascularization with elective PCI for non-IRA after primary PCI may exert a beneficial effect on long-term symptomatology and left ventricular function in patients with st-elevation Mt and multi-vessel disease.

关键词： multi-vessel disease percutaneous coronary intervention revascularization st-elevation myocardial infarction

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Long-term Outcomes of Primary Percutaneous Coronary Intervention with Second-generation Drug-eluting stents in st-elevation myocardial infarction Patients Caused by Very Late stent Thrombosis

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Chinese Medical Journal 2017年第8期130卷 929-935页

作者： Chen He Yuan-Liang Ma Chuang-Shi Wang Lin Jiang Jia-Hui Zhang Yi Yao Xiao-FangTang Bo Xu Run-Lin Gao Jin-Qing Yuan state Key Laboratory of Cardiovascular Disease National Center for Cardiovascular Diseases Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China

Background： The st-segment elevation myocardial inthrction （stEMI） patients due to stent thrombosis （st） remain a therapeutic challenge for a clinician. Till date, very few researches have been conducted regarding the safety and effectiveness of primary percutaneous coronary intervention （PCI） with second-generation drug-eluting stents （DES） for stEMI caused by very late st （VLst）. This retrospective study evaluated the safety, efficacy, and outcomes of primary PCI with second-generation DES for stEM1 due to VLst compared with primary PCI for stEM1 due to de novo lesion. Methods： Between January 2007 and December 2013, stEMI patients with primary PCI in Fuwai Hospital had only second-generation DES implanted for de novo lesion （558 patients） and VLst （50 patients） were included in this retrospective study. The primary end points included cardiac death and reinfarction. The secondary end points included cardiac death, reinfarction, and target lesion revascularization. Continuous variables were expressed as mean （standard deviation） or median （interquartile range） and compared by student＇s t-test or Mann-Whitney U-test as appropriate. Categorical variables were expressed as counts and percentages, and comparison of these variables was performed with Chi-square or Fisher＇s exact test. A two-tailed value of P 〈 0.05 was considered statistically significant for all comparisons. statistical analyses were performed by SAS software （version 9.4, SAS Institute Inc., Cary, USA） for Windows. Results： In-hospital primary end point and the secondary end point were no significant differences between two groups （P = 1.000 and P = 1.000, respectively）. No significant differences between two groups were observed according to the long-term primary end point and the secondary end point. Kaplan-Meier survival curves showed no significant difference between the two groups in the primary end point and the secondary end point at 2 years （P- 0.340 and P = 0,243, respectively）. According to Cox analysis, female, intra-aortic balloon pump

关键词： Primary Percutaneous Coronary Intervention Second-generation Drug-eluting stents st-elevation myocardial infarction stent Thrombosis

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Impact of emergency percutaneous coronary intervention on outcomes of st-segment elevation myocardial infarction patients complicated by out-of-hospital cardiac arrest

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Chinese Medical Journal 2012年第8期125卷 1405-1409页

作者： LIU Hong-wei PAN Wei WANG Lan-feng SUN Yan-ming LI Zhu-qin WANG Zhong-hua Coronary Care Unit Division of CardiologyFirst Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiang 150001China

Background Cardiac arrest is one of the most serious complications of acute myocardial infarction （AMI）, especially in the out-of-hospital patients. There is no general consensus as to whether percutaneous coronary intervention （PCI） is effective in treating st-segment elevation myocardial infarction （stEMI） patients complicated by out-of-hospital cardiac arrest （OHCA）. In our study, we evaluated the efficacy of PCI in treating stEMI patients complicated by OHCA through observing their clinical conditions in hospital; including total mortality, adverse cardiac events, stroke, acute renal failure, and gastrointestinal bleeding events. Methods A total of 1827 stEMI patients were enrolled in this study, where 81 were stEMI with OHCA. Between the patients with and without OHCA, and the OHCA patients with and without PCI, we compared the clinical characteristics during hospitalization, including total mortality and incidences of adverse cardiac events, and stroke. Results Compared to the patients without OHCA, the OHCA patients had significantly lower systolic blood pressure （P 〈0.05） and a faster heart rate （P〈0.05）, and a higher percentage of Killip class IV or Glasgow coma scale （GCS）〈7 on admission （P 〈0.001）. And the in-hospital mortality was higher in the OHCA patients （55.6% vs. 2.4%, P 〈0.001）. Comparing the OHCA patients without PCI to the patients with PCI, there was no obvious difference of heart rate, blood pressure or the percentage of Killip class IV and GCS -〈7 on admission, but the incidences of cardiogenic shock, stroke were significantly lower in the with-PCI group during hospitalization （P 〈0.001, P 〈0.05）. And the in-hospital mortality of the OHCA patients receiving PCI was significantly lower （36.7% vs. 84.3%, P 〈0.001）. Conclusions During hospitalization, the incidence of adverse events and mortality are higher in the stEMI with OHCA patients, comparing with the stEMI without OHCA. Emergency PCI reduces the incidence of adverse events and decreases mortality during hospitalization, which is effe

