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The contribution of gender and age on early and late mortality following st-segment elevation myocardial infarction： results from the Korean Acute myocardial infarction National Registry with Registries

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Journal of Geriatric Cardiology 2018年第3期15卷 205-214页

作者： Ae-Young Her Etm-Seok Shin Yong Hoon Kim Scot Garg Myung Ho Jeong Division of Cardiology Department of Internal Medicine Kangwon National University School of Medicine Chuncheon South Korea Department of Cardiology Ulsan University Hospital University of Ulsan College of Medicine Ulsan Republic of Korea East Lancashire Hospitals NHS Trust Blackburn Lancashire UK The Heart Center of Chonnam National University Hospital Gwangju Republic of Korea

Background Although previous studies using Korean data have already reported higher rates of mortality in women, it is less clear whether these gender differences in prognosis post st-segment elevation myocardial infarction （stEMI）, are age dependent. The aim of this study is to examine the gender-age interaction with early and late mortality in patients with stEMI enrolled in the Korean nationwide regis-try. Methods This prospective study stratified outcomes according to gender and age from 17,021 stEMI patients. We compared in-hospital, early （30 days） and late （12 months） mortality between gender to examine the gender-age interaction in multivariable models. Results In younger women （〈 60 years）, in-hospital [5.8% vs. 2.5%, P 〈 0.001; unadjusted odds ratios （OR）： 2.41, 95% confidence inter-vals （CI）： 1.59-3.66], early （6.2% vs. 2.6%, P 〈 0.001; unadjusted OR： 2.4, 95% CI： 2.12-2.72） and late mortality （7.0% vs. 3.1%, P 〉 0.001; unadjusted OR： 2.33, 95% CI： 2.08-2.61） were significantly higher compared with men. However, after adjustment for patient characteristics, Killip class ≥ 3, symptom to balloon time and major bleeding, and in-hospital bleeding, overall early and late mortality were no longer re-lated to gender in any age groups. Conclusions Among a Korean population with stEMI, higher early and late mortality in younger women may be explained by poor patient characteristics, higher Killip class ≥3, longer symptom to balloon time and more frequent major bleeding. Therefore, based on gender-age differences, more precise and aggressive preventive strategies focused on risk factor reduction, education and more intensive management for yotmger women should be performed.

关键词： Age Gender Mortality st-segment elevation myocardial infarction

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Effects of nicorandil on myocardial infarct size in patients with st-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention:study design and protocol for the randomized controlled trial

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Journal of Geriatric Cardiology 2020年第8期17卷 519-524页

作者： Xiao-Si JIANG Li-Chao TIAN Zi-Chao JIANG Yu-Ting ZOU Ping LI Xin-Chun YANG Xi SU Jin-Wen TIAN Bei SHI Zong-Zhuang LI Yong-Jun LI Ren-Qiang YANG Geng QIAN Yun-Dai CHEN Department of Cardiology the First Medical Center of Chinese PLA General HospitalBeijingChina The School of Medicine Nankai UniversityTianjinChina Department of Cardiology the First People's Hospital of YunlinGuangxiChina Department of Cardiology Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina Department of Cardiology Wuhan Asia Heart HospitalWuhanChina Department of Cardiology Hainan Hospital of PLA General HospitalHainanChina Department of Cardiology Affiliated Hospital of Zunyi Medical CollegeGuizhouChina Department of Cardiology Guizhou Provincial People's HospitalGuizhouChina Department of Cardiology the Second Hospital of Hebei Medical UniversityHebeiChina Department of Cardiology the Second Affiliated Hospital of Nanchang UniversityJiangxiChina

Previous studies have shown that nicorandil has a protective effect on ***,there is no study to investigate whether perioperative intravenous nicorandil can further reduce the myocardial infarct size in patients with st-segment elevation myocardial infarction(stEMI)compared to the current standard of percutaneous coronary intervention(PCI)*** CHANGE(China-Administration of Nicorandil Group)study is a multicenter,prospective,randomized,double-blind and parallel-controlled clinical study of stEMI patients undergoing primary PCI in China,aiming to evaluate the efficacy and safety of intravenous nicorandil in ameliorating the myocardial infarct size in stEMI patients undergoing primary PCI and provide evidence-based support for myocardial protection strategies of stEMI patients.

