Post-traumatic Stress Disorder and Risk Factors in Patients With Acute Myocardial Infarction After Emergency Percutaneous Coronary Intervention: A Longitudinal Study

This study aimed to investigate the status and risk factors of post-traumatic stress disorder (PTSD) in patients with acute myocardial infarction (AMI) after emergency percutaneous coronary intervention (PCI) in acute and convalescence phases. A longitudinal study design was used. Two questionnaire surveys were conducted in the acute stage of hospitalization, and 3 months after onset in patients. Logistic regression was used to analyze the risk factors for PTSD in AMI patients. The incidence of PTSD was 33.1 and 20.4% in acute and convalescent patients, respectively. The risk factors related to PTSD were door-to-balloon time (DTB) (≥92.6 min), left ventricular ejection fraction (LVEF) (<50%), smoking, anxiety, and depression. AMI patients after PCI had PTSD in the acute and convalescent stage. The findings indicate that tailored measures should be developed and carried out to prevent PTSD and improve the mental health of patients with AMI after undergoing PCI.

Effect of Early Protective Lung Ventilation on Mortality and Hemodynamics in Patients With Acute Myocardial Infarction Complicated With Cardiogenic Shock and Pulmonary Edema Undergoing Emergency Interventional Therapy

Background: To investigate the effect of early protective lung ventilation (EPLV) on mortality and hemodynamic parameters in patients with acute myocardial infarction complicated with cardiogenic shock (CS) and pulmonary edema undergoing emergency percutaneous coronary intervention (PCI).Methods: From January 2015 to June 2017, patients with acute myocardial infarction complicated with CS and pulmonary edema were admitted to the Tianjin chest Hospital. Based on the use of a mechanical ventilator, patients were divided into the EPLV and Non-invasive ventilation (NIV) groups. Hemodynamic indexes and in-hospital mortality of patients between the two groups was analyzed.Results: The EPLV group consisted of 51 patients and the NIV group consisted of 38 patients. The difference in mortality rates was statistically significant between the EPLV and NIV groups (P=0.01). Central venous pressure, pulmonary artery pressure, and pulmonary capillary wedge pressure after emergency PCI in the EPLV group were lower compared to patients in the NIV group ((P<0.05). Man arterial pressure in patients in the EPLV group was higher compared to NIV patients (P<0.05). Logistic regression analysis showed that EPLV did not increase the risk of mortality (P=0.37, OR=2.16, 95% CI (0.31, 9.52)).Conclusion: EPLV resulted in lower mortality and improved hemodynamic function in patients with acute myocardial infarction complicated with CS and pulmonary edema undergoing emergency PCI.

Impact of Pre-Revascularization and Post-Revascularization Cardiac Arrest on Survival Prognosis in Patients With Acute Myocardial Infarction and Following Emergency Percutaneous Coronary Intervention

Objectives: To evaluate the effects of occurrence and timing of sudden cardiac arrest (SCA) on survival in patients with acute myocardial infarction (AMI) who underwent emergency percutaneous coronary intervention (PCI).Methods: We analyzed 1,956 consecutive patients with AMI with emergency PCI from 2014 to 2018. Patients with cardiac arrest events were identified, and their medical records were reviewed.Results: Patients were divided into non-cardiac arrest group (NCA group, n = 1,724), pre-revascularization cardiac arrest (PRCA group, n = 175), and post-revascularization SCA (POCA group, n = 57) according to SCA timing. Compared to NCA group, PRCA group and POCA group presented with higher brain natriuretic polypeptide (BNP), more often Killip class 3/4, atrial fibrillation, and less often completed recovery of coronary artery perfusion (all p &lt; 0.05). Both patients with PRCA and POCA showed increased 30-day all-cause mortality when compared to patients with NCA (8.0 and 70.2% vs. 2.9%, both p &lt; 0.001). However, when compared to patients with NCA, patients with PRCA did not lead to higher mortality during long-term follow-up (median time 917 days) (16.3 vs. 18.6%, p = 0.441), whereas patients with POCA were associated with increased all-cause mortality (36.3 vs. 18.6%, p &lt; 0.001). Multivariate analysis identified Killip class 3/4, atrial fibrillation, high maximum MB isoenzyme of creatine kianse, and high creatinine as predictive factors for POCA. In Cox regression analysis, POCA was found as a strong mortality-increase predictor (HR, 8.87; 95% CI, 2.26–34.72; p = 0.002) for long-term all-cause death.Conclusions: POCA appeared to be a strong life-threatening factor for 30-day and long-term all-cause mortality among patients with AMI who admitted alive and underwent emergency PCI. However, PRCA experience did not lead to a poorer long-term survival in patients with AMI surviving the first 30 days.

