Objective To estimate the incidence of post-myocardial infarction depression among Chinese acute myocardial infarction (AMI) patients by meta-analysis and to provide references for the management of AMI patients. Methods We searched databases including PubMed, The Cochrane Library (Issue 6, 2016), CNKI, CBM, WanFang Data and VIP from January 2000 to July 2016, to collect literature regarding the incidence of post-myocardial infarction depression among patients with AMI. Two reviewers independently screened literature, extracted data and evaluated the methodological quality of the included studies. Then meta-analysis was performed by using Comprehensive Meta Analysis (CMA) 2.0 software. Results Totally, 22 cross-sectional studies were included, involving 2 986 AMI patients, of which1 239 were post-myocardial infarction depression patients. The overall incidence of post-myocardial infarction depression among the AMI patients was 42.7% (95%CI 36.3% to 49.4%). There was no statistical differences observed when the studies were stratified by sex, regions, scales and years (allP values>0.05). Conclusion In China, the incidence of post-myocardial infarction depression is high and rising year by year roughly among AMI patients. The status should be paid more attention.
Objective To investigate the early and long-outcomes of coronary artery bypass grafting(CABG) in acute myocardial infarction (AMI) patients with coronary artery disease(CAD)(age≤45 years). Methods Data of 596 adult CAD patients (include AMI and Angina) who underwent CABG in our hospital were collected retrospectively from May 2010 to October 2018. In an AMI group, 234 were male patients with an average age of 41.59±3.79 years; 26 were female patients with an average age of 41.64±3.03 years. In an angina group, 280 were male patients with an average age of 42.19±2.90 years; 56 were female patients with an average age of 41.54±3.52 years. Preoperative baseline variables, perioperative mortality, major adverse cardiac and cerebrovascular events (MACCE) were compared between two group. Results There was no significant difference in all preoperative variables. Seven patients were died and the hospital mortality rate was 1.23% (1.54% vs. 0.89%, P=0.477). The complications including reoperation for bleeding, cerebral infarction, renal failure and atrial fibrillation arrhythmia were without significant difference between two group (P>0.05). The intensive care unit stay duration (30.66±27.46 h vs. 23.96±15.11 h), intubation duration (22.54±22.31 h vs. 18.64±11.81 h) and hospitalization costs (97 186±33 741¥ vs. 90 081±24 537¥, P=0.003) were greater in the AMI group. The hospital mortality rate and complications rate were without significant difference between STEMI (ST segment elevated myocardial infarction) and NSTEMI (non-ST-segment elevated myocardial infarction) subgroups (P>0.05). The follow-up rate was 92.6% (546 patients) and the follow-up time was 4 (0.5 to 8.5) years. All cause-mortality rate was 3.85% (21 patients), and freedom MACCE was 72.2%. The freedom from MACCE, recurred angina and cerebral infarction were without significant difference, but AMI was associated with higher rate of PCI procedure. Conclusion CABG procedure in CAD patients under 45 years accompanied AMI is safety and reliable both in early and the long-term outcomes.
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.
【摘要】 目的 观察70岁以上老年心肌梗死急性期血清胱抑素C（cystatin C，CysC）水平，探讨急性心肌梗死后CysC水平变化的意义。 方法 顺序入选2010年7月-2011年7月期间70岁以上急性心肌梗死患者58例及正常对照58例。入选对象均经冠状动脉造影检查确诊或排除诊断，记录急性心肌梗死患者梗死部位和梗死相关血管，并计算Gensini积分。所有入选对象采血，使用乳胶增强免疫透射比浊法测定急性期血清CysC水平。 结果 心肌梗死急性期，血清CysC水平低于正常对照组（Plt;0.05）；不同冠状动脉病变评分与血清CysC水平呈负相关，Gensini积分越高，血清CysC水平越低。 结论 血清CysC与冠心病关系密切。检测CysC，为冠心病的风险预测、老年患者危险分层和治疗提供一条新的线索和途径。
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.
目的:观察血清C-反应蛋白(CRP) 水平与急性心肌梗死(AMI)患者6个月时心功能及病死率的关系。方法:入选我院572例AMI住院患者,根据入院时CRP水平分为CRP升高组及CRP正常组,随访6个月,记录超声心动图结果及死亡例数。结果:两组基线资料无明显差异。与入院时CRP正常组比较,CRP升高组患者6个月时LVEDD、LVESD,住院期间及随访期间病死率显著增加,而6个月时LVEF显著降低 (P lt; 0.05)。多因素分析结果显示入院时CRP升高是AMI患者住院期间及6个月病死率的独立危险因素。结论:血清CRP升高是AMI患者心功能及病死率的预测因素,关注AMI患者血清CRP水平,尽早开始控制,有利于改善AMI的预后。
目的 探讨急性心肌梗死冠状动脉介入治疗（PCI）术后患者梗死区心肌存活性对左室重构及功能的影响。 方法 2006年2月－2010年12月208例急性心肌梗死急诊PCI术后的患者接受静息状态下18氟-脱氧葡萄正电子断层显像进行心肌代谢显像检查，根据基线梗死区心肌有无存活分为两组，同时进行超声心动图检查，评价左室壁运动、左室射血分数，左室舒张末内径、左房内径及舒张期二尖瓣血流速度峰值的比值。血运重建术后12个月随访超声心动图，观察梗死区心肌存活状态对于左室重构以及心功能的影响。 结果 PCI术后12个月，有存活心肌组左室射血分数（46.7 ± 6.98）%高于无存活心肌组（45.1 ± 7.12）%，两组差异有统计学意义（P＜0.01），有存活心肌组左室舒张末期内径（53.17 ± 3.89） mm小于无存活心肌组（55.46 ± 4.75） mm，两组差异有统计学意义（P＜0.05）。左房内径及舒张期二尖瓣血流速度峰值的比值两组随访时均无明显变化。 结论 急性心肌梗死行PCI治疗后的患者，在有存活心肌的情况下，心功能改善明显；而梗死区无心肌存活的患者，12个月后，心功能减低，左室重构更加明显。
ObjectiveTo identify the risk factors for hospital mortality in patients with acute myocardial infarction (AMI) after emergency coronary artery bypass grafting (CABG).MethodsWe retrospectively analyzed the clinical data of 145 AMI patients undergoing emergency CABG surgery in Qingdao Municipal Hospital from 2009 to 2019. There were 108 (74.5%) males and 37 (25.5%) females with a mean age of 67.7±11.5 years. According to whether there was in-hospital death after surgery, the patients were divided into a survival group (132 patients) and a death group (13 patients). Preoperative and operative data were analyzed by univariate analysis, followed by multivariate logistic regression analysis, to identify the risk factors for hospital mortality.ResultsOver all, 13 patients died in the hospital after operation, with a mortality rate of 9.0%. In univariate analysis, significant risk factors for hospital mortality were age≥70 years, recent myocardial infarction, left ventricular ejection fraction (LVEF)<30%, left main stenosis/dissection, operation time and simultaneous surgeries (P<0.05). Multivariate logistic regression analysis showed that LVEF<30% (OR=2.235, 95%CI 1.024-9.411, P=0.014), recent myocardial infarction (OR=4.027, 95%CI 1.934-14.268, P=0.032), operation time (OR=1.039, 95%CI 1.014-1.064, P=0.002) were independent risk factors for hospital mortality after emergency CABG.ConclusionEmergency CABG in patients with AMI has good benefits, but patients with LVEF<30% and recent myocardial infarction have high in-hospital mortality, so the operation time should be shortened as much as possible.