Objective To evaluate the diagnostic value of human heart-type fatty acid-binding protein for early detection of acute myocardial infarction (AMI). Methods Studies involving this biomarker were identified from MEDLINE, EMbase, CBM and VIP (1970 to 2006). Relevant journals (1980 to 2006) were also handsearched. The quality of the included studies was assessed using the QUADAS tool. Data extraction and analysis were conducted by software of EXCEL2003 and Metadisc. Results We included 13 studies, which were heterogeneous (P=0, I2=58.5%). Five studies (n=396) included in the group assessed the test at the first three hours after chest pain onset. These studies were homogeneous (P= 0.49, I2=0). The pooled sensitivity was 0.86 ( 95%CI 0.80 to 0.91), the pooled specificity was 0.76( 95%CI 0.80 to 0.91), and the area under the curve was 0.88 (SE=0.032 3). In the group of 0 to 6 hours after chest pain onset, 10 included studies (n=1 175) were heterogeneous (P=0, I2=69%). The pooled sensitivity was 0.86 (95%CI 0.83 to 0.89), the pooled specificity was 0.79 (95%CI 0.76 to 0.82), and the area under the curve was 0.92 (SE=0.019). In the group of 6 to 12 hours after chest pain onset, 4 included studies (n=215) were homogeneous (P=0.56, I2=0). The pooled sensitivity was 0.97 (95%CI 0.91 to 0.99), the pooled specificity was 0.52 (95%CI 0.42 to 0.61), and the area under the curve was 0.810 with (SE=0.152 2). In the group of 0 to 12 hours after chest pain, 11 included studies (n=1 352) were heterogeneous (P=0.56, I2=59%). The pooled sensitivity was 0.88 (95%CI 0.84 to 0.89), the pooled specificity was 0.75 (95%CI 0.71 to 0.78), and the areas under the curve was 0.91 (SE=0.016 4). Conclusions In this systematic review, we found that H-FABP has an acceptable diagnostic accuracy within 3 hours after the onset of symptoms, and within 12 hours after the onset of symptoms, H-FABP has a high diagnostic efficacy. So H-FABP may be a new symbol for the early diagnosis of AMI.
Objective\ To analyze the experiences of emergent or urgent coronary artery bypass grafting(CABG) for patients with acute myocardial infarction(AMI). Methods\ From May, 1996 through December, 1999, 9 patients with AMI underwent emergent CABG including eight males and one female, with mean age 61 years, and year range 44 70. The localization of the AMI was anterior in 4 and inferior in 5. The interval between the onset of AMI and CABG was within 24 hours in 7 cases, 10 days in 1 case and 14 days in 1 case....
Objective To study the influence of autologous bone mesenchymal stem cells (BMSCs) on myocardial structure and cardiac function after being implantated into acute infarcted myocardial site. Methods Bone marrow was aspirated from the posterosuperior iliac spine of Guizhou Xiang swine. After being isolated, cultured and co cultured with 5 azacytidine, either autologous BMSCs (total cells 2×10 6, experimental group, n =12), or a comparable volume of culture medium (control group, n =12), was injected into the left anterior descending(LAD) branch of coronary artery just distal to the ligation site of the LAD. The same volume of BMSCs or culture medium was injected into several spots in the infarcted myocardium. Echocardiographic measurements were performed three or six weeks after implantation to assess the myocardial structure and cardiac function. Results Left ventricular function, including eject fraction(EF), fractional shortening and wall thickening, were higher in experimental group when compared with control group. The thickness of the ventricular wall and septum was also found increased while the left ventricular chamber size was smaller in experimental group. Conclusion Implantation of BMSCs into the infarcted myocardium is believed to attenuate the remodeling process, inhibit the extent of wall thinning and dilatation of the ventricular chamber. BMSCs implantation may also improve the contractile ability of the myocardium and cardiac function.
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 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.
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.
Objective To evaluate the feasibility and efficacy of emergency percutaneous coronary intervention( PCI) under mechanical ventilation for the treatment of patients with acute myocardial infarction complicated with acute pulmonary edema. Methods The clinical data of 15 patients admitted to the emergency ward for acute pulmonary edema caused by acute myocardial infarction from 2007 to 2009 were retrospectively analyzed. These patients received emergency PCI under mechanical ventilatory support.Parameters involved changes of symptoms, arterial blood gas, left ventricular ejection fraction( LVEF) , plasma concentrations of B-type natriuretic peptide( BNP) , and high sensitivity reactive protein( hs-CRP) . Results All patients showed significant improvements in dyspnea, artery blood gas parameters after PCI( P lt;0. 01) .LVEF increased significantly after PCI compared with before weaning [ ( 37. 36 ±0. 02) % vs ( 47. 41 ±0. 02) % , F =461. 47, P lt; 0. 05] . The concentrations of BNP and hs-CRP returned to lower level 4 weeks after PCI [ ( 99. 34 ±5. 15) fmol /mL vs ( 430. 50 ±96. 08) fmol /mL, ( 8. 35 ±2. 49) ng/mL vs ( 89. 50 ±9. 30) ng/mL, both P lt;0. 01] . Conclusion Emergency PCI under mechanical ventilatory support is a feasible and effective approach for patients with acute myocardial infarction complicated with acute pulmonary edema.
Abstract: Ventricular septal rupture is a rare complication of acute myocardial infarction, but it can easily lead to such complications as acute heart failure and cardiac shock with sinister prognosis. Surgical treatment is a fundamental measure to improve the prognosis, and the selection of operation time is a key factor. The basic guiding principles of operation timing are as follows. Those patients who have acute heart failure and/or cardiac shock soon after the onset of ventricular septal rupture, and can not be controlled by nonsurgery therapy and are also unable to tolerate surgery, will die soon. For them, surgery treatment cannot be implemented because they have missed the optimal operation time. For those whose perforation was so small that they can be stably controlled by nonsurgery therapy, surgery treatment can be postponed for 1 to 4 weeks. However, emergency operation should be performed in time once the condition of the patients becomes unstable. For others, no matter in what state they are, surgical treatment should be implemented immediately.
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.