背景导管消融术是临床治疗心房颤动(AF)的主要手段,但术后仍存在一定复发风险,而老年AF患者导管消融术后低静息心率(RHR)发生率及复发率均较高.目的 探讨低RHR与≥65岁AF患者导管消融术后复发的关系.方法 选取2015年1月—2017年10月泰州市人民医院和苏州大学附属第一医院收治的≥65岁并行左心房环肺静脉导管消融术的AF患者82例,根据术前RHR分为A组(<50次/min,n=11)、B组(50～59次/min,n=17)、C组(≥60次/min,n=54);根据术后3个月AF复发情况分为复发组(n=25)和非复发组(n=57).比较A组、B组、C组患者一般资料〔包括性别、年龄、AF病程、CHADS2评分、合并症(包括高血压、糖尿病、心力衰竭)、器质性心脏病发生情况〕、左心房直径、左心室射血分数(LVEF)、术后3个月复发率,并比较A、B、C组导管消融术前及术后3个月RHR;比较复发组与非复发组患者一般资料、左心室直径、LVEF、随访1年RHR;低RHR与≥65岁AF患者导管消融术后复发的关系分析采用多因素Logistic回归分析.结果 (1)A、B、C组患者年龄、AF病程、左心房直径及术后3个月复发率比较,差异有统计学意义(P<0.05);A、B、C组患者性别,CHADS2评分,高血压、糖尿病、心力衰竭及器质性心脏病发生率,LVEF比较,差异无统计学意义(P>0.05).(2)A组患者术前及术后3个月RHR比较,差异无统计学意义(P>0.05);B、C组患者术后3个月RHR高于术前(P<0.05).(3)本组患者导管消融术后复发率为30.5％(25/82).复发组与非复发组患者性别,年龄,AF病程,高血压、糖尿病、心力衰竭、器质性心脏病发生率,LVEF,随访1年RHR比较,差异无统计学意义(P>0.05);复发组患者CHADS2评分高于非复发组,左心房直径长于非复发组(P<0.05).(4)多因素Logistic回归分析结果显示,术前RHR<50次/min是≥65岁AF患者导管消融术后复发的独立危险因素(P<0.05).结论 ≥65岁AF患者导管消融术后复发率较高,而术前RHR<50次/min是≥65岁AF患者导管消融术后复发的独立危险因素,临床上应采取针对性措施控制RHR以降低患者导管消融术后复发风险.

Background Chest pain center (CPC) accreditation plays an important role in the management of acute myocardial infarction (AMI). However, no evidence shows whether the outcomes of AMI patients are improved with CPC accreditation in China. Methods and Results This retrospective analysis is based on a predesigned nationwide registry, CCC‐ACS (Improving Care for Cardiovascular Disease in China‐Acute Coronary Syndrome). The primary outcome was major adverse cardiovascular events (MACE), including all‐cause death, reinfarction, stent thrombosis, stroke, and heart failure. A total of 15 344 AMI patients, from 40 CPC‐accredited hospitals, were enrolled, including 7544 admitted before and 7800 after accreditation. In propensity score matching, 6700 patients in each group were matched. The incidence of 7‐day MACE (6.7% versus 8.0%; P=0.003) and all‐cause death (1.1% versus 1.6%; P=0.021) was lower after accreditation. In multivariate adjusted mixed‐effects Cox proportional hazards models, CPC accreditation was associated with significantly decreased risk of MACE (hazard ratio: 0.78; 95% CI, 0.68–0.91) and all‐cause death (hazard ratio: 0.71; 95% CI, 0.51–0.99). The risk of MACE and all‐cause death both followed a reverse J‐shaped trend: the risk of MACE and all‐cause death decreased gradually after achieving CPC accreditation, with minimal risk occurring in the first year, but increased in the second year and after. Conclusions Based on a large‐scale national registry data set, CPC accreditation was associated with better in‐hospital outcomes for AMI patients. However, the benefits seemed to attenuate over time, and reaccreditation may be essential for maintaining AMI care quality and outcomes.