Elevated serum FGF21 predicts the major adverse cardiovascular events in STEMI patients after emergency percutaneous coronary intervention

Background Although there have been several studies related to serum fibroblast growth factor 21 (FGF21) levels and acute myocardial infarction, the value of serum FGF21 levels in ST-segment elevation myocardial infarction (STEMI) patients after emergency percutaneous coronary intervention (PCI) has not been previously investigated. Methods A total of 348 STEMI patients who underwent emergency PCI were enrolled from January 2016 to December 2018. The primary endpoint was the occurrence of major adverse cardiovascular events (MACEs), with a median follow-up of 24 months. Eighty patients with stable angina (SA) who underwent selective PCI served as the control group. Serum FGF21 levels were measured by ELISA. Results Serum FGF21 levels were significantly higher in the STEMI group than in the SA group (225.03 ± 37.98 vs. 135.51 ± 34.48, P < 0.001). Multiple linear regression analysis revealed that serum FGF21 levels were correlated with NT-proBNP (P < 0.001). According to receiver operating characteristic (ROC) analysis, the areas under the ROC curve (AUCs) of FGF21 and NT-proBNP were 0.812 and 0.865, respectively. The Kaplan-Meier curves showed that STEMI patients with lower FGF21 levels had an increased MACE-free survival rate. Cox analysis revealed that high FGF21 levels (HR: 2.011, 95% CI: [1.160–3.489]) proved to be a powerful tool in predicting the risk of MACEs among STEMI patients after emergency PCI. Conclusion Elevated FGF21 levels on admission have been shown to be a powerful predictor of MACEs for STEMI patients after emergency PCI.

Influence of complex medical rehabilitation methods with the inclusion of nicotinic acid electrophoresis on the dynamics of metabolic status indicators in patients with myocardial infarction after percutaneous coronary interventions

A study of the metabolic status of 123myocardial infarction patients who underwent emergency percutaneous coronary intervention and were admitted to the inpatient stage of rehabilitation has been carried out. The examination of the patients revealed a high incidence of hyperglycemia, hyperuricemia, dyslipidemia and atherogenic cholesterol fraction. It has been found that the administration of a pathogenetically based therapeutic complex including physical therapy, manual massage, dry carbon dioxide baths, and 1% nicotinic acid electrophoresis has a significant antiatherogenic effect, and contributes to the correction of uric acid and glucose levels, and insulin resistance.

Pre-Procedural Lpa level and ApoB/ApoA1 Ratio and the Risk for Contrast-Induced Acute Kidney Injury in Patients Undergoing Emergency Percutaneous Coronary Intervention

Background: High serum Lpa level and ApoB/ApoA1 ratio are risk factors for cardiovascular disease and kidney disease, and have been found to be related to the prevalence and prognosis of a variety of kidney diseases. However, it is not clear whether the preoperative serum Lpa level and ApoB/ApoA1 ratio are related to the incidence of CI-AKI after PCI.Methods: The 931 patients who underwent emergency PCI surgery from July 2018 to July 2020 were included. According to whether the serum creatinine level was higher than the baseline level (≥25% or ≥0.5 mg/dL) 48-72 hours after PCI, these participants were divided into CI-AKI group (n=174) and non-CI-AKI group(n=757). We detected the serum Lpa, ApoA1 and ApoB levels of the patients when they were admitted to the hospital, and calculated ApoB/ApoA1. Logistic regression and restricted cubic spline analyses were used to determine the correlation between Lpa concentration and ApoB/ApoA1 ratio and the risk of CI-AKI.Results: Among 931 patients undergoing emergency PCI, 174 (18.69%) patients developed CI-AKI. The preoperative Lpa level and ApoB/ApoA1 ratio of the CI-AKI group were higher than those of the non-CI-AKI group, and the differences were statistically significant (P <0.05). In each logistic regression model, we found that preoperative serum Lpa level and ApoB / ApoA1 ratio were inversely associated with the incidence of CI-AKI(P <0.05). After adjusting all the risk factors included in this study, restricted cubic spline analyses found that the preoperative Lpa level and the ApoB/ApoA1 ratio were positively correlated with the incidence of CI-AKI within a certain range.Conclusion: The preoperative high levels of Lpa and the ratio of ApoB/ApoA1 are independent risk factors for the onset of CI-AKI.

Manuscript title Microparticles Containing MiR-625-5p In Coronary Artery Reduce Myocardial Fibrosis After Myocardial Infarction

PurposeBlood from infarct-related arteries obtained by thrombus aspiration is good material for studying the local microenvironment of blood vessels in myocardial infarction. Here, we aimed to observe the effects of intracoronary microparticles (MPs) on cardiac fibrosis and to find associated microRNAs in MPs.MethodsBlood samples were collected from patients with ST-segment elevation myocardial infarction who underwent emergency percutaneous coronary intervention, and sub-supersonic centrifugation was used to separate the MPs.ResultsWe found that rats treated with intracoronary MPs showed better cardiac function after myocardial infarction compared with rats treated with PBS control or peripheral MPs. RNA microarray analysis indicated that microRNAs, especially miR-625-5p, may play a role in the process. Supplementation with miR-625-5p inhibited proliferation of cardiac fibroblasts and myocardial fibrosis in a mouse myocardial infarction model. ConclusionOur findings indicate that plasma MPs in infarct-related arteries in patients with acute myocardial infarction can inhibit myocardial fibrosis and improve cardiac function, with a process mediated by miR-625-5p and HMGA1 (high mobility group AT-hook 1). The current study may provide a possible reference for thrombus aspiration standard.