[Show abstract][Hide abstract] ABSTRACT: Background:
Few studies have reported the effect of aldosterone receptor antagonist (ARA) on myocardial remodeling after acute myocardial infarction (AMI). This study was undertaken to investigate the preventive effect of ARA on myocardial remodeling after AMI.
A total of 616 patients who had been admitted into the CCU of the First Affiliated Hospital of Harbin Medical University from January 2008 to January 2010 were studied prospectively. Only 528 patients were observed completely, including 266 of the control group and 262 of the treatment group. There was no statistical difference in age, gender, medical history, admission situation, and treatment between the two groups (P>0.05). The preventive effects of spironolactone on cardiac remodeling, left ventricular function, renal function and blood levels of potassium were evaluated by echocardiography, serum potassium and serum creatinine at one-month and one-year follow-up.
The echocardiography indicators such as LVESD, LVEDD, LVEF, LAD-ML and LAD-SI were significantly improved in the treatment group compared with the control group at one year (P<0.05). In the treatment group, LVESD, LVEDD, LVPWT, LVEF, LAD-ML and LAD-SI were more significantly improved at one year than one month (P<0.05, P=0.007 to LVEF), and in the control group LVEF was more significantly improved at one year than one month (P=0.0277). There were no significant differences in serum potassium and serum creatinine levels between the two groups.
On the basis of conventional treatment, the early combination of low-dose spironolactone (20 mg/d) could inhibit cardiac remodeling at late stage and prevent heart failure.
[Show abstract][Hide abstract] ABSTRACT: 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.
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.
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).
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 effective for treating STEMI with OHCA patients.
Full-text · Article · Apr 2012 · Chinese medical journal
[Show abstract][Hide abstract] ABSTRACT: To evaluate the outcome of ST-elevation acute myocardial infarction (STEMI) patients complicated pre-hospital cardiac arrest underwent percutaneous coronary intervention (PCI).
From September 2004 to November 2008, 1446 consecutive patients with acute STEMI underwent PCI in our department. 49 out of 1446 patients complicated by pre-hospital cardiac arrest. Clinical outcome including total mortality, adverse cardiac events, stroke and bleeding events during the hospitalization period and within 1 year after discharge was compared between patients with or without pre-hospital cardiac arrest.
PCI success rate was similar (85.7% vs. 88.8%, P = 0.497) while the incidence of in-hospital cardiogenic shock 22.4% vs. 3.0%, P < 0.001 and cardiac arrest (44.9% vs. 5.9%, P < 0.001) and in-hospital mortality (36.7% vs. 2.0%, P < 0.001) were significantly higher in patients with pre-hospital cardiac arrest than patients without pre-hospital cardiac arrest. Time from symptom onset to emergency treatment, asystole as initial rhythm, Glasgow coma scale (GCS ≤ 7) and cardiogenic shock on admission were independent risk factors of in-hospital death in patients with pre-hospital cardiac arrest. During follow up, incidences of overall mortality, re-infarction, revascularization and stroke were similar between the two groups.
STEMI patients with pre-hospital cardiac arrest undergoing emergency PCI are facing higher risk of cardiogenic shock and cardiac arrest and higher in-hospital mortality compared to those without pre-hospital cardiac arrest. However, the post-hospital discharge outcome was similar between the two groups.
No preview · Article · Oct 2010 · Zhonghua xin xue guan bing za zhi [Chinese journal of cardiovascular diseases]
[Show abstract][Hide abstract] ABSTRACT: HMG-CoA reductase inhibitors (statins) have antiatherogenic effects beyond their cholesterol-lowing effect. Whether atorvastatin has a stronger antioxidant effect than other statins is uncertain.
To determine the effects of simvastatin and atorvastatin on markers of oxidative stress in patients with coronary heart disease (CHD).
This study was comprised of 164 patients with CHD and a control population of 122 healthy subjects. The patients with CHD were divided into 2 groups and treated with either simvastatin 20 mg/day or atorvastatin 10 mg/day. The markers of oxidative stress were measured before and after 12 weeks of treatment.
The effects of atorvastatin on reducing oxidative stress were significantly greater compared with those of simvastatin (P < 0.05). The changes in the markers of oxidative stress did not correlate with the changes in the plasma lipid profile (P > 0.05).
This study suggests that atorvastatin reduces oxidative stress more effectively than simvastatin.
[Show abstract][Hide abstract] ABSTRACT: To study the efficacy of percutaneous thrombectomy (PT) in improving myocardial microcirculation in elderly acute myocardial infarction (AMI) patients.