关键词： Cardiovascular disease myocardial infarct size Nicorandil Primary percutaneous coronary intervention st-segment elevation myocardial infarction

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stenting versus non-stenting treatment of intermediate stenosis culprit lesion in acute st-segment elevation myocardial infarction： a multicenter random- ized clinical trial

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Journal of Geriatric Cardiology 2017年第2期14卷 108-117页

作者： Jing DAI Shu-Zheng LYU Yun-Dai CHEN Xian-Tao SONG Min ZHANG Wei-Min LI Yang ZHENG Shang-Yu WEN Shao-Ping NIE Yu-Jie ZENG Hai GAO Yi-Tong MA Shu-Yang ZHANG Li-Jun GUO Zheng ZHANG Department of Cardiology Capital Medical University Affiliated Beijing Anzhen Hospital Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing China Department of Cardiology Chinese PLA General Hospital Beijing China Department of Cardiology the First Affiliated Hospital of Harbin Medical University Harbin Heilongjiang China Department of Cardiology the First Bethune Hospital of Jilin University Changchun Jilin China Department of Cardiology Daqing Oi[field General Hospital Daqing Heilongjiang China Department of Cardiology the First Affiliated Hospital of Xinjiang Medical University Urumchi Xinjiang Uygur Autonomous Region China Department of Cardiology Peking Union Medical College Hospital Beijing China Department of Cardiology Peking University Third Hospital Beijing China Department of Cardiology the First Hospital of Lanzhou University Lanzhou Gansu China

Background The benefit/risk ratio of stenting in acute st-segment elevation myocardial infarction （stEMI） patients with single vessel intermediate stenosis culprit lesions merits further study, therefore the subject of the present study. Methods and results It was a pro- spective, multicenter, randomized controlled trial. Between April 2012 and July 2015, 399 acute stEMI patients with single vessel disease and intermediate （40%-70%） stenosis of the culprit lesion before or after aspiration thrombectomy and/or intracoronary tirofiban （15 pg/kg） were enrolled and were randomly assigned （h 1） to stenting group （n = 201） and non-stenting group （n = 198）. In stenting group, patients received pharmacologic therapy plus standard percutaneous coronary intervention （PCI） with stent implantation. In non-stenting group, pa- tients received pharmacologic therapy and PCI （thrombectomy）, but without dilatation or stenting. Primary endpoint was 12-month rate of major adverse cardiac and eerebrovascular events （MACCE）, a composite of cardiac death, non-fatal myocardial infarction （M1）, repeat re- vascularization and stroke. Secondary endpoints were 12-month rates of all cause death, ischemia driven admission and bleeding complica- tion. Median follow-up time was 12.4 ~ 3.1 months. At 12 months, MACCE occurred in 8.0% of the patients in stenting group, as compared with 15.2% in the non-stenting group （adjusted HR： 0.42, 95% Ch 0.19-0.89, P = 0.02）. The stenting group had lower non-fatal MI rate than non-stenting group, （1.5% vs. 5.5%, P = 0.03）. The two groups shared similar cardiac death, repeat revascularization, stroke, all cause death, ischemia driven readmission and bleeding rates at 12 months. Conclusions stent implantation had better efficacy and safety in reducing MACCE risks among acute stEMI patients with single vessel intermediate stenosis culprit lesions.

关键词： Acute myocardial infarction Anti-thrombotic therapy Clinical trial Primary percutaneous coronary intervention stent st-segment elevation myocardial infarction

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Culprit vessel only versus ＂one-week＂ staged percutaneous coronary intervention for multivessel disease in patients presenting with st-segment elevation myocardial infarction

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Journal of Geriatric Cardiology 2015年第3期12卷 226-231页

作者： Li-Xiang MA Zhen-Hua LU Le WANG Xin DU Chang-Sheng MA Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beo'ing China

