Objective To observe the effects of taurine on ventricular remodeling of rats with acute myocardial infarction (AMI) though the establishment of rat AMI model by ligating the left anterior descending coronary branch. Methods Sixty 8-week-old male Wistar rats were randomly divided into four groups: sham group, AMI group, small-dose and high-dose taurine group, with 15 rats in each. Rats in the AMI group and taurine groups received ligation of the anterior descending coronary branch to establish an animal model of AMI. Meanwhile, rats in the sham group were subjected to sham coronary ligature. From the next day of the operation, rats in the taurine groups were dosed orally per day with taurine 300 mg/kg or 400 mg/kg for 8 weeks, respectively. Echocardiographic images were acquired before and 8 weeks after the operation, to get the indexes such as left ventricular end systolic diameter (LVIDs), left ventricular end diastolic diameter (LVIDd), left ventricular posterior wall end diastolic thickness (LVPWd), left ventricular ejection fraction (LVEF), fractional shortening (FS), mitral inflow velocity E (E), mitral inflow velocity A (A), and E/A ratio, and all the measurements above were expressed as the average of 6 consecutive cardiac cycles. After the animals were executed, cardiac mass and left ventricular mass were measured, and cardiac mass index (CMI) and left ventricular mass index (LVMI) were calculated. Brain natriuretic peptide (BNP) in all groups were measured by enzyme-linked immunosorbent assay before and 8 weeks after the operation. Results In comparison with the AMI group, CMI, LVMI, LVIDd and LVIDs of the small-dose and high-dose taurine groups were lower, and LVPWd, LVEF, FS and E/A were higher (P<0.05). Plasma BNP level in the AMI group and two taurine-treated groups were higher than that in the sham group, and it was the highest in the AMI group (P<0.05). Conclusion Taurine has a protective effect on ventricular remodeling in rats with AMI, and the protective effect is dose-dependent.
ObjectiveTo systematically review the efficacy and safety of early oxygen therapy for patients with acute myocardial infarction (AMI). MethodsWe searched databases including PubMed, EMbase, The Cochrane Library (Issue 11, 2015) and CBM from inception to October 2015, to collect randomized controlled trials (RCTs) about early oxygen therapy for patients with AMI. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software. ResultsA total of 7 RCTs involving 1 388 patients were included. The results of meta-analysis showed that, there were no significant differences between the oxygen therapy group and the control group in mortality (OR=1.12, 95%CI 0.57 to 2.20, P=0.75), the incidence of major cardiovascular and cerebrovascular events (MACCE) (OR=1.00, 95%CI 0.46 to 2.18, P=1.00), the incidence of arrhythmia (OR=1.01, 95%CI 0.45 to 2.24, P=0.98) and the incidence of cardiac death (OR=0.53, 95%CI 0.17 to 1.67, P=0.28). But, the oxygen therapy group had higher risk of recurrent myocardial infarction (OR=5.50, 95%CI 1.44 to 20.99, P=0.01) and longer average hospital length of stay (MD=1.28, 95%CI 1.10 to 1.47, P<0.0001). ConclusionThe efficacy of early oxygen therapy for patients with AMI is not clear, even may increase the risk of recurrent myocardial infarction and the average hospital length of stay. Due to the limited quantity and quality of include studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo systematically review the efficacy of early use of heparin for thrombolytic therapy in patients with acute myocardial infarction (AMI). MethodsThe Chinese databases involving VIP, CNKI, WanFang Data, CBM and foreign language databases including PubMed and The Cochrane Library (Issue 1, 2013) were electronically searched from inception to January 2013. Randomized controlled trials (RCTs) on early use of heparin in the treatment of AMI were included. Two reviewers assessed the quality of each trial and extracted data independently according to the Cochrane Handbook. RevMan5.2 software was used for statistical analysis. ResultsA total of 23 RCTs involving 2 697 patients were included. The results of meta-analysis showed that the heparin group was superior to the control group in increasing of the rate of coronary artery recanalization, decreasing the time of recanalization, reducing the rate of re-infarction and the death rate, and decreasing the time of ST-T fell for 50%, the time of enzyme peak showed and the time of chest pain relief. There had no significant difference observed in the incidence of adverse reaction between the two groups. ConclusionIt is effective to use heparin before thrombolytic therapy in AMI.