A total of 104 patients (> or = 65 years) with AMI and coronary thrombus shown by angiography were randomly divided into a group of percutaneous coronary intervention (PCI) (n=52) and a group of PCI plus PT (n=52). At 24 h and 1 week after PCI, real-time myocardial contrast echocardiography was performed by contrast pulse sequencing technology. Contrast score index, contrast defect length/left ventricle length [CDL/LVL (%)], wall motion score index and wall motion abnormal length/LVL (%) were calculated.
At each time point, in patients treated with PCI plus PT, contrast score index, CDL/LVL (%), wall motion score index and wall motion abnormal length/LVL (%) were significantly lower than that in the PCI group.
Thrombectomy reduces the noreflow and the extent of microvascular obstruction, thus it was a feasible therapy in elderly patients with AMI.
Full-text · Article · Mar 2010 · Coronary artery disease
[Show abstract][Hide abstract] ABSTRACT: 1. In the present study, we investigated the effects of the R219K polymorphism of the ATP-binding cassette transporter A1 (ABCA1) gene on serum lipid levels and the response to statin therapy in Chinese patients with coronary heart disease (CHD). 2. The study population consisted of 365 patients with CHD and 246 control subjects without signs or symptoms of CHD. Patients with CHD were treated with 20 mg/day pravastatin. Fasting serum lipids were determined before and after 12 weeks of treatment. Genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). 3. The R219K polymorphism of the ABCA1 gene was not significantly associated with CHD (P > 0.05). Compared with controls, patients with the RR genotype had significantly higher serum triglyceride levels and lower high-density lipoprotein-cholesterol (HDL-C) levels than those with the KK genotype (P < 0.05). In addition, the effects of pravastatin in increasing HDL-C levels were significantly greater in patients with the KK genotype compared with those with the RR genotype (P < 0.05). 4. In conclusion, the R219K polymorphism of ABCA1 was associated with altered lipoprotein levels and the R219K variant significantly modulated the HDL-C response to pravastatin in Chinese patients with CHD.
No preview · Article · Jun 2009 · Clinical and Experimental Pharmacology and Physiology
[Show abstract][Hide abstract] ABSTRACT: Myocardial ischemia and reperfusion (MI/R) is associated with an intense inflammatory reaction, which may lead to myocyte injury. Because statins protect the myocardium against ischemia-reperfusion injury via a mechanism unrelated to cholesterol lowering, we hypothesized that the protective effect of statins was related to the expression of TNF-alpha (TNF-alpha) and interleukin-10 (IL-10) mRNA. Seventy-two rats were randomly divided into three groups as follows: sham, I/R and I/R+atorvastatin. Atorvastatin (20 mg kg(-1)day(-1)) treatment was administered daily via oral gavage to rats for 2, 7 or 14 days. Ischemia was induced via a 30-min coronary occlusion. Reperfusion was allowed until 2, 7 or 14 days while atorvastatin treatment continued. We measured infarct size, hemodynamics and the plasma levels and the mRNA expression of TNF-alpha and IL-10 in the three groups. We demonstrated that the up-regulation of expression of both TNF-alpha mRNA and IL-10 mRNA was associated the increased plasma levels of TNF-alpha and IL-10 in the ischemic and reperfused myocardium compared with that in the sham group (P<0.01). Atorvastatin treatment prevented ischemia-reperfusion-induced up-regulation of both TNF-alpha and IL-10 mRNA, and improved left ventricular function (P<0.01). Our findings suggested that atorvastatin may attenuate MI/R and better recovery of left ventricle function following ischemia and reperfusion and IL-10 was not directly likely involved in this protective mechanism.
No preview · Article · May 2009 · Biochemical and Biophysical Research Communications
[Show abstract][Hide abstract] ABSTRACT: To investigate whether leptin receptor (LEPR) 223A>G polymorphism influences serum lipid levels and whether this polymorphism affects the effectiveness of simvastatin in Chinese patients with coronary heart disease (CHD).
A total of 312 patients with CHD were treated with simvastatin 20 mg/day. Fasting serum lipids were determined before and after 12 weeks of treatment.
Patients with AA genotype had significantly higher total cholesterol (TC) levels and lower high-density lipoprotein cholesterol (HDL-C) levels than those with GG genotype (P < 0.05) before simvastatin treatment. In addition, the ability of simvastatin to increase HDL-C levels was significantly lower in patients with AA genotype than those with GG genotype (P < 0.05).
The 223A>G polymorphism of LEPR significantly modulates the HDL-C response to simvastatin in Chinese patients with CHD.
No preview · Article · Oct 2008 · European Journal of Clinical Pharmacology
[Show abstract][Hide abstract] ABSTRACT: To assess the safety and efficacy of 40 mg daily atorvastatin in patients with acute myocardial infarction.
