Background Mortality and morbidity of acute myocardial infarction remains high. Intravenous magnesium started early after the onset of myocardial infarction is a promising adjunctive treatment that may limit infarct size, prevent serious arrhythmias, and reduce mortality. Several earlier trials and meta-analyses demonstrated a mortality rate reduction with magnesium treatment, but one mega trial found no benefit. Objective To examine the effect of intravenous magnesium versus control on early mortality and morbidity, stratified by time since onset of symptoms (lt;6 hours, 6+ hours), use of thrombolysis (used, not used), dose of magnesium used (lt;75 mmol, 75+ mmol). Search strategy We search the Cochrane controlled trial register (CCTR) of Cochrane Library, Medline and Embase. We also search Chinese Biomedical Disk (CBM disk) to identify the Chinese trials. Each database will be searched from its starting date to the first-half year of 2002. Selection criteria All randomized controlled trials that compared intravenous magnesium with placebo in the presence or absence of fibrolytic therapy in addition to routine treatment are eligible if they reported mortality and clinical events within 35 days of onset, regardless of language. Methods of review A data abstraction form will be specifically developed to extract information from the eligible articles. The quality assessment of RCT will be focused on method of treatment assignment, blinding of participants and investigators, control of selection bias after treatment assignment. The selection of studies, data extraction and assessment of methodological quality will be performed independently by two reviewers. Disagreements will be resolved through discussion, when necessary, in consultation with a third reviewer. Publication bias, heterogeneity and sensitivity analysis will be performed. The odds ratio (OR) will be used to pooling the effect if appropriate.
Objective To investigate appropriate treatment strategy and timing for patients with subacute myocardial infarction and severe ischemic mitral regurgitation （IMR）. Methods A total of 89 patients with subacute myocardial infarction and severe IMR underwent surgical treatment from January 2005 to December 2011 in Beijing Anzhen Hospital. There were 66 male patients and 23 female patients with their mean age of 64 （55-73） years. All the patients received only coronary artery bypass grafting （CABG） after 3 months of medication treatment without specific management for their IMR. Echocardiography was examined before medication treatment，preoperatively and 6 months after CABG to analyze their IMR degree and measure left ventricular end-systolic dimension （LVESD），left ventricular end diastolic dimension （LVEDD） and left ventricular ejection fraction （LVEF）. Results There was no surgery-related death，perioperative myocardial ischemia or other severe postoperative complication. Eighty-one patients （91.0%） were followed up for 6-60 months. At 6 months after CABG，mitral regurgitation area （3.1±1.3 cm2 vs. 5.6±2.3 cm2），LVEDD （51.3±4.2 mm vs. 54.3±5.5 mm） and LVESD （31.7±3.9 mm vs. 34.6±4.3 mm） were significantly decreased than preoperative values （P＜0.05），but LVEF was not statistically different from preoperative value （59.1%±3.9% vs. 58.9%±5.6%，P＞0.05）. From the third year during follow-up，all the patients received annual CT examination of their coronary artery，and no significant graft stenosis （graft stenosis＞50%） was found. Conclusion With appropriately delayed CABG and right medication treatment，patients with subacute myocardial infarction and severe IMR may no longer need concomitant surgical management for their IMR， which can decrease surgical risks and reduce treatment cost.
ObjectiveTo observe the clinical efficacy and safety of reteplase in prehospital thrombolysis for ST-segment elevation acute myocardial infarction. MethodsWe retrospectively analyzed the clinical data of 62 patients with acute ST-segment elevation myocardial infarction treated in our hospital between September 2010 and December 2012.They were randomly divided into two groups:the treatment group with 22 patients given reteplase thrombolysis therapy in the prehospital ambulance and/or emergency department,and the control group with 40 patients receiving thrombolytic therapy in the hospital.Then,we compared 60-minute and 120-minute recanalization rate,the rate of complicating with various kinds of adverse reactions and the composite end-point event rate between the two groups. ResultsSixty minutes and 120 minutes after thrombolysis,the clinical judgment recanalization rate in the treatment group was significantly higher than that in the control group (P<0.05).Four weeks after hospitalization,the rate of complicating with various kinds of hemorrhage,hypotension and death rate in the two groups had no statistical difference (P>0.05). ConclusionPrehospital thrombolysis treatment for ST-segment elevation acute myocardial infarction has a better clinical efficacy and is worth popularizing in basic unit hospitals.
In order to construct and express human cardiac troponin C-linker-troponin I(P) fusion protein, detect its activity and prepare lyophilized protein, we searched the CDs of human cTnC and cTnI from GenBank, synthesized cTnC and cTnI(30-110aa) into cloning vector by a short DNA sequence coding for 15 neutral amino acid residues. pColdⅠ-cTnC-linker-TnI(P) was constructed and transformed into E. coli BL21(DE3). Then, cTnC-linker-TnI(P) fusion protein was induced by isopropyl-β-D-thiogalactopyranoside (IPTG). Soluable expression of cTnC-linker-TnI(P) in prokaryotic system was successfully obtained. The fusion protein was purified by Ni2+ Sepharose 6 Fast Flow affinity chromatography with over 95% purity and prepared into lyophilized protein. The activity of purified cTnC-linker-TnI(P) and its lyophilized protein were detected by Wondfo FinecareTM cTnI Test. Lyophilized protein of cTnC-linker-TnI(P) was stable for 10 or more days at 37℃and 4 or more months at 25℃and 4℃. The expression system established in this research is feasible and efficient. Lyophilized protein is stable enough to be provided as biological raw materials for further research.