Background: Previous trials of PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitors demonstrated reductions in major adverse cardiovascular events, but not death. We assessed the effects of alirocumab on death after index acute coronary syndrome. Methods: ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) was a double-blind, randomized comparison of alirocumab or placebo in 18 924 patients who had an ACS 1 to 12 months previously and elevated atherogenic lipoproteins despite intensive statin therapy. Alirocumab dose was blindly titrated to target achieved low-density lipoprotein cholesterol (LDL-C) between 25 and 50 mg/dL. We examined the effects of treatment on all-cause death and its components, cardiovascular and noncardiovascular death, with log-rank testing. Joint semiparametric models tested associations between nonfatal cardiovascular events and cardiovascular or noncardiovascular death. Results: Median follow-up was 2.8 years. Death occurred in 334 (3.5%) and 392 (4.1%) patients, respectively, in the alirocumab and placebo groups (hazard ratio [HR], 0.85; 95% CI, 0.73 to 0.98; P=0.03, nominal P value). This resulted from nonsignificantly fewer cardiovascular (240 [2.5%] vs 271 [2.9%]; HR, 0.88; 95% CI, 0.74 to 1.05; P=0.15) and noncardiovascular (94 [1.0%] vs 121 [1.3%]; HR, 0.77; 95% CI, 0.59 to 1.01; P=0.06) deaths with alirocumab. In a prespecified analysis of 8242 patients eligible for >= 3 years follow-up, alirocumab reduced death (HR, 0.78; 95% CI, 0.65 to 0.94; P=0.01). Patients with nonfatal cardiovascular events were at increased risk for cardiovascular and noncardiovascular deaths (P<0.0001 for the associations). Alirocumab reduced total nonfatal cardiovascular events (P<0.001) and thereby may have attenuated the number of cardiovascular and noncardiovascular deaths. A post hoc analysis found that, compared to patients with lower LDL-C, patients with baseline LDL-C >= 100 mg/dL (2.59 mmol/L) had a greater absolute risk of death and a larger mortality benefit from alirocumab (HR, 0.71; 95% CI, 0.56 to 0.90; P-interaction=0.007). In the alirocumab group, all-cause death declined with achieved LDL-C at 4 months of treatment, to a level of approximately 30 mg/dL (adjusted P=0.017 for linear trend). Conclusions: Alirocumab added to intensive statin therapy has the potential to reduce death after acute coronary syndrome, particularly if treatment is maintained for >= 3 years, if baseline LDL-C is >= 100 mg/dL, or if achieved LDL-C is low.

OBJECTIVE:The optimal dose of Fasudil is still controversial in congenital heart disease accompanied with severe pulmonary hypertension (CHD-PAH). This study aimed to compare acute hemodynamic changes after different doses of Fasudil in 60 consecutive adult patients with CHD-PAH.DESIGN:Prospective randomized controlled trial.SETTING:Tertiary cardiology center.PATIENTS:Adult patients with CHD-PAH.INTERVENTIONS:Patients were randomized to Fasudil 30 or 60 mg.OUTCOME MEASURES:The hemodynamic parameters were measured at baseline and after 30 minutes of Fasudil through right cardiac catheterization. Blood gas results were obtained from the pulmonary artery, right ventricle, right atrium, superior and inferior vena cava, and femoral artery. Pulmonary vascular resistance (PVR) and systemic arterial resistance (SVR) were calculated.RESULTS:The changes in systolic pulmonary artery pressure (sPAP) (-13.1% vs -9.3%, P < .05), diastolic PAP (dPAP) (-17.6% vs -14.5%, P < .05), mean PAP (mPAP) (-12.4% vs -8.5%, P < .05), and PVR (-35.8% vs -22.2%, P < .05) were more pronounced in the 60-mg group than in the 30-mg group. All patients had no obvious adverse reactions related to peripheral blood pressure.CONCLUSIONS:Fasudil could improve the hemodynamics of patients with CHD-PAH, especially with the 60-mg dose. There were no serious adverse reactions.

