| ObjectiveThe first part is a series of clinical studies on the characteristics of complications and intervention methods of acute myocardial infarction under the regional coordinated treatment system,including:(1)To investigate the prognosis of post-thrombolytic interventional(PI)therapy and direct percutaneous coronary intervention(PCI)in regional coordinated acute myocardial infarction treatment system;(2)To investigate the clinical characteristics and prognosis of patients with acute anterior wall myocardial infarction combined with new-onset right bundle branch block in regional coordinated acute myocardial infarction treatment system;(3)To investigate the clinical characteristics and risk factors of heart rupture in regional coordinated acute myocardial infarction treatment system;(4)To investigate the interventional treatment of interventricular septal perforation couple with acute myocardial infarction in regional coordinated acute myocardial infarction treatment system.The second part is fundamental research,to elucidate whether circHIPK3 could inhibit proliferation and induce apoptosis of cardiomyocytes via binding to miRNA-124-3p,thus aggravating myocardial I/R inj ury.Methods:Part one:(1)The 981 patients selected in succession were divided into PI and PCI groups.Analyze the major adverse cardiovascular events(MACEs)in the hospital and within 6 months after discharge,and analyze any bleeding events in the hospital and 6 months after discharge.Relationship between different reperfusion strategies and clinical prognosis by logistic regression analysis.(2)A total of 63 patients with acute anterior wall myocardial infarction combined with new-onset right bundle block in First Hospital of Lanzhou University from January 2014 to January 2017 were analyzed retrospectively.Matching according to 1:2,including 126 cases of acute anterior wall myocardial infarction admitted to the hospital during the same period.The baseline data and coronary angiography results were analyzed.The patients were followed up by telephone for 2 years and the prognosis was observed.(3)A total of 295 patients with acute ST segment elevation myocardial infarction admitted to the heart center in the First Hospital of Lanzhou University from January 2008 to December 2018 were analyzed retrospectively,of which 59 cases were combined with heart rupture,Matching according to 1:4,the control group included 236 non-cardiac rupture patients,those people had the same date of acute myocardial infarction onset and area of myocardial infarction.To compare the clinical characteristics of heart rupture group and non-heart rupture group,and analyze the factors related to heart rupture.(4)The basic data and prognosis of 8 patients with acute myocardial infarction complicated with ventricular septal perforation undergoing transcatheter closure were retrospectively analyzedPart two:CircHIPK3 expression in HCM cells simulated with myocardial I/R was determined by quantitative real-time polymerase chain reaction(qRT-PCR).Influences of circHIPK3 on myocardial injury marker levels of lactate dehydrogenase(LDH),malondialdehyde(MDA),superoxide dismutase(SOD)and Glutathione peroxidase(GSH-PX)in the in vitro model of myocardial I/R were evaluated using the relative commercial kits.Regulatory effects of circHIPK3 on proliferative ability and apoptosis of simulated HCM cells were examined by cell counting kit-8(CCK-8)assay and flow cytometry,respectively.Dual-luciferase reporter gene assay was conducted to verify the binding of circHIPK3 to miRNA-124-3p.Finally,the roles of circHIPK3/miRNA-124-3p axis in regulating apoptotic gene expressions and cardiomyocyte repair after myocardial I/R were exploredResultsPart one:(1)Before and after matching,compared with direct PCI,the preoperative and postoperative TIMI3 blood flow ratio and non-PCI hospital stay time of PI group patients were increased,while the reperfusion time,hospital MACE and incidence of malignant arrhythmia were decreased.Before matching,the incidence of all-cause death events in PI group was lower than that in direct PCI group(P<0.05),and there was no significant difference between the two groups after matching.There was no significant difference between the two groups in MACE and incidence of any bleeding events within 6 months after discharge.(2)In the group with acute anterior wall myocardial infarction combined with new-onset right bundle branch block,the proportion of anterior descending proximal branch lesion and occlusion ware higher than that of the control group.The results of in-hospital and follow-up death endpoints suggest that the mortality rate of acute ST-segment elevation myocardial infarction complicated with right bundle branch is significantly increased.(3)The results showed that the age,female,Q wave in ECG AVL lead,admission heart rate and right bundle branch block in acute ST-segment elevation myocardial infarction combined with cardiac rupture group were significantly higher than those in the control group.(4)Of the 8 patients,2 patients failed to Interventricular septum occlusion due to the short onset-blocking time,and died of cardiogenic shock during the perioperative period.The remaining 6 patients were successfully blocked.Follow-up for 2.25 years showed that one patient died of cerebral hemorrhage after 23 months of blocking,and the cardiac function of the remaining 5 patients was significantly improved.Part two:CircHIPK3 was highly expressed in HCM cells with simulated myocardial I/R relative to those with normoxic treatment.Overexpression of circHIPK3 in simulated HCM cells decreased levels of LDH,SOD and GSH-PX,whereas increased MDA level.Inhibited proliferation and accelerated apoptosis were observed in simulated HCM cells overexpressing circHIPK3.CircHIPK3 overexpression reversed the protective effects of miRNA-124-3p on myocardial I/R and cardiomyocyte apoptosis CircHIPK3.Conclusion:Part one:(1)For patients with STEMI who fail to undergo timely primary PCI,pharmacoinvasive strategy within a regional myocardial infarction network is an effective and realistic way to reperfusion.(2)The results of in-hospital and follow-up death endpoints suggest that the mortality rate of acute ST-segment elevation myocardial infarction complicated with new-onset right bundle branch is significantly increased.(3)Age,total ischemia time,AVL lead Q wave,combined right bundle branch block,and heart rate increase are independent risk factors for heart rupture associated with acute ST segment elevation myocardial infarction.(4)It is feasible to treat acute myocardial infarction with septal perforation by catheter occlusion to improve long-term prognosis.Part two:CircHIPK3 inhibits proliferative ability and induces apoptosis of cardiomyocytes after myocardial I/R injury by binding to miRNA-124-3p,which may serve as a potential therapeutic target for I/R. |
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