BACKGROUND:Microvascular occlusion (MVO) determined by cardiac magnetic resonance (CMR) exists both in acute phase and recovery period after myocardial infarction. This study aimed to examine the long-term prognosis predictive value of persistent MVO for ST-segment elevation myocardial infarction (STEMI). METHODS:A prospective cohort enrolled 344 patients with STEMI who received primary percutaneous coronary intervention and underwent CMR both in 5 to 7 days and 6 months after STEMI to determine if MVO had occurred. All patients were followed up for 5 years, and major adverse cardiovascular events (MACE) were recorded. RESULTS:This study included 344 STEMI patients with an average age of 57 years at 6 centers in China. A total of 192 (55.81%) patients with STEMI did not have MVO by CMR, and 105 (30.52%) patients showed transient MVO in acute phase of myocardial infarction and 47 (13.66%) patients showed persistent MVO at 6 months after infarction. The patients with persistent MVO had the largest infarct size and the lowest left ventricular ejection fraction both in 5 to 7 days and 6 months after infarction (all P < .001). Patients with persistent MVO showed a significantly higher incidence of 5-years MACE than those without MVO or with MVO in only 1 week (66.0% vs 18.8% and 27.6%, respectively; P < .001). Persistent MVO was an independent strong predictor of MACE after adjustment for other CMR variables (OR: 3.912, 95% CI: 1.904-8.037; P < .001). A propensity score-matched population comprised 43 patients with persistent MVO and 43 patients with transient MVO in only 1 week. The patients with persistent MVO had a higher incidence of MACE than those with transient MVO (65.1% [28/43] vs 37.2% [16/43]; P = .010). CONCLUSION:Persistent MVO by CMR at the chronic phase of STEMI provides useful prognostic information regarding long-term outcomes after primary percutaneous coronary intervention.

Background:Type 2 diabetes (T2DM) is a major risk factor for myocardial infarction. Thrombus aspiration was considered a good way to deal with coronary thrombus in the treatment of acute myocardial infarction. However, recent studies have found that routine thrombus aspiration is not beneficial. This study is designed to investigate whether intracoronary artery retrograde thrombolysis (ICART) is more effective than thrombus aspiration or percutaneous transluminal coronary angioplasty (PTCA) in improving myocardial perfusion in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI).Methods/Design:IntraCoronary Artery Retrograde Thrombolysis (ICART) vs. thrombus aspiration or PTCA in STEMI trial is a single-center, prospective, randomized open-label trial with blinded evaluation of endpoints. A total of 286 patients with STEMI undergoing PPCI are randomly assigned to two groups: ICART and thrombus aspiration or PTCA. The primary endpoint is the incidence of >70% ST-segment elevation resolution. Secondary outcomes include distal embolization, myocardial blush grade, thrombolysis in myocardial infarction (TIMI) flow grade, and in-hospital bleeding.Discussion:The ICART trial is the first randomized clinical trial (RCT) to date to verify the effect of ICART vs. thrombus aspiration or PTCA on myocardial perfusion in patients with STEMI undergoing PPCI.Clinical Trial Registration:[https://www.chictr.org.cn/], identifier [ChiCTR1900023849].

Background:The management of a large thrombus burden in patients with acute myocardial infarction and diabetes is still a worldwide problem. Case presentation:A 74-year-old Chinese woman presented with ST-segment elevation myocardial infarction (STEMI) complicated with diabetes mellitus and hypertension. Angiography revealed massive thrombus formation in the mid-segment of the right coronary artery leading to vascular occlusion. The sheared balloon was placed far from the occlusion segment and urokinase (100,000 u) was administered for intracoronary artery retrograde thrombolysis, and thrombolysis in myocardial infarction (TIMI) grade 3 blood flow was restored within 7 min. At last, one stent was accurately implanted into the culprit's vessel. No-reflow, coronary slow flow, and reperfusion arrhythmia were not observed during this process. Conclusion:Intracoronary artery retrograde thrombolysis (ICART) can be effectively and safely used in patients with STEMI along with diabetes mellitus and hypertension, even if the myocardial infarction exceeds 12 h (REST or named ICART ClinicalTrials.gov number, ChiCTR1900023849).

ST段抬高型心肌梗死是常见的心血管急危重症,致死率和致残率高.尽早实现心肌再灌注可有效挽救濒死心肌,改善ST段抬高型心肌梗死患者的预后,冠状动脉内溶栓在实现再灌注过程中发挥重要作用.现从血栓形成的机制、溶栓剂分类、冠状动脉内正向溶栓、血栓抽吸、血栓抽吸联合冠状动脉内溶栓、冠状动脉内逆向溶栓及应用前景等方面展开综述.

中国胸痛中心建设已进入普及阶段,但是院外、院内流程优化主要使用纸质版表格收集关键数据,工作量大且繁琐,而且面临二次录入.因此,设计基于院前急救的胸痛中心一体化信息系统,在胸痛救治过程实现院前、院中,区域医疗中心与基层医疗机构共同联动,从而有效缩减胸痛患者救治流程,减轻工作量,对提高救治效率至关重要.

为培训临床高层次医师,提高医疗质量,目前我国大多数省份及地区要求进行住院医师规范化培训,是医学生毕业后医学教育的重要组成部分,其培训质量直接影响到未来临床医生的医疗水平.心血管内科作为内科学中重要的轮转科室,其学科本身所具有的专科性及实践性的特点,同时也是所有规培医师在其以后的职业生涯中打牢临床基本功的学科.然而,在日常临床实践中科室发现心内科规培轮转医师以及带教方法存在问题,文章对出现的问题做简要探讨并提出相应的经验与建议,希望能为今后心血管内科住院医师规范化培训制度提供一点参考.

心血管疾病严重危害人类健康,且耗费大量医疗资源.随着人工智能可穿戴设备及物联网在医疗保健方面的迅速应用,基于电子医疗的远程监控架构在心血管疾病方面显现出了重要作用.现从心血管病流行病学、心血管病与胸痛中心、人工智能可穿戴设备、基于人工智能及物联网的胸痛区域救治平台等方面展开综述.

Previous studies have shown that nicorandil has a protective effect on cardiomyocytes. However, there is no study to investigate whether perioperative intravenous nicorandil can further reduce the myocardial infarct size in patients with ST-segment elevation myocardial infarction (STEMI) compared to the current standard of percutaneous coronary intervention (PCI) regimen. The CHANGE (China-Admini stration of Nicorandil Group) study is a multicenter, prospective, randomized, double-blind and parallel-controlled clinical study of STEMI patients undergoing primary PCI in China, aiming to evaluate the efficacy and safety of intravenous nicorandil in ameliorating the myocar dial infarct size in STEMI patients undergoing primary PCI and provide evidence-based support for myocardial protection strategies of STEMI patients.

Background and aims: Type 2 diabetes mellitus (T2DM) is a well-recognized independent risk factor for ASCVD, the aim of this study was to investigate the effects of a dipeptidyl peptidase-4 inhibitor, sitagliptin, on prevention of progression of coronary atherosclerosis assessed by three-dimensional quantitative coronary angiography (3D-QCA) in T2DM patients with coronary artery disease (CAD). Methods: This was a prospective, randomized, double-center, open-label, blinded end point, controlled 18-month study in patients with CAD and T2DM. A total of 149 patients, who had at least 1 atherosclerotic plaque with 20%-80% luminal narrowing in a coronary artery, and had not undergone intervention during a clinically indicated coronary angiography or percutaneous coronary intervention, were randomized to sitagliptin group (n = 74) or control group (n = 75). Atherosclerosis progression was measured by repeat 3D-QCA examination in 88 patients at study completion. The primary outcome was changes in percent atheroma volume (PAV) from baseline to study completion measured by 3D-QCA. Secondary outcomes included change in 3D-QCA-derived total atheroma volume (TAV) and late lumen loss (LLL). Results: The primary outcome of PAV increased of 1.69% (95%CL, - 0.8%-4.2%) with sitagliptin and 5.12% (95%CL, 3.49%-6.74%) with the conventional treatment (p = 0.023). The secondary outcome of change in TAV in patients treated with sitagliptin increased of 6.45 mm(3) (95%CL,-2.46 to 6.36 mm(3)) and 9.45 mm(3) (95%CL,-4.52 to 10.14 mm(3)) with conventional treatment (p = 0.023), however, no significant difference between groups was observed (p = 0.175). Patients treated with sitagliptin had similar LLL as compared with conventional antidiabetics (- 0.06, 95%CL, - 0.22 to 0.03 vs. - 0.08, - 0.23 to - 0.03 mm, p = 0.689). Conclusions: In patients with type 2 diabetes and coronary artery disease, treatment with sitagliptin resulted in a significantly lower rate of progression of coronary atherosclerosis compared with conventional treatment.

Background Clearance of coronary arterial thrombosis is necessary in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI). There is currently no highly-recommended method of thrombus removal during interventional procedures. We describe a new method for opening culprit vessels to treat STEMI: intracoronary arterial retrograde thrombolysis (ICART) with PCI. Methods & Results Eight patients underwent ICART. The guidewire was advanced to the distal coronary artery through the occlusion lesion. Then, we inserted a microcatheter into the distal end of the occluded coronary artery over the guidewire. Urokinase (5-10 wu) mixed with contrast agents was slowly injected into the occluded section of the coronary artery through the microcatheter. The intracoronary thrombus gradually dissolved in 3-17 min, and the effect of thrombolysis was visible in real time. Stents were then implanted according to the characteristics of the recanalized culprit lesion to achieve full revascularization. One patient experienced premature ventricular contraction during vascular revascularization, and no malignant arrhythmias were seen in any patient. No reflow or slow flow was not observed post PCI. Thrombolysis in myocardial infarction flow grade and myocardial blush grade post-primary PCI was 3 in all eight patients. No patients experienced bleeding or stroke. Conclusions ICART was accurate and effective for treating intracoronary thrombi in patients with STEMI in this preliminary study. ICART was an effective, feasible, and simple approach to the management of STEMI, and no intraprocedural complications occurred in any of the patients. ICART may be a breakthrough in the treatment of acute STEMI.

老年人群高血压发病率随年龄的增长升高.由于年龄增长导致血管重塑和血管功能变化,以及压力反射调节和体液调节的病理生理变化,老年高血压有其自身的发病特点和临床特征.现着重探讨中国老年人高血压的诊治研究进展.

Objective To investigate the changes of transcranial Doppler pulsation index ( PI ) of middle cerebral artery and risk factors in ischemic stroke patients .Methods The clinical data of 65 patients with ischemic stroke admitted to the Second Hospital of Datong from July 2017 to July 2018 were retrospectively analyzed to explore the correlation between PI and ischemic stroke .All patients underwent transcranial Doppler ultrasonography .Results In patients with ischemic stroke , PI value of middle cerebral artery in the infarcted side group was significantly higher than that in the non-infarcted side group, the difference was significant ( P<0.05 ) .Compared the PI value between lacunar infarction group and large infarction group , there was no significant difference ( P>0.05 ) .The increase of PI was correlated with age and body mass index ( BMI ) . Conclusions PI is an important indicator for predicting ischemic stroke .PI value is closely related with age and BMI , and should be paid attention to by obese patients .

高血压是全球范围内重要死亡因素之一,远程医疗模式在疾病诊断和治疗过程中发挥了重要作用.现从高血压流行病学、远程医疗模式、远程医疗在高血压患者管理中的应用、经济成本分析以及在未来研究中需解决的问题及应用前景等方面展开综述.

目的 评估高敏C反应蛋白(high-sensitive C-reactive protein,hs-CRP)在2型糖尿病(type 2 diabetes mellitus,T2DM)合并冠状动脉临界病变患者斑块进展中的预测价值.方法 入选解放军总医院第一医学中心2015年12月-2016年12月行冠状动脉CT检查提示存在临界病变的T2DM患者587例并完成1年随访,检测其基线血浆hs-CRP的水平,根据hs-CRP水平高低分为hs-CRP<2 mg/L组和hs-CRP≥2 mg/L组.1年后再次行冠状动脉CT并进行斑块进展评估,观察2组斑块进展情况.结果 两组基线资料均无统计学差异;血浆hs-CRP≥2 mg/L组斑块进展的比例高于hs-CRP<2 mg/L组(37.5％vs 23.8％,P=0.003),斑块不稳定性指标正性重构、点状钙化、低密度斑块比例高于hs-CRP<2 mg/L组(P均<0.05);随访1年后hs-CRP≥2 mg/L组出现不良心血管事件的比例高于hs-CRP<2 mg/L组(P<0.05).结论 hs-CRP≥2 mg/L是T2DM患者合并冠状动脉临界病变斑块进展的危险因素.

高血压是心血管疾病的主要危险因素,尤其是对于高血压病合并2型糖尿病的患者,两种疾病并发可显著增加患者心、脑、肾等靶器官损害风险,有效降低高血压和控制高血糖是降低心血管远期严重并发症的发生和降低该类患者病死率的关键.血管紧张素转换酶抑制剂和血管紧张素Ⅱ受体阻滞剂是大多数指南推荐的首选降压药物,二甲双胍、胰高血糖素样肽-1受体激动剂、钠-葡萄糖同向转运蛋白2抑制剂等降糖药物有一定协同降压作用.现简要阐述目前针对高血压合并2型糖尿病的患者在治疗上的进展.

目的 :探讨分析丹参多酚酸盐治疗冠心病的临床疗效及安全性.方法 :将我院2017年6月到2017年12月收治的75例冠心病患者随机分为两组,对照组患者(37例)应用马来酸桂哌齐特治疗,对观察组患者(38例)应用丹参多酚酸盐治疗,对比2组总有效率及不良反应情况.结果 :观察组总有效率为89.47％,对照组为62.16％,对比P<0.01,差异具有显著性;观察组不良反应发生率为7.89％,对照组不良反应发生率为10.82％,对比P>0.05,无明显差异.结论 :丹参多酚酸盐治疗冠心病临床疗效可靠、安全.

Objective To investigate the relationship between plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) and myocardial remodeling in hypertensive patients over 80 years old.Methods A total of 113 patients ( >80 years old) admitted in our hospital from Feb .2012 to Apr.2016 were enrolled in this study .They were divided into hypertension group (n=71) and normal blood pressure (control) group (n=42), and the former group was further assigned into 3 subgroups according to their systolic blood pvessure (SBP) and diastolic blood pressure (DBP), that is, level 1 subgroup (SBP 140 -159 mmHg, DBP 90-99 mmHg, n=5), level 2 subgroup (SBP 160-179 mmHg, DBP 10-109 mmHg, n=17) and level 3 subgroup (SBP≥180 mmHg, DBP ≥110 mmHg, n =49 ) .The plasma NT-proBNP level was determined and compared among the groups and subgroups , and its correlation with myocardial remodeling indicators was analyzed .Results With the increase of blood pressure levels, the plasma NT-proBNP level was gradually elevated .Except the level 1 subgroup and control group , significant differences were found in the plasma level among other groups ( P<0.05).The NT-proBNP level was positively correlated to hypertension duration (r=0.508), 24-hour DBP (r=0.312), left ventricular mass index (r=0.301), interventricular septum thickness (r=0.285), and negatively to E/A ratio (r=-0.376, all P<0.01).Conclusion A good correlation is observed between NT-proBNP level and myocardial remodeling in hypertensive patients aged over 80