目的 探讨冷冻球囊消融术(CBA)和射频消融术(RFCA)对心房颤动(简称房颤)患者治疗的有效性以及安全性;并分析房颤消融术后复发的危险因素.方法 选择本院行环肺静脉电隔离术的房颤患者共124例,按手术方式的不同分为CBA组(n=69),RFCA组(n=55).患者出院后定期进行门诊或电话随访,3个月空白期之后体表心电图记录到房颤 、心房扑动(简称房扑)或房性心动过速(简称房速),或24 h动态心电图检查中出现超过30 s的房颤 、房扑或房速均被视为术后复发,比较两组有效性及安全性.根据有无复发分为复发组与无复发组,比较两组特征,分析复发的影响因素.结果 ① 术后共有119例患者完成随访,完成随访的67例CBA组患者中25例(37.3％)在术后3个月复发;52例RFCA组患者中18例(34.6％)复发,两组间无差异(P=0.761).② 并发症方面,CBA组中有1例出现穿刺部位血肿,3例出现一过性膈神经麻痹;RFCA组有4例出现穿刺部位血肿,1例出现动静脉瘘,2例出现心包压塞;两组均未发生心房食管瘘 、膈神经损伤 、严重肺静脉狭窄等严重并发症.③ 复发组左房内径(LAD)大于无复发组[(43.10±5.78)mm vs(40.49±5.09)mm,P=0.012].多因素Logistic回归分析发现LAD为房颤消融术后病人复发的独立危险因素(OR 1.090,95％CI 1.008～1.178,P<0.05).结论 冷冻球囊消融治疗房颤的有效性及安全性不劣于射频消融术;LAD是房颤消融术后预测患者复发的独立危险因素.

目的:探讨阵发性心房颤动(房颤)患者行环肺静脉隔离(CPVI)术后心率减速力(DC)的变化及其对CPVI术后房颤复发的预测价值.方法:选取2015-01-2017-01在苏州大学附属第一医院心内科住院首次行CPVI术的阵发性房颤患者133例,分别于术前、术后急性期、术后3个月行Holter检查;术后急性期Holter检查于术后24～72 h进行;根据3个月空白期后是否复发,分为复发组(36例)和未复发组(97例);术后急性期DC值变化率为术后急性期与术前DC差值占术前DC值的比率;分析比较两组各时段DC值及变化率的差别,采用Kaplan-Meier法分析术后急性期DC变化率对CPVI术后房颤复发的影响.结果:①未复发组[(6.72±2.04) ms∶(3.99±1.90) ms,P＜0.05]和复发组[(7.05±2.71)ms∶(4.53±1.36) ms,P＜0.05]患者术后急性期DC值均较术前明显下降,两组间术前和术后急性期DC值均无明显差别,但复发组术后急性期DC变化率明显低于未复发组[(0.30±0.16)∶(0.44±0.26),P＜0.05];②Kaplan-Merier法分析结果显示,术后急性期DC变化率＜0.3的CPVI术后复发率明显增加(log rank=6.956,P＜0.05).结论:阵发性房颤患者CPVI术后急性期DC减低,提示迷走神经功能受损;CPVI术后急性期DC变化率＜0.3对房颤复发有一定预警价值.

BACKGROUND:The peri-crux area is an anatomical structure of the heart. Unfortunately, important information on this area mainly derives from autopsy heart with a small, under-representative sample size, resulting in limited clinical applications. Furthermore, little has been done to standardize the definition of the peri-crux area on coronary computed tomography angiography (CCTA) images or to investigate coronary artery anatomy wherein potential values are attracting experienced inventional cardiologists in terms of the revascularization strategies. The current study aimed to identify the peri-crux cordis area and to observe coronary artery anatomical distributions in this area on CCTA.METHODS:A total of 1,006 consecutive patients undergoing CCTA exams were enrolled. We delineated the peri-crux cordis area based on the posterior interatrial sulcus, posterior interventricular sulcus (PIS), left and right posterior atrioventricular groove on the diaphragmatic surface of the heart. Then we observed the coronary artery distributions in the peri-crux cordis area in different sexes.RESULTS:We have defined the peri-crux cordis area according to the anatomical landmarks on the diaphragmatic surface of the heart on CCTA images. We have observed 8 coronary artery distributions in the peri-crux cordis area. Right dominance has 4 types (types 1-4); left, 1 type (type 0) and balanced, 3 types (types 5-7). Out of the 1,006 cases, the type 1 is commonest with 834 cases (82.9%). There are no statistically significant differences in terms of coronary dominances and coronary artery distributions in the peri-crux cordis area between sexes (P>0.05).CONCLUSIONS:We have defined the peri-crux cordis area utilizing the anatomical landmarks of the heart on CCTA images, where 8 types of coronary artery distributions have been identified. The current study may provide interventional cardiologists with useful information on recognition of coronary artery dominance, use of collateral channels for revascularization of chronic total occluded lesions, and evaluation of prognosis in patients with coronary artery disease (CAD).

No data exist on comparisons of efficacy, safety, and recurrence risk factors of paroxysmal and persistent atrial fibrillation (AF) ablation using robotic magnetic navigation system (MNS), respectively.

We investigated the effect of Wnt11 on mitochondrial membrane integrity in cardiomyocytes (CMs) and the underlying mechanism of Wnt11-mediated CM protection against hypoxic injury. A rat mesenchymal stem cell (MSC) line that overexpresses Wnt11 (MSCWnt11 ) and a control cell line transduced with empty vector (MSCNull ) were established to determine the cardioprotective role of Wnt11 in response to hypoxia. Mitochondrial membrane integrity in MSCWnt11 cells was assessed using fluorescence assays. The role of paracrine signaling mediated by vascular endothelial growth factor (VEGF), basic fibroblast growth factor (b-FGF), and insulin-like growth factor 1 (IGF-1) in protecting CMs against hypoxia were investigated using cocultures of primary CMs from neonatal rats with conditioned medium (CdM) from MSCWnt11 . MSCWnt11 cells exposed to hypoxia reduced lactate dehydrogenase release from CMs and increased CM survival under hypoxia. In addition, CMs cocultured with CdM that were exposed to hypoxia showed reduced CM apoptosis and necrosis. There was significantly higher VEGF and IGF-1 release in the MSCWnt11 group compared with the MSCNull group, and the addition of anti-VEGF and anti-IGF-1 antibodies inhibited secretion. Moreover, mitochondrial membrane integrity was maintained in the MSCWnt11 cell line. In conclusion, overexpression of Wnt11 in MSCs promotes IGF-1 and VEGF release, thereby protecting CMs against hypoxia.

冠状动脉疾病是指冠状动脉粥样硬化致使管腔发生堵塞以及冠状动脉发生功能性改变.其为导致患者心绞痛、心肌梗死、心力衰竭甚至猝死的根本原因.介入治疗是目前公认的冠状动脉疾病的有效方法.虽然不断发展的介入技术和器械在冠状动脉疾病的治疗中展现了良好的效果,能够给患者带来长期无冠状动脉事件生存的临床获益,但是支架内再狭窄仍然是阻碍冠状动脉疾病治疗进展的主要原因,还需进一步改进介入手段或器械.近年来随着可吸收药物洗脱支架(BVS)以及药物涂层球囊(DCB)的出现,再狭窄的问题又有了新的解决方案.

Objective To compare the degree of myocardial injury between radiofrequency(RF),and cryoballon (CB),and to explore the possible clinical significance of it.Methods Forty-five patients with atrial fibrillation (AF),were treated with pulmonary vein isolation and were divided into two groups according to different ablation procedures:RF group(n =20) and CB group(n =25).Samples of cardiac troponin Ⅰ (cTnⅠ) were collected before the operation,within 6-12 h after the operation and within 3-5 days after the operation.Each patient was per formed with 12 leads ECG holter within 3-5 days after the operation.Results ①Compared with the preoperative cTnⅠ level,the cTnⅠ value both had an increase in the RF[1.59(0.82,1.95)μg /L vs 0.01(0.01,0.01)μg /L] group and CB group[7.16(4.23,9.31)μg /L vs 0.01(0.01,0.01)μg /L] within 6-12 h after the operation,and the cTnⅠ value both had a decrease in the RF[0.09(0.03,0.29)μg/L vs 1.59(0.82,1.95)] group and CB group[0.45(0.13,0.86)μg/L vs 7.16(4.23,9.31)μg/L] within 3-5 days after the operation;②Compared with the RF group,the CB group had a higher increase in the cTnⅠ level no matter within 6-12 h or 3-5 days after the operation,and the difference between the two groups was statistically significant.③No statistically significant difference was shown in the recurrence rate between the RF group and CB group(25％ vs 32％,P=0.607)during the acute stage after the operation.Conclusion Compared with the radiofrequency ablation,the degree of myocardial injury is greater in the cryoablation ablation,and there is no difference in the recurrence of the post-procedure acute phase between the two procedure.

目的 探讨磁导航指导下阵发性心房颤动(简称房颤)与持续性房颤导管消融的方法 学、安全性和有效性并进行比较.方法151例房颤患者,按房颤类型分为阵发性房颤组(n=102)和持续性房颤组(n=49).两组患者均在磁导航指导下进行左心房建模及双侧肺静脉前庭电隔离术,其中持续性房颤患者同时行左房顶部和二尖瓣狭部线性消融术.分析两组患者手术操作时间、从建模到肺静脉隔离时间、X线暴露时间、肺静脉前庭隔离急性成功率及手术相关并发症.术后1、3、6个月和1年分别进行随访,观察并比较两组患者房颤的复发率.结果 阵发性房颤组与持续性房颤组肺静脉前庭隔离急性成功率分别为98.04％和97.96％(P=0.974);两组患者手术操作时间、从建模到肺静脉隔离时间、X线暴露时间及导管消融时间无明显差异(P>0.05);阵发性房颤组术后发生2例血胸;持续性房颤组1例发生腹股沟处血肿;随访1年,两组房颤消融成功率分别为70.6％和57.1％(P=0.102).结论 磁导航指导下阵发性房颤和持续性房颤导管消融均具有较高的有效性和安全性.

Objective To investigate the relationship between coronary collateral circulation and myocardial no-reflow (MNR) in patients with ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI). Methods 227 STEMI patients who were treated by the PCI from June 2013 to December 2017 in hospital were divided into MNR group and control group, and their clinical data were statistically analyzed. MNR was defined as TIMI ≤ grade 2, including 33 patients with MNR and 194 controls. Results (1)The STEMI patients with MNR were positively associated with coronary collateral circulation, where the difference between groups is statistically significant (P＜0.001). (2)Multifactorial Logistic regression analysis showed that intravascular injection of tirofiban, smoking, stroke, platelet count and coronary collateral circulation are independent predictor of MNR. Conclusion Coronary collateral circulation decrease the possibility for patients of MNR after PCI.

目的:了解目前非瓣膜性心房颤动(non-valvular atrial fibrillation,NVAF)患者的抗凝治疗现状,并分析其影响因素.方法:选择2017年1月1日至2017年9月30日在苏州、无锡地区4所医院住院及门诊的NVAF患者,分析其一般资料、临床特征及抗凝药物的治疗情况.采用CHA2DS2-VASc评分评估NVAF患者的卒中风险;采用HAS-BLED评分评估抗凝出血风险.结果:共纳入NVAF患者453例,卒中风险高危(CHA2DS2-VASc评分≥2分)者365例(80.6％).其中,19例(5.2％)服用新型口服抗凝药治疗,87例(23.8％)服用华法林治疗,119例(32.6％)抗血小板药物治疗,140例(38.4％)未行抗凝治疗.年龄、心房颤动(AF)症状严重程度是影响NVAF卒中风险高危患者是否进行抗凝治疗的因素;60岁以上、有轻中度AF症状者接受抗凝治疗率较高(P＜0.05).结论:目前NVAF患者抗凝治疗率仍很低,须进行干预,尤其应对60岁以下及无症状的AF患者进行抗凝知识宣教.

BACKGROUND:The aim of this study was to evaluate the role of remote ischemic postconditioning (RIPC) of the upper arm on protection from cardiac ischemia-reperfusion injury following primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). MATERIAL AND METHODS:Eighty patients with STEMI were randomized into two groups: primary PCI (N=44) and primary PCI+RIPC (N=36). RIPC consisted of four cycles of 5 minutes of occlusion and five minutes of reperfusion by cuff inflation and deflation of the upper arm, commencing within one minute of the first PCI balloon dilatation. Peripheral venous blood samples were collected before PCI and at 0.5, 8, 24, 48, and 72 hours after PCI. Levels of creatine kinase-MB (CK-MB), serum creatinine (Cr), nitric oxide (NO), and stromal cell-derived factor-1α (SDF-1α) were measured. The rates of acute kidney injury (AKI) and the estimated glomerular filtration rate (eGFR) were calculated. RESULTS:Patients in the primary PCI+RIPC group, compared with the primary PCI group, had significantly lower peak CK-MB concentrations (P<0.01), a significantly increased left ventricular ejection fraction (LVEF) (P=0.01), a significantly lower rate of AKI (P<0.01) a significantly increased eGFR (P<0.01), and decreased area under the curve (AUC) of CK-MB, NO and SDF-1α. CONCLUSIONS:RIPC of the upper arm following primary PCI in patients with acute STEMI might provide cardiac and renal protection from ischemia-reperfusion injury via the actions of SDF-1α, and NO.

Objective To study the association between serum albumin level and first-onset AMI.Methods A total of 2172 patients with first-onset AMI served as an observation group and 3395 CHD-free patients served as a control group.The association between serum albumin level and first-onset AMI was analyzed by logistic regression analysis.Results The serum albumin level was significantly lower in observation group than in control group (40.0 g/L vs 41.4 g/L,P=0.000).On a continuous scale,when serum albumin level decreased by 1 standard deviation (～4 g/L),adjusted OR (95％CI) was 1.87 (1.75-2.01),1.85 (1.71-2.01),1.48 (1.26-1.74) for AMI in the total patients,male patients and female patients,respectively.On a categorical scale,Q1 (albumin level ≥43.8 g/L) was used as reference.Stratifying by age showed that adjusted OR (95％CI) was Q2 1.43 (1.12-1.82),Q3 1.95 (1.53-2.47),Q4 2.52 (1.95-3.27),Q5 4.51 (3.40-6.00) for AMI in patients aged ＜65 years and was Q2 1.61 (1.042.5),Q3 2.21 (1.48-3.31),Q4 3.34 (2.244.99),Q5 4.77 (3.22-7.08) in patients aged ≥65 years (P-for-trend ＜ 0.01).Stratifying by gender showed that serum albumin level was negatively associated with AMI in both sexes (P-for-trend ＜0.01).Conclusions Serum albumin level is negatively associated with the risk of first-onset AMI in a dose-response manner regardless of stratifying by age and/or gender.

The recovery of ischemic myocardium blood perfusion is the main treatment option for acute myocardial infarction (AMI). However, this treatment option has multiple side effects that directly affect the quality of life of the patients. The activation of platelet function plays an important role in the occurrence, development and treatment of AMI. The aim of the present study was to analyze the effects of remote ischemic post-conditioning on platelet activation of AMI patients with primary PCI treatment and clinical prognosis. A total of 71 patients with AMI were treated with primary percutaneous coronary intervention (PCI). They were randomly divided into control group (n=34) and observation group (n=37). The patients in the observation group were treated with remote ischemic post-conditioning. Further, flow cytometer was used to detect the platelet alpha granule membrane glycoprotein (CD62P) and the percentages of activated IIb/IIIa (PAC-1). The maximum platelet aggregation rate induced by adenosine diphosphate (ADP) and arachidonic acid (AA) was measured by light transmittance aggrometer. The incidence of major adverse cardiac events (MACE) was compared between the two groups during the follow-up period of 6 months. The percentage of CD62P (24 h after PCI) in the observation group was significantly lower than control group (P<0.05). Further, the incidence of MACE in the observation group was also lower than that of the control group (P<0.05). Remote ischemic post-conditioning could reduce the incidence of MACE in patients with AMI after primary PCI treatment. Moreover, the above observation may be related to the improvement of platelet CD62P activation.

Objectives: Dabigatran etexilate is widely used for stroke prevention in the patients with atrial fibrillation. The anticoagulation activity of dabigatran is not necessary monitored in routine clinical practice. We aimed to study the effect of dabigatran on thrombin generation (TG) and coagulation assays in rabbit and human plasma. Methods: Rabbits received different concentrations of dabigatran etexilate (5 mg/kg, 10 mg/kg). Patients with atrial fibrillation took 110 mg dabigatran etexilate twice daily. The concentrations of dabigatran in rabbit and human plasma were detected by liquid chromatography/tandem mass spectrometry (LC-MS/MS) and ecarin chromogenic assay (ECA). The relationship between plasma dabigatran concentrations and the activated partial thromboplastin time (aPTT), prothrombin time (PT), thrombin time (TT), and TG were evaluated. Results: There was strong correlation between LC-MS/MS and ECA (P < 0.001). Bland Altman analysis demonstrated that ECA assay could accurately predict human plasma dabigatran concentrations whereas underestimate the plasma concentrations of dabigatran in rabbits. Both the PT and the aPTT assays showed low correlations with dabigatran. The TT assay was highly sensitive to dabigatran levels. Low concentrations of dabigatran paradoxically increased TG. Conclusions: LC-MS/MS is the gold standard for detecting the concentrations of dabigatran. ECA correlates well with LC-MS/MS. The coagulation assays depend more on other factors. Paradoxical enhancement of TG may predict clinically rebound hypercoagulability and warrants further exploration.

BACKGROUND:Little is known about the relationship between C-reactive protein (CRP) and long-term mortality after acute myocardial infarction (AMI) in diabetic patients. The current study aimed to examine whether CRP levels are associated with for long-term all-cause, cardiovascular, and cardiac mortality in AMI patients with diabetes and those without separately. METHODS:The cohort study included 663 diabetic and 1853 non-diabetic patients with AMI. The median follow-up time was 1045 days (2.9 years). RESULTS:According to the median concentration of serum CRP (8.95 mg/l), the patients were divided into two groups. The low CRP level group (<8.95 mg/l) served as a reference. In diabetic patients with AMI, the adjusted hazard ratios (HRs) for long-term all-cause, cardiovascular, and cardiac mortality were 1.62 (P = 0.027), 1.91 (P = 0.008), and 2.08 (P = 0.007), respectively. In non-diabetic patients with AMI, the adjusted hazard ratios (HRs) for long-term all-cause, cardiovascular, and cardiac mortality were 1.72 (P < 0.001), 1.8 (P < 0.001), and 1.78 (P = 0.001), respectively. CONCLUSIONS:Regardless of whether patients had diabetes or not, CRP value is an independent predictor of long-term, all-cause, cardiovascular, and cardiac mortality after AMI.