A total of 1102 patients with AMI admitted to our hospital from 2003 to 2007 were assigned to atorvastatin 40 mg daily within 24 hours of hospitalization and continued till 3 months post discharge. Patients with LDL-C < 2.0 mmol/L or increased liver enzyme level (3 times higher than normal) at discharge received atorvastatin 20 mg daily. Lipid profiles, high-sensitivity C-reactive protein, liver enzyme level were measured at admission, hospital discharge and 3 months after discharge.
(1)The mean hospitalization duration was (10.17 +/- 1.83) days. LDL-C was continuously decreased [(3.24 +/- 1.04) mmol/L at admission, (2.27 +/- 2.00) mmol/L at discharge and (1.48 +/- 0.78) mmol/L at 3 months after discharge, all P < 0.05]. HDL-C decreased from (1.45 +/- 0.38) mmol/L to (1.20 +/- 0.30) mmol/L at hospital discharge, then increased to (1.65 +/- 1.79) mmol/L at 3 months after hospital discharge (all P < 0.05). TC and apoB were also significantly decreased from admission to discharge (all P < 0.05). (2) high-sensitivity C-reactive protein level significantly decreased from admission to hospital discharge and at 1 months after hospital discharge [(49.71 +/- 50.46) mg/L vs. (8.80 +/- 17.66) mg/L vs. (2.61 +/- 2.30) mg/L, all P < 0.05]. (3) Increased ALT > 120 U/L (3 times higher than normal) were found in 127(11.25%), AST > 120 U/L were found in 26(2.40%) patients at discharge. There were still 4 patients with increased ALT (> 120 U/L) at 1 months after discharge and all returned to normal at 3 months after discharge.
Intensive atorvastatin therapy with a dose of 40 mg daily is safe and effective for patients with AMI.
No preview · Article · Jul 2008 · Zhonghua xin xue guan bing za zhi [Chinese journal of cardiovascular diseases]
[Show abstract][Hide abstract] ABSTRACT: To study the efficacy of the percutaneous thrombectomy on no-reflow in the patients with acute myocardial infarction (AMI) with angiographically proven thrombus.
A total of 68 patients suffering from AMI with coronary thrombus shown by angiography were randomly divided into a group of percutaneous coronary intervention (PCI) therapy (n = 34) and a group of PCI plus percutaneous thrombectomy (n = 34). At 24 hours and 1 week after PCI, real-time imaging was performed by contrast pulse sequencing technology. Contrast score index (CSI), regional wall motion score index (WMSI), endocardial length of contrast defect (CDL) and wall motion abnormality (WML) were calculated.
In patients treated with a percutaneous thrombectomy, CSI, WMSI, CDL/left ventricular length (LV), and WML/LV were significantly lower than in PCI group at both time points of observation, and these indexes were markedly decreased at 1 week after PCI compared with 24 hours after PCI (P<0.05 or P<0.01).
The beneficial effect of the thrombectomy occurs at the microvascular level. Thrombectomy reduces the no-flow phenomenon and the extent of microvascular obstruction, thus it is a feasible therapy in patients with AMI.
No preview · Article · Nov 2007 · Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue
[Show abstract][Hide abstract] ABSTRACT: To evaluate the prognostic significance of hyponatremia in patients with AMI.
The study population consisted of 670 patients with AMI in coronary care unit in our hospital from January 2003 to December 2004. The patients were designed into three groups according to serum sodium concentration within twenty four to forty eight hours following the onset of AMI: Group A. Na(+) > or = 135 mmol/L; Group B. Na(+) 120-135 mmol/L; Group C. Na(+) < or = 120 mmol/L. The data of myocardial enzymes, myocardial infarction size, heart function and inhospital mortality were analyzed retrospectively.
1. The inhospital mortality of each group: group A was 7.6% (17/225), group B was 8.1% (34/421), group C was 33.3% (8/24). The difference between group C and group B or group A was significant. The P value was little than 0.05. 2. Activities of serum creatine phosphatase kinase and serum creatine phosphatase kinase isoenzymes and myocardial infarction sizes in each group were different (P < 0.05). 3. 59 cases of all died and 611 cases of all recovered in duration of hospital stay. Serum sodium concentrations of the recovered group were (133.00 +/- 5.25) mmol/L, and that of the died group were (122.00 +/- 7.25) mmol/L (P < 0.01). 4. In a multivariate logistic regression analysis, hyponatremia was associated with 30-day mortality in patients with AMI. In analysis of the association between the degree of hyponatremia and outcome, we observed that the risk of 30-day mortality increased with the severity of hyponatremia.
Hyponatremia may be one of the important markers that predict a worse prognosis in patients with AMI.
No preview · Article · Mar 2006 · Zhonghua xin xue guan bing za zhi [Chinese journal of cardiovascular diseases]