Objective To explore the impact of a ＂one-week＂ staged muhivessel percutaneous coronary intervention （PCI） versus culprit-only PCI on deaths and major adverse cardiac events （MACE）. Methods We retrospectively analyzed 447 patients with multivessel disease who experienced a st-segment elevation myocardial infarction （stEMI） within 12 h before undergoing PCI between July 26, 2008 and Septem- ber 25, 201 l. After completion of PCI in the infarct artery, 201 patients still in the hospital agreed to undergo PCI in non-infarct arteries with more than 70% stenosis for a ＂one-week＂ staged multivessel PCI. A total of 246 patients only received intervention for the culprit vessel. Follow-up ended on September 9, 2014. This study examined the differences in deaths from any cause （i.e., cardiac and noncardiac） and MACE between the two treatment groups. Results Compared to a culprit-only PCI treatment approach, the ＂one-week＂ staged multivessel PCI was strongly associated with greater benefits for 55-month all cause death [41 （16.7%） vs. 13 （6.5%）, P = 0.004] and MACE [82 （33.3%） vs. 40 （19.9%）, P = 0.002] rates. In addition, there were significant differences in the number of myocardial infarctions [43 （17.5%） vs. 20 （10.0%）, P = 0.023], coronary-artery bypass grafting [CABG; 20 （8.1%） vs. 6 （3.0%）, P = 0.021], and PCI [31 （12.6%） vs. 12 （6.0%）, P - 0.018]. Patients undergoing culprit-only PCI compared to ＂one-week＂ PCI had the same number of stent thrombosis events [7 （2.8%） vs. 3 （1.5%）, P - 0.522]. Conclusions Compared to a culprit-only PCI treatment approach, ＂one-week＂ staged multi-vessel PCI was a safe and effective selection for stEMI and multi-vessel PCL

关键词： st-segment elevation myocardial infarction Percutaneous coronary intervention Multivessel revascularization

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Long-term outcomes of staged recanalization for concurrent chronic total occlusion in patients with st-segment elevation myocardial infarction after primary percutaneous coronary intervention

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Journal of Geriatric Cardiology 2020年第1期17卷 16-25,I0002-I0007页

作者： Kong-Yong CUI Fei YUAN Hong LIU Feng XU Min ZHANG Wei WANG Ming-Duo ZHANG Yun-Lu WANG Dong-Feng ZHANG Xiao ZHANG Jin-Fan TIAN Shu-Zheng LYU Department of Cardiology Beijing Anzhen HospitalCapital Medical University and Beijing Institute of HeartLung and Blood Vessel DiseasesBeijingChina Department of Anesthesiology Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina Department of VIP Clinic Beijing Anzhen HospitalCapital Medical UniversityBeijingChina

Background In patients with acute st-segment elevation myocardial infarction(stEMI)who undergo primary percutaneous coronary intervention(PCI),approximately 10%are concomitant with a chronic total occlusion(CTO)in a non-culprit ***,the impact of staged CTO recanalization on prognosis in this cohort remains *** study aimed to compare the long-term outcomes of staged CTO recanalization versus medical therapy in patients with stEMI after primary *** Between January 2005 and December 2016,a total of 287 patients were treated with staged CTO-PCI(n=91)or medical therapy(n=196)after primary PCI in our *** primary endpoint was major adverse cardiovascular and cerebrovascular event(MACCE),defined as a composite of all-cause death,nonfatal myocardial infarction(MI),stroke or unplanned *** propensity-score matching,77 pairs of well-balanced patients were *** The mean follow-up period was 6.06 ***,the incidence of the primary endpoint of MACCE was significantly lower in staged CTO-PCI group than that in medical therapy group in both overall population(22.0%vs.46.9%;hazard ratio(HR)=0.48,95%CI:0.29-0.77)and propensity-matched cohorts(22.1%vs.42.9%;HR:0.48,95%CI:0.27-0.86).In addition,staged CTO-PCI was also associated with reduced risk of the composite of cardiac death,nonfatal MI or stroke compared with medical therapy in both overall population(9.9%vs.26.5%;hazard ratio(HR)=0.39,95%CI:0.19-0.79)and propensity-matched cohorts(9.1%vs.22.1%;HR:0.40,95%CI:0.16-0.96).After correction of the possible confounders,staged CTO-PCI was independently associated with reduced risks of MACCE(adjusted HR:0.46,95%CI:0.28-0.75),the composite of cardiac death,nonfatal MI or stroke(adjusted HR:0.45,95%CI:0.22-0.94)and all-cause mortality(adjusted HR:0.32,95%CI:0.13-0.83).Moreover,the results of sensitivity analysis were almost concordant with the overall *** In patients with stEMI and a concurrent