Objective To detect the bile acid profile in serum based on liquid chromatography-tandem mass spectrometry, and construct a combined biomarker diagnostic model for differentiating acute myocardial infarction (AMI) from unstable angina (UA). Methods A total of 180 patients with acute coronary syndrome who visited Huludao Central Hospital between August 2023 and February 2024 were randomly selected, and there were 117 patients with UA and 63 patients with AMI. Using liquid chromatography-tandem mass spectrometry, 15 bile acid subtypes in serum were detected. Orthogonal partial least squares discriminant analysis was used to compare the serum bile acid metabolic profiles of the subjects. Differences in metabolites were screened based on a significance level of P<0.05 and variable importance in projection (VIP)>1. Multiple logistic regression analysis was performed to construct a diagnostic model for differentiating AMI from UA, and the diagnostic performance of the model was evaluated using receiver operating characteristic (ROC) curve and other statistical methods. Results The differential bile acid biomarkers in the serum of UA and AMI patients included glycodeoxycholic acid, glycochenodeoxycholic acid (GCDCA), deoxycholic acid (DCA), glycocholic acid, and aurodeoxycholic acid (TDCA) (P<0.05, VIP>1). A binary logistic stepwise regression analysis showed that three bile acid biomarkers (GCDCA, DCA, and TDCA) and three common biochemical indicators (aspartate aminotransferase, creatine kinase, and total bile acid) were factors differentiating AMI from UA (P<0.05). The area under the ROC curve of the model was 0.986 [95% confidence interval (0.973, 0.999), P<0.001], demonstrating a good diagnostic performance. Conclusions GCDCA, DCA, and TDCA can serve as potential biomarkers for distinguishing AMI from UA. The model combining these three bile acids with aspartate aminotransferase, creatine kinase, and total bile acid can effectively identify AMI.
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.
Objective To explore the risk factors for long-term death of patients with acute myocardial infarction (AMI) and reduced left ventricular ejection fraction (LVEF), and develop and validate a prediction model for long-term death. Methods This retrospective cohort study included 1013 patients diagnosed with AMI and reduced LVEF in West China Hospital of Sichuan University between January 2010 and June 2019. Using the RAND function of Excel software, patients were randomly divided into three groups, two of which were combined for the purpose of establishing the model, and the third group was used for validation of the model. The endpoint of the study was all-cause mortality, and the follow-up was until January 20th, 2021. Cox proportional hazard model was used to evaluate the risk factors affecting the long-term death, and then a prediction model based on those risk factors was established and validated. Results During a median follow-up of 1377 days, 296 patients died. Multivariate Cox regression analysis showed that age≥65 years [hazard ratio (HR)=1.842, 95% confidence interval (CI) (1.067, 3.179), P=0.028], Killip class≥Ⅲ[HR=1.941, 95%CI (1.188, 3.170), P=0.008], N-terminal pro-brain natriuretic peptide≥5598 pg/mL [HR=2.122, 95%CI (1.228, 3.665), P=0.007], no percutaneous coronary intervention [HR=2.181, 95%CI (1.351, 3.524), P=0.001], no use of statins [HR=2.441, 95%CI (1.338, 4.454), P=0.004], and no use of β-blockers [HR=1.671, 95%CI (1.026, 2.720), P=0.039] were independent risk factors for long-term death. The prediction model was established and patients were divided into three risk groups according to the total score, namely low-risk group (0-2), medium-risk group (4-6), and high-risk group (8-12). The results of receiver operating characteristic curve [area under curve (AUC)=0.724, 95%CI (0.680, 0.767), P<0.001], Hosmer-Lemeshow test (P=0.108), and Kaplan-Meier survival curve (P<0.001) showed that the prediction model had an efficient prediction ability, and a strong ability in discriminating different groups. The model was also shown to be valid in the validation group [AUC=0.758, 95%CI (0.703, 0.813), P<0.001]. Conclusions In patients with AMI and reduced LVEF, age≥65 years, Killip class≥Ⅲ, N-terminal pro-brain natriuretic peptide≥5598 pg/mL, no percutaneous coronary intervention, no use of statins, and no use of β-blockers are independent risk factors for long-term death. The developed risk prediction model based on these risk factors has a strong prediction ability.
Objective To search, evaluate and summarize the relevant evidence of the treatment and management of patients with acute myocardial infarction (AMI) under the chest pain center mode by using the evidence-based medicine method, so as to provide references for optimizing the clinical pathway, improving the medical quality and improving the prognosis of patients. Methods Relevant evidence on the treatment and management of AMI patients in relevant databases and websites at home and abroad was retrieved, and the retrieval time limit was from the establishment of databases to January 1, 2025. The quality of the included literature was evaluated, and the evidence was extracted and summarized. Results A total of 15 articles were included, including 2 clinical decisions, 2 systematic reviews, 8 guidelines, and 3 expert consensuses. Finally, 23 pieces of best evidence were extracted, including the basic conditions of chest pain center, the evaluation and treatment of patients with acute chest pain, the integration of pre-hospital emergency system and hospital green channel, and training and education. Conclusions The best evidence for the treatment and management of AMI under the chest pain center mode can provide evidence-based basis for clinical practice. It is necessary to combine the situation of the chest pain center, fully consider the validity and feasibility of the evidence, and help the chest pain center improve the medical quality and improve the prognosis of patients in a standardized and scientific way.
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.