| Part I Influence of the optimized emergency easy access since pre-admission on process time parameter and prognosis of patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary interventionObjective:To evaluate the influence of three different clinic pathways on the fist medical contact to ballon(FMC2B) time, the first medical contact to the anti-platelet(FMC2A) time, the first medical contact to sign(FMC2S) time,door-to-ballon(D2B) time and the prognosis of patients with ST- segment elevation myocardial infarction(STEMI) treated with primarypercutaneous coronary intervention.Method:180 consecutive patients were divided into traditional access group,easy access group and optimized easy access group.The FMC2 B tme,FMC2 A time,FMC2 S time,D2 B time, recurrence rate of non-fatal myocardial infarction, heart failure, cerebrovascular accident, all-cause and cardiac death during the period of hospitalization and major cardiovascular events during the follow-up period were recorded.Result:1.There was no significant difference in the three groups in baseline characteristics(P>0.05). FMC2 B time, FMC2 A time,FMC2 S time,D2 B time in the traditional access, easy acsess,optimized easy access reduced in turn(all P< 0.05); the percentage of FMC2 B time within 120 minutes and D2 B within 90 minutes in the traditional access, easy acsess,optimized easy access increased in turn(all P< 0.05).2.During the period of hospitalization,the recurrent non-fatal myocardial infarction,cerebral vascular accident and the occurrence of heart failure had no significant difference in the three groups(P> 0.05). Easy access group and optimized easy access group had lower cardiovascular disease mortality and all-cause mortality during hospitalization than traditional access group(all P< 0.05), optimized access group had lower cardiovascular disease mortality and all-cause mortality during hospitalization than easy access group, but the difference was not significant(P>0.05);During the follow-up period, the rates of recurrent angina, nonfatal myocardial infarction, target vessel revascularization,severe arrhythmia in the three groups were no difference(P>0.05), while the optimized easy access group and easy access group had significantly lower rates of heart failure,rehospitalization due to cardiac disease, all-cause mortality and cardiac mortality than the traditional access group(P< 0.05).3.Through the regression of the related risk factors for cardiovascular events in thethree groups,we found the age(P=0.025),smoking(P=0.013), diabetes mellitus(P=0.031),double vessel lesion(P=0.007) and three vessel lesion(P=0.011),FMC2B(P=0.034),FMC2A(P=0.028),FMC2S(P=0.0346),D2B(P=0.025) were risk factors forcardiovascularevents.Furthermore,the FMC2 B time,FMC2 A time,FMC2 S time, D2 B time, age were independent risk factors for the occurrence of cardiovascularevents after PCI.Conclusion:The optimized easy access could reduce further FMC2 B time,FMC2 A time,FMC2 S time and D2 B time delay, and also improve the prognosis of patients with STEMI.Part II Impact of plasma inflammatory cytokines andmajorcardiovascular events in patients with STEMI who been treated with different therapies on non-infarct-related arteryafterurgent PCIObjective:To compare the different results on majorcardiovascular events,plasma inflammatory cytokines(hs CRP,s CD40 L,IL-6 and TNF-a)and coronary angiography betweenmedicine and medicine combined with percutaneous coronary intervention(PCI) in patients with AMI who had been treated by urgent PCI and were confirmed to be multivessel coronary disease.Method:From June 2011 to June 2014, a total of 131 patients with AMI who had been treated by urgent PCI and were confirmed to be multivessel coronary disease in our hospital,among them 51 patients(39 %) achieved medicine combined with PCI(P group) and80(61 %) patients achieved medicine( M group). One 1-year outcome was compared between the two groups.Result:1.The average age,sexes,causes,risk factors of coronary artery disease CAD, heart function, liver and kidney Function, medicines, the time of symptom onset to balloon dilatation, the time of treatment to balloon dilatation and the related data of emergency coronary angiography and PCI were no difference between the two groups(P >0.05).2.The rates of recrudescent angina, recurrence hospital admission related to heart diseases during 3 to 12 months were significantly lower in P group patients compared with the patients in M group(P < 0.05),However,the heart failure,mortality rate and mortality rateof cardiovascular disease, nonfatal myocardial infarction, target vascular revascularization.,severe arrhythmia were no difference between the two groups(P>0.05).3.The rate of stent thrombosis and stent restenosis of infarct-related artery between the two subgroups were no significant difference(P>0.05),and the non-infarct-related artery using PCI treatment had no additional increase in stent restenosis, segmental restenosis,stent thrombosis and other events.4. The baseline of hs CRP,s CD40 L,IL-6 and TNF-α were no difference between the twogroups(P>0.05),the level of hs CRP,s CD40 L,IL-6,TNF-α were all decreased in the two groups after 1 year(P< 0.05),while the difference value were no statisticalsignificance between the two groups(P >0.05).5.The difference value of hs CRP and s CD40 L levels were independent factors affecting the occurrence of majorcardiovascular events during the follow-up period.Conclusion:1.Compared with the medicine therapy,the medicine combined with PCI therapy could decrease the rates of recrudescent angina,recurrence hospital admission related to heart diseases during 3 to 12 months but could not reduce the other major cardiac events in STEMI patients.2.The medicine combined with PCI therapy and the medicine therapy had similar rates of stent thrombosis and stent restenosis of infarct-related artery,the non-infarct-related artery using PCI treatment had no additional increase in stent restenosis, segmental restenosis, stent thrombosis and other events.3.The medicine combined with PCI therapy and the medicine therapy could reduce inflammatory factors level after STEMI, but they had no significant difference to reduce the inflammatory reaction.4.The changes of hs CRP and s CD40 L levels in patients with STEMI after emergency PCI had certain predictive value for the occurrence of MACEs and can help us to screening relatively high-risk patients.Part III A retrospective study of a small sample of patients with acute ST segment elevation myocardial infarction who were intervened non-infarct-related artery simultaneously Objective:To compare the different results on majorcardiovascular events,plasma inflammatory cytokines(hs CRP,s CD40 L,IL-6 and TNF-a)between non-infarct-related artery intervention simultaneously and non-infarct-related artery intervention stagedly in patients with AMI who had been treated by urgent PCI and were confirmed to be multivessel coronary disease.Method:From June 2011 to June 2014, a total of 74 patients with AMI who had been treated by urgent PCI and were confirmed to be multivessel coronary disease in our hospital,among them 24(32%) patients achieved non-infarct-related artery intervention simultaneously(S group) and 50(68%) patients achieved non-infarct-related artery intervention stagedly( NS group). One 1-year outcome was compared between the two groups.Result:1.The average age,sexes,causes,risk factors of coronary artery disease CAD, heart function,liver and kidney Function,medicines,the time of symptom onset to balloon dilatation, the time of treatment to balloon dilatation and the related data of emergency coronary angiography and PCI were no difference between the two groups(P >0.05).2. The recrudescent angina,recurrence hospital admission related to heart diseases the heart failure,mortality rate and mortality rateof cardiovascular disease,non-fatal myocardial infarction,target vascular revascularization,severe arrhythmia were no difference between the two groups whether short or long-term(P>0.05).3. The baseline of hs CRP,s CD40 L,IL-6 and TNF-α were no difference between the two groups(P>0.05),the level of hs CRP,s CD40 L,IL-6 and TNF-α were all decreased in the two groups after 1 year(P< 0.05),while the difference value were no statisticalsignificance between the two groups(P >0.05).Conclusion:1.Compared with non-infarct-related artery intervention stagedly,the non-infarct-related artery intervention simultaneously had similar rates of major cardiac events(recrudescent angina,recurrence hospital admission related to heart diseases the heartfailure,mortality rate and mortality rateof cardiovascular disease,non-fatal myocardial infarction,target vascular revascularization, severe arrhythmia),this study suggests it was safe to intervene simultaneously the non-infarct-related artery after urgent PCI.2.The non-infarct-related artery intervention simultaneously and the non-infarct-related artery intervention stagedly could reduce inflammatory factors level after STEMI,but they had no significant difference to reduce the inflammatory reaction. |