关键词： Concurrent chronic total occlusion Long-term outcome staged recanalization st-segment elevation myocardial infarction

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Post-dilatation improves stent apposition in patients with st-segment elevation myocardial infarction receiving primary percutaneous intervention: A multicenter, randomized controlled trial using optical coherence tomography

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World Journal of Emergency Medicine 2020年第2期11卷 87-92页

作者： Jun Jiang Nai-liang Tian Han-bin Cui Chang-ling Li Xian-bao Liu Liang Dong Yong Sun Xiao-min Chen Shao-liang Chen Bo Xu Jian-an Wang Department of Cardiology the Second Affi liated Hospital of Zhejiang University School of MedicineHangzhouChina Department of Cardiology Nanjing First HospitalNanjingChina Department of Cardiology Ningbo First HospitalNingboChina Department of Cardiology Fuwai HospitalNational Center for Cardiovascular DiseasesBeijingChina

BACKGROUND: stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying st-segment elevation myocardial infarction(stEMI).This study assessed the effectiveness of post-dilatation in primary percutaneous coronary intervention(pPCI) for acute ***: The multi-center POst-stEMI trial enrolled 41 consecutive stEMI patients with symptom onset stent *** were randomly assigned to control group(n=20) or post-dilatation group(n=21) in which a non-compliant balloon was inflated to >16 atm *** apposition and coverage were evaluated by optical coherence tomography(OCT) after intracoronary verapamil administration via thrombus aspiration catheter, post pPCI and at 7-month *** primary endpoint was rate of incomplete strut apposition(ISA) at 7 months after ***: There were similar baseline characteristics except for stent length(21.9 [SD 6.5] mm vs.26.0 [SD 5.8] mm, respectively, P=0.03).In post-dilatation *** group, ISA rate was lower(2.5% vs.4.5%, P=0.04) immediately after pPCI without affecting final TIMI flow 3 rate(95.2% vs.95.0%, P>0.05) or corrected TIMI frame counts(22.6±9.4 vs.22.0±9.7, P>0.05); and at 7-month follow-up(0.7% vs.1.8%, Pstudy endpoint, with similar strut coverage(98.5% vs.98.4%, P=0.63) and 1-year rate of major adverse cardiovascular events(MACE).CONCLUSION: In stEMI patients, post-dilatation after stent implantation and thrombus aspiration improved strut apposition up to 7 months without affecting coronary blood flow or 1-year MACE *** and longer term studies are warranted to further assess safety(Clinical *** identifier: NCT02121223).

关键词： st-segment elevation myocardial infarction Post-dilatation Incomplete strut apposition Optical coherence tomography

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Relationship of Microvascular Obstruction with Global and Regional myocardial Function Determined by Cardiac Magnetic Resonance after st-segment elevation myocardial infarction

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Chinese Medical Sciences Journal 2023年第1期38卷 11-19页

作者： Ya-Nan Zhao Jia-Ning Cui Xing-Hua Zhang Jin-Feng Li Shi-Min Chen Xiu-Zheng Yue Tao Li Department of Radiology First Medical Center of Chinese People’s Liberation Army General HospitalBeijing 100853China Department of Epidemiology and statistics graduate school of Chinese People’s Liberation Army General HospitalBeijing 100853China Philips Healthcare Beijing 100600China

Objective To investigate the impact of microvascular obstruction(MVO)on the global and regional myocardial function by cardiac magnetic resonance feature-tracking(CMR-FT)in st-segment-elevation myocardial infarction(stEMI)patients after percutaneous coronary *** Consecutive acute stEMI patients who underwent cardiac magnetic resonance imaging 1-7 days after successful reperfusion by percutaneous coronary intervention treatment were included in this retrospective *** on the presence or absence of MVO on late gadolinium enhancement images,patients were divided into groups with MVO and without *** infarct zone,adjacent zone,and remote zone were determined based on a myocardial 16-segment *** radial strain(RS),circumferential strain(CS),and longitudinal strain(LS)of the global left ventricle(LV)and the infarct,adjacent,and remote zones were measured by CMRFT from cine images and compared between patients with and without MVO using independent-samples *** regression analysis was used to assess the association of MVO with the impaired LV *** A total of 157 stEMI patients(mean age 56.66±11.38 years)were *** was detected in 37.58%(59/157)of stEMI patients,and the mean size of MVO was 3.00±3.76 *** with patients without MVO(n=98),the MVO group had significantly reduced LV global RS(t=-4.30,Pstic regression analysis,while only heart rate(OR=1.08,95%CI:1.03-1.13,P=0.001)and LV infarct size(OR=1.10,95%CI:1