关键词： percutaneous coronary intervention out-of-hospital cardiac arrest st-elevation myocardial infarction prognosis

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The association between the level of serum conjugated bilirubin and mortality in patients with st-segment elevation myocardial infarction undergoing percutaneous coronary intervention

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South China Journal of Cardiology 2023年第3期24卷 138-145页

作者：裴星刘德辉 Department of Cardiology Guangzhou Eighth People's Hospital510060China

Background Even with percutaneous coronary intervention(PCI),patients with st-segment elevation myocardial infarction(stEMI)faced a substantial mortality.We aimed to evaluate the relationship between the level of bilirubin and mortality in patients with stEMI undergoing PCI.Methods Patients with the diagnosis of stEMI and subsequently treated with PCI was enrolled retrospectively in Guangzhou Eighth People's Hospital,from March2013 to October 2019.The primary clinical outcome was in-hospital death,and the secondary clinical outcome was one-year mortality.Results Overall,844 patients were included.The receiver-operation characteristics(ROC)curves analysis showed a higher discriminative ability for conjugated bilirubin(CB=0.805,95%CI:0.703-0.907,Pstic regression analysis,CB≥5.7 umol/L were associated with in-hospital death(OR=10.77,Psting confounding factors,CB≥5.7 umol/L was independently correlated with in-hospital death(OR=5.13,95%CI:1.67-15.75,P=0.004).During one-year follow-up,there were 69(10.5%)patients died in the lower CB group and40(21.3%)patients died in the higher CB group(log-rank=41.90,PstEMI patients treated with PCI.

关键词： st-elevation myocardial infarction Percutaneous coronary intervention Mortality Bilirubin

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The role of neutrophil to platelet ratio in predicting death in elderly patients with st-elevation myocardial infarction receiving percutaneous coronary intervention

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South China Journal of Cardiology 2023年第3期24卷 113-120页

作者：高晶胡培航谢银均卢沛珊廖游玩 Department of Geriatric Intensive Medicine Guangdong Provincial Geriatrics InstituteGuangdong Provincial People's HospitalGuangdong Academy of Medical SciencesSouthern Medical UniversityGuangzhou 510080China

Background Despite receiving percutaneous coronary intervention(PCI),the mortality in elderly patients with st-segment elevation myocardial infarction(stEMI)remains high.The aim of this study was to explore the prognostic value of neutrophil to platelet ratio(NPR)in elderly stEMI patients receiving PCI.Methods Patients≥65 years old with the diagnosis of stEMI who had received PCI was retrospectively enrolled between January 2010 and April 2016 in the Guangdong Provincial People's Hospital.The relationship between NPR and inhospital and 1-year mortality was evaluated.Results A total of 767 elderly patients with stEMI were included and divided into three groups according to the tertiles of NPR:stic regression analysis showed an independent correlation between elevated NPR and in-hospital death[odds ratio(OR)=1.02,95%confidential interval(CI):1.01-1.03,Pstic curve(AUC)analysis demonstrated a relatively high predictive value for NPR in identifying in-hospital death(AUC=0.765,95%CI:0.704-0.825,P54(HR=2.70,95%CI 1.72-4.22,PstEMI receiving PCI.

关键词： st-elevation myocardial infarction neutrophil platelet mortality elderly population

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Development of Primary Percutaneous Coronary Intervention as a National Reperfusion strategy for Patients with st-elevation myocardial infarction and Assessment of Its Use in Egypt

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Cardiovascular Innovations and Applications 2020年第2期4卷 269-278页

作者： Mohamed Sobhy Ahmed Elshal Noha Ghanem Hosam Hasan-Ali Nabil Farag Nireen Okasha El Sayed Farag Mohamed Sadaka Hisham Abo El Enein Sameh Salama Hazem Khamis Khaled Shokry Hany Ragy Amany Elshorbagy Radwa Mehanna Cardiology Department Faculty of MedicineAlexandria University HospitalAlexandriaEgypt International Center for Organization and Marketing AlexandriaEgypt Cardiology Department Faculty of Medicine Assiut University HospitalAssiut GovernorateEgypt Cardiology Department Faculty of Medicine Ain Shams University HospitalHeliopolisEgypt Cardiology Department Nasser InstituteCairoEgypt Cardiology Department Faculty of MedicineZagazig University HospitalZagazigEgypt Cardiology Department Faculty of MedicineBanha University HospitalBanhaEgypt Cardiology Department Faculty of MedicineKasr El Ainy HospitalKasr Al AinyEgypt Cardiology Department Wady El Nile HospitalZeitounEgypt Cardiology Department Military HospitalHeliopolisCairoEgypt Cardiology Department National Heart InstituteHeliopolisCairoEgypt Physiology Department Faculty of MedicineAlexandria UniversityAlexandriaEgypt

Objective:Early treatment of acute ischemia of the heart by performing immediate percutaneous coronary intervention(PCI)to restore blood fl ow in patients with the clinical presentation of an acute coronary syndrome and more specifi cally with st-elevation myocardial infarction(stEMI)can save lives.This study aims to identify the mean time(door to balloon time and fi rst contact to balloon time)to primary PCI for stEMI patients and to assess the percentage of primary PCI and its success rate in Egypt.Methods:A registry study of patients presenting to cardiac centers in Egypt was designed,where patients’basic characteristics,the treatment strategy,and the door to balloon time and the fi rst contact to balloon time were assessed.Results:One thousand six hundred fi fty stEMI patients with a mean age of 57 years were included in the study.Immediate transfer for primary PCI was the most used treatment strategy,representing 74.6%of all treatment strategies used.The door to balloon time and the fi rst contact to balloon time were 50 and 60 minutes,respectively,with a primary PCI success rate of 65.1%.Conclusion:The registry study results showed a marked improvement by implementation of the best treatment strategy with respect to the time factor to achieve a better outcome for stEMI patients in Egypt.

关键词： st-elevation myocardial infarction primary percutaneous coronary intervention door to balloon time fi rst medical contact to balloon time

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Application of N-terminal pro-brain natriuretic peptide concentration and the Global Registry of Acute Coronary Events risk score to predict major adverse cardiac events in patients with st-elevation myocardial infarction after PCI

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South China Journal of Cardiology 2021年第3期22卷 171-176,190页

作者： ZHANG Xue-dan WANG Xi-hui HU Pei-jing DU Zhan-kui The Second Affiliated Hospital of Xi’an Medical College Xi’an 710038shanxichina

Identifying patients with high risk of death after myocardial infarction is a cornerstone of modern cardiovascular health care.The purpose of this study was to explore the predictive ability of N-terminal probrain natriuretic peptide(NT-pro-BNP)concentration and global acute coronary event register(GRACE)risk score in the prognosis of st-segment elevation myocardial infarction(stEMI)patients,to find a better method for early risk stratification and prognosis judgment in the clinical diagnosis and treatment of stEMI patients,and to provide reliable clinical basis for making the best individualized treatment strategies for patients.Methods The final analysis included 118 confirmed stEMI patients who had received acute percutaneous coronary intervention(PCI).Thirty patients with stEMI were included in the major cardiac adverse events(MACEs)group,and the rest were included in the non-MACEs group.Multivariate Cox regression analysis was used to assess the relationship between the risk factors and MACEs.The receiver operator curves(ROC)were used to determine the area under the statistical curve(AUC).The linear correlation analysis confirmed the relationship between NT-proBNP concentration and GRACE score.Results After adjustment for sex,history of current smoking,hypertension,diabetes mellitus,cerebral artery disease and coronary artery vessel lesion(single-vessel lesion,2-vessel lesion,3-vessel lesion),onset time and medication,the multivariate Cox’s regression analysis showed that NT-proBNP concentration and GRACE score were the independent predictors for MACEs in stEMI patients who received PCI.Linear regression analysis showed that the level of NT-pro-BNP was positively correlated with GRACE score(r=0.612,P=0.000).The area under the curve(AUC)for GRACE,NT-pro-BNP and their combination were 0.757,0.723 and 0.782,respectively.Conclusions In a one-year follow-up,the concentration of NTpro-BNP and GRACE score were valuable of prediction for MACEs in stEMI patients who received PCI.In addition,NT-pro-BNP concentration w

关键词： acute myocardial infarction st-elevation myocardial infarction N-terminal-pro-brian natriuretic peptide GRACE prediction MACEs

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