Objective This study was to evaluate the efficacy and safety of a short acting reduced dose fibrinolytic regimen to promote early infarct related artery (IRA) patency for acyute myocardial infarction (AMI) patients re...Objective This study was to evaluate the efficacy and safety of a short acting reduced dose fibrinolytic regimen to promote early infarct related artery (IRA) patency for acyute myocardial infarction (AMI) patients referred for percutaneous coronary intervention (PCI).Methods Following aspirin and heparin, 166 patients were randomized to a 50 mg bolus of recombinant tissue type plasminogen activator(rt PA) or to a same volume sodium chloride injection followed by immediate primary PCI. The end points included patency rates on catheterization laboratory (cath lab) arrival, revascularization results when PCI was performed, complication rates, left ventricular function and restored patency rate following PCI. Results Patency on cath lab arrival was 64% with rt PA (34% TIMI 3,30% TIMI 2), while 31% of placebo (13% TIMI 3, 18% TIMI 2). There was no difference in the restored TIMI 3 rates of IRA between the two groups (85% vs 87%). No difference were observed in stroke or major bleeding. Left ventricular function was similar in both groups (52±9% vs 50±8%), but left ventricular ejection fraction fraction (LVEF) was higher with patent IRA (TIMI 3) on cath lab arrival than that of others (56±12% vs 48±10%).Conclusions Strategy thrombolytic regimens were compatible with subsequent PCI lead to more frequenc early recanalization (before cath lab arrival), which facilitates greater left ventricular function preservation with no augmentation of adverse events.展开更多
目的通过对比分析去肾神经术(renal denervation,RD)和药物治疗对急性心肌梗死(acute myocardial infarction,AMI)后心力衰竭(heart failure,HF)大鼠模型心功能、肾素-血管紧张素-醛固酮系统、交感神经系统和心脏自主神经系统的影响,探...目的通过对比分析去肾神经术(renal denervation,RD)和药物治疗对急性心肌梗死(acute myocardial infarction,AMI)后心力衰竭(heart failure,HF)大鼠模型心功能、肾素-血管紧张素-醛固酮系统、交感神经系统和心脏自主神经系统的影响,探究RD与抗HF药物的疗效差异、最佳治疗时机以及疗效机制。方法 140只雄性Wistar大鼠,随机分为对照组、AMI组(心肌梗死组)、RD组(去肾神经组)、MI-1d+RD组(AMI后1天行RD)、MI-1d+Drugs组(AMI后1天予以药物治疗)、MI-4w+RD组(AMI后4周行RD)、MI-4w+Drugs组(AMI后4周予以药物治疗),每组各20只。AMI后1天及4周后分别行RD、β受体阻滞剂(β-blocker)+血管紧张素受体拮抗剂(ACEI)药物联合治疗。检测并记录AMI后8周各组大鼠模型的心功能、血浆脑钠尿肽(brain natriuretic peptide,BNP)、肾素、血管紧张素Ⅱ(Ang Ⅱ)、醛固酮(aldosterone,ALD)、去甲肾上腺素(norepinephrine,NE)水平,梗死心肌NE含量,心率和5 min内NN间期标准差(standard deviation of NN intervals,SDNN)。结果 AMI后8周,对照组、AMI组、RD组、MI-1d+RD组、MI-1d+Drugs组、MI-4w+RD组、MI-4w+Drugs组大鼠的左心室射血分数(left ventricular ejection fraction,LVEF)分别为85%、36%、82%、77%、65%、53%、45%。AMI组大鼠较对照组LVEF显著下降( P <0.05),血浆BNP、肾素、Ang Ⅱ、ALD、NE水平均显著增加( P <0.05),梗死心肌NE水平、HR显下降( P <0.05),SDNN显著增加( P <0.05)。MI-1d+RD组大鼠较AMI及MI-1d+Drugs组LVEF显著增加( P <0.05),血浆BNP、肾素、Ang II、ALD、NE水平均显著下降( P < 0.05 )。MI-1d+RD组、MI-1d+Drugs组大鼠较AMI组梗死心肌NE含量、心率显著均增加( P <0.05),SDNN显著下降( P <0.05);MI-4w+RD组、MI-4w+Drugs组大鼠较AMI组梗死心肌NE、心率及SDNN差异均无统计学意义( P >0.05)。结论 AMI后早期行RD改善心功能的疗效强于β受体阻滞剂与血管紧张素转化酶抑制剂联合治疗,其疗效机制包括抑制交感神经系统、肾素-血管紧张素-醛固酮系统活性以及调节心脏交感-迷走神经功能平衡。展开更多
Objective : To evaluate the dynamic change ofinfarct related arteries (IRA) with continued monitoring of STsegmentin early acute myocardial infarction (AMI)- Methods :61 patients (46 males and 15 females , aged 39 ～8...Objective : To evaluate the dynamic change ofinfarct related arteries (IRA) with continued monitoring of STsegmentin early acute myocardial infarction (AMI)- Methods :61 patients (46 males and 15 females , aged 39 ～80) with AMIunderwent 24 hours , Holter monitoring within 6 hours after the symptom onset- The changes of STsegment was observed continually and was compared with the results of coronary arteries angiography- Results : ①In the patients who had occluded IRA, STsegmentremained elevated with a tendency to decline- ②In those who had successful reperfusion ,STsegment reduced rapidly after reperfusion and then kept stable- ③Intermittent fluctuating up and down of STsegment was observed com monly during the first 24 hours in all AMIpatients ,especially in the earliertime after successfulthrombolysis- Conclusion : The dynamic changes of IRA between opening and occluding were showed in early AMI- The continued monitoring of STsegment can be used to evaluate the dynamic changes of IRA-展开更多
文摘Objective This study was to evaluate the efficacy and safety of a short acting reduced dose fibrinolytic regimen to promote early infarct related artery (IRA) patency for acyute myocardial infarction (AMI) patients referred for percutaneous coronary intervention (PCI).Methods Following aspirin and heparin, 166 patients were randomized to a 50 mg bolus of recombinant tissue type plasminogen activator(rt PA) or to a same volume sodium chloride injection followed by immediate primary PCI. The end points included patency rates on catheterization laboratory (cath lab) arrival, revascularization results when PCI was performed, complication rates, left ventricular function and restored patency rate following PCI. Results Patency on cath lab arrival was 64% with rt PA (34% TIMI 3,30% TIMI 2), while 31% of placebo (13% TIMI 3, 18% TIMI 2). There was no difference in the restored TIMI 3 rates of IRA between the two groups (85% vs 87%). No difference were observed in stroke or major bleeding. Left ventricular function was similar in both groups (52±9% vs 50±8%), but left ventricular ejection fraction fraction (LVEF) was higher with patent IRA (TIMI 3) on cath lab arrival than that of others (56±12% vs 48±10%).Conclusions Strategy thrombolytic regimens were compatible with subsequent PCI lead to more frequenc early recanalization (before cath lab arrival), which facilitates greater left ventricular function preservation with no augmentation of adverse events.
文摘目的通过对比分析去肾神经术(renal denervation,RD)和药物治疗对急性心肌梗死(acute myocardial infarction,AMI)后心力衰竭(heart failure,HF)大鼠模型心功能、肾素-血管紧张素-醛固酮系统、交感神经系统和心脏自主神经系统的影响,探究RD与抗HF药物的疗效差异、最佳治疗时机以及疗效机制。方法 140只雄性Wistar大鼠,随机分为对照组、AMI组(心肌梗死组)、RD组(去肾神经组)、MI-1d+RD组(AMI后1天行RD)、MI-1d+Drugs组(AMI后1天予以药物治疗)、MI-4w+RD组(AMI后4周行RD)、MI-4w+Drugs组(AMI后4周予以药物治疗),每组各20只。AMI后1天及4周后分别行RD、β受体阻滞剂(β-blocker)+血管紧张素受体拮抗剂(ACEI)药物联合治疗。检测并记录AMI后8周各组大鼠模型的心功能、血浆脑钠尿肽(brain natriuretic peptide,BNP)、肾素、血管紧张素Ⅱ(Ang Ⅱ)、醛固酮(aldosterone,ALD)、去甲肾上腺素(norepinephrine,NE)水平,梗死心肌NE含量,心率和5 min内NN间期标准差(standard deviation of NN intervals,SDNN)。结果 AMI后8周,对照组、AMI组、RD组、MI-1d+RD组、MI-1d+Drugs组、MI-4w+RD组、MI-4w+Drugs组大鼠的左心室射血分数(left ventricular ejection fraction,LVEF)分别为85%、36%、82%、77%、65%、53%、45%。AMI组大鼠较对照组LVEF显著下降( P <0.05),血浆BNP、肾素、Ang Ⅱ、ALD、NE水平均显著增加( P <0.05),梗死心肌NE水平、HR显下降( P <0.05),SDNN显著增加( P <0.05)。MI-1d+RD组大鼠较AMI及MI-1d+Drugs组LVEF显著增加( P <0.05),血浆BNP、肾素、Ang II、ALD、NE水平均显著下降( P < 0.05 )。MI-1d+RD组、MI-1d+Drugs组大鼠较AMI组梗死心肌NE含量、心率显著均增加( P <0.05),SDNN显著下降( P <0.05);MI-4w+RD组、MI-4w+Drugs组大鼠较AMI组梗死心肌NE、心率及SDNN差异均无统计学意义( P >0.05)。结论 AMI后早期行RD改善心功能的疗效强于β受体阻滞剂与血管紧张素转化酶抑制剂联合治疗,其疗效机制包括抑制交感神经系统、肾素-血管紧张素-醛固酮系统活性以及调节心脏交感-迷走神经功能平衡。
文摘Objective : To evaluate the dynamic change ofinfarct related arteries (IRA) with continued monitoring of STsegmentin early acute myocardial infarction (AMI)- Methods :61 patients (46 males and 15 females , aged 39 ～80) with AMIunderwent 24 hours , Holter monitoring within 6 hours after the symptom onset- The changes of STsegment was observed continually and was compared with the results of coronary arteries angiography- Results : ①In the patients who had occluded IRA, STsegmentremained elevated with a tendency to decline- ②In those who had successful reperfusion ,STsegment reduced rapidly after reperfusion and then kept stable- ③Intermittent fluctuating up and down of STsegment was observed com monly during the first 24 hours in all AMIpatients ,especially in the earliertime after successfulthrombolysis- Conclusion : The dynamic changes of IRA between opening and occluding were showed in early AMI- The continued monitoring of STsegment can be used to evaluate the dynamic changes of IRA-