关键词： cardiac magnetic resonance feature tracking st-segment elevation myocardial infarction microvascular obstruction myocardial strain myocardial function

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Effects of Loading-Dose statins Combined with PCSK9 Inhibitor Pre-Treatment before Primary Percutaneous Coronary Intervention on the Short-Term Prognosis in Patients with st-segment elevation myocardial infarction

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Cardiovascular Innovations and Applications 2022年第3期7卷 8-15页

作者： Zhe Wang Qingbo Bao Xiaojian Song Hengjie Song Shoudong Wei Junwei Lv Fei Wang Jian An Department of Cardiology Shanxi Cardiovascular Disease HospitalTaiyuanChina Emergency Department Shanxi Cardiovascular Disease HospitalTaiyuanChina Cardiac Catheterization Laboratory Shanxi Cardiovascular Disease HospitalTaiyuanChina Department of Geriatric Medicine Shanxi Cardiovascular Disease HospitalTaiyuanChina

Objective:This study was aimed at investigating the effects of preoperative treatment with a loading dose of statins combined with a PCSK9 inhibitor on coronary blood perfusion and short-term cardiovascular adverse events in patients with st-segment elevation myocardial infarction(stEMI).Method:Sixty-five patients with stEMI who had visited the Shanxi Cardiovascular Disease Hospital between May 2018 and May 2021 were enrolled in the *** enrolled patients had no history of oral statins or antiplatelet *** patients were divided into a combined treatment group(loading dose of statins combined with PCSK9 inhibitors,35 patients)and a routine treatment group(loading dose of statins only,30 patients).The primary endpoints were thrombolysis in myocardial infarction(TIMI)blood flow grading,corrected TIMI frame count(CTFC),and TIMI myocardial perfusion grading(TMPG),immediately after and 30 days after the *** secondary endpoint was a composite endpoint of cardiovascular death,nonfatal myocardial infarction,and target vessel revascularization 30 days after the ***:The combined treatment group had significantly lower CTFC(14.09±8.42 vs 26±12.42,P=0.04)and better TMPG(2.74±0.61 vs 2.5±0.73,P=0.04)than the routine treatment group immediately after the ***,the combined treatment group had a significantly lower CTFC(16.29±7.39 vs 26.23±11.53,P=0.04)and significantly better TMPG(2.94±0.24 vs 2.76±0.43,P=0.01)than the routine treatment group 1 month after the ***:Preoperative treatment with a loading dose of high-intensity statins combined with PCSK9 inhibitors increased coronary blood flow and myocardial perfusion after emergency thrombus aspiration in patients with ***,the treatment did not significantly decrease the incidence of cardiovascular death,nonfatal myocardial infarction,or target vessel revascularization.

关键词： PCSK9 inhibitor st-segment elevation myocardial infarction thrombus aspiration

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Comparison of Diver CE and ZEEK manual aspiration catheters for thrombectomy in st-segment elevation myocardial infarction

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Chinese Medical Journal 2009年第6期122卷 648-654页

作者： ZHAO Han-jun YAN Hong-bing WANG Jian SONG Li LI Qing-xiang LI Shi-ying CHI Yun-peng WU Zheng ZHANG Xiao-jiang ZHAO Yong ZHENG Bin 28th Division Beijing Anzhen Hospital of Capital Medical University Beijing 100029 China

Background A growing volume of data suggests that simple manual thrombus aspiration followed by direct stenting improves myocardial reperfusion and clinical outcome compared with conventional primary PCI, but there is still limited data comparing the in vivo performance among different devices. This study aimed to compare the efficacy and operability of thrombus aspiration by the Diver CE （Invatec, Brescia, Italy） and ZEEK （Zeon Medical Inc., Tokyo, Japan） aspiration catheters in st-segment elevation myocardial infarction （stEMI） and their impact on 3-month outcome.Methods From September 2004 to June 2008, 298 consecutive patients with stEMI who received manual thrombus aspiration were involved in a single center retrospective analysis. Of them, 229 and 69 were treated with Diver CE and ZEEK aspiration catheters, respectively. Primary endpoints were myocardial blush grade （MBG）, thrombolysis in myocardial infarction （TIMI） flow grade, st-segment elevation resolution （stR）, device pushability and trackability as judged by the frequency of usage of dual guide wires and aspiration efficacy as indicated by size distribution of aspirated thrombi. Secondary endpoints were 3-month outcome including left ventricular end diastolic diameter （LVEDD）, left ventricular ejection fraction （LVEF）, as well as cardiac death, target lesion revascularization （TLR）, re-infarction and their combination as major adverse cardiac events （MACE）. Results Baseline characteristics were not different between the two groups expect for a higher frequency of temporary cardiac pacing in the ZEEK group （ZEEK） than in the Diver CE group （Diver CE）（0.44% vs 5.8%, P=0.002）. Visible retrieved thrombi were achieved in 65.9% of the Diver CE and 68.1% of the ZEEK （P=0.74）. Aspirated thrombi were categorized as small thrombi （〈3.5 mm）, moderate thrombi （3.5-7.0 mm） and large thrombi （〉7.0 mm）. Small thrombi were more frequently seen in the Diver CE （61.6% vs 42.6%）, whereas moderate and larger thrombi wer

关键词： primary percutaneous coronary intervention st-segment elevation myocardial infarction manual thrombus aspiration

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Chinese Medical Journal 2018年第12期131卷 1420-1429页

作者： Wen-Xia Fu Tie-Nan Zhou Xiao-Zeng Wang Lei Zhang Quan-Min Jing Ya-Ling Han Department of Cardiology The General Hospital of Shenyang Military Region Shenyang Liaoning 110016 China

Background： Females with st-segment elevation myocardial infarction （stEMI） have higher in-hospital and short-term mortality rates compared with males in China, suggesting that a sex disparity exists. The age of onset of stEM1 is ahead of time and tends to be younger. However, there are relatively little data on the significance of sex on prognosis for long-term outcomes for adult patients with stEMI alter percutaneous coronary intervention （PCI） in China. This study sought to analyze the sex differences in 30-day, l-year, and long-term net adverse clinical events （NACEs） in Chinese adult patients with stEMI after PCI. Methods： This study retrospectively analyzed 1920 consecutive stEMI patients （age 〈60 years） treated with PCI fYom January 01, 2006, to December 31,2012. A propensity score analysis between males and females was perfimned to adjust tbr differences in baseline characteristics and comorbidities. The primary endpoint was the incidence of 3-year NACE. Survival curves were constructed with Kaplan- Meier estimates and compared by log-rank tests between the two groups. Multivariate analysis was perforated using a Cox proportional hazards model for 3-year NACE. Results： Compared with males, females had higher risk profiles associated with old age, longer prehospital delay at the onset of stEMI, hypertension, diabetes mellitus, and chronic kidney disease, and a higher Killip class （≥3）, with more multivessel diseases （P 〈 0.05）. The female group had a higher levels of low-density lipoprotein （2.72 [2.27, 3.29] vs. 2.53 [2,12, 3.00], P 〈（1.001）, high-density lipoprotein （ 1.43 [1.23, 1.71] vs. 1.36 [1.11, 1.63], P - 0.003）, total cholesterol （4.98±1.10 vs. 4.70 ±1.15, t = -3.508, P 〈 0.001）, and estimated glomerular filtration rate （103.12 ± 22.22 vs. 87.55 ±18.03, t = 11.834, P〈 0.001 ） than the male group. In the propensity-matched analysis, being female was associated with a higher risk for 3-year NACE and major adverse cardiac or cerebral events compared w

关键词： Percutaneous Coronary Intervention: Prognosis Sex st-segment elevation myocardial infarction

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