ObjectiveTo systematically review the effectiveness and safety of domestic tirofiban for Chinese population with non ST-elevation acute coronary syndromes (NSTE-ACS) in non-interventional therapy. MethodsWe searched databases including The Cochrane Library (Issue 11, 2013), PubMed, EMbase, CBM, CNKI, VIP and WanFang Data from 1994 to 2014 to collect randomized controlled trials (RCTs) about domestic tirofiban for NSTE-ACS patients in non-interventional therapy. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Meta-analysis was then conducted using RevMan 5.2 software. ResultsA total of 23 RCTs were enrolled involving 2 425 patients. The results of meta-analysis showed that:a) the effectiveness of tirofiban in the trial group was significantly better than that in the control group (OR=3.62, 95%CI 2.33 to 5.63, P<0.000 01); b) ST segment down improvement in the trial group was better than that in the control group (WMD=0.39, 95%CI 0.30 to 0.49, P<0.000 01); c) improvement of platelet aggregation in the trial group was better than that in the control group (WMD=27.89, 95%CI 25.45 to 30.34, P<0.000 01); d) the incidences of cardiovascular events of composite endpoints in the trial group were lower than that in the control group (during 36 h:OR=0.20, 95%CI 0.12 to 0.31, P<0.000 01; and after 30 days:OR=0.31, 95%CI 0.23 to 0.42, P<0.000 01); and e) the incidence rate of bleeding in the trial group was higher than that in the control group (OR=1.53, 95%CI 1.09 to 2.15, P=0.02). ConclusionCompared with routine drugs used alone, tirofiban has better therapeutic effects in non-interventional therapy for Chinese population with NSTE-ACS, but the incidence of bleeding is relatively high.
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.
Cardiogenic shock (CS) describes a physiological state of end-organ hypoperfusion characterized by reduced cardiac output in the presence of adequate intravascular volume. Mortality still remains exceptionally high. Veno-arterial extracorporeal membrane oxygenation (VA ECMO) has become the preferred device for short-term hemodynamic support in patients with CS. ECMO provides the highest cardiac output, complete cardiopulmonary support. In addition, the device has portable characteristics, more familiar to medical personnel. VA ECMO provides cardiopulmonary support for patients in profound CS as a bridge to myocardial recovery. This review provides an overview of VA ECMO in salvage of CS, emphasizing the indications, management and further direction.
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.
ObjectiveTo establish and validate the diagnostic model of ferroptosis genes for acute myocardial infarction (AMI) based on bioinformatics. MethodsFive AMI gene expression data were obtained from Gene Expression Omnibus (GEO), namely GSE66360, GSE48060, GSE60993, GSE83500, GSE34198. Among them, GSE66360 was used as the training set to perform differential analysis, and intersection of differential genes and ferroptosis genes was taken to obtain differentially expressed ferroptosis genes in AMI. GO and KEGG enrichment analysis was performed using Metascape website. Subsequently, random forest (RF) algorithm was used to screen out key genes with high classification performance according to the Keeny coefficient score, and artificial neural network (ANN) diagnostic model of AMI ferroptosis feature gene was constructed by model group GSE83500. The area under the receiver operating characteristic curve (AUC) of 10-fold cross-validation was used to evaluate the performance and generalization ability of the model, and 3 external independent datasets were used to verify the diagnostic performance of this model. The single sample gene setenrichment analysis was used to explore the difference in immune cell infiltration between infarcted myocardium and normal myocardium after AMI. In addition, correlation analysis between immune cells and key genes was also conducted. Finally, potential drugs that would prevent and treat AMI by regulating ferroptosis were screened out from the Coremin Medical platform. ResultsA total of 16 differentially expressed ferroptosis genes were obtained in the training set, GO enrichment analysis showed that they mainly participated in biological functions such as cellular response to biological stimuli and chemical stress, regulation of interleukin 17, etc. KEGG enrichment analysis showed that these genes were significantly enriched in NOD-like receptor signaling pathway, programmed cell necrosis, Leishmaniasis and other pathways. Four genes with good classification performance were screened out using RF algorithm, namely EPAS1, SLC7A5, FTH1, and ZFP36. The results of 10-fold cross-validation showed that the minimum AUC value was 0.746, the maximum value was 0.906, and the average value was 0.805. The AUC of the ANN model was 0.859, and the AUC values of the three independent validation sets were 0.763 (GSE48060), 0.673 (GSE60993), 0.698 (GSE34198). Immune cell infiltration found that macrophages, mast cells and monocytes were significantly active after AMI. Correlation analysis found that there were positive correlations between 4 key genes and activated dendritic cells, eosinophils and γδT cells. A total of 20 potential western medicines were predicted which could prevent and treat AMI by regulating ferroptosis, and the predicted potential Chinese medicine was mainly heat-clearing and detoxifying and blood-activating and removing blood stasis drugs. ConclusionThe identified AMI ferroptosis genes by bioinformatics method have certain diagnostic significance, which provides a reference for disease diagnosis and treatment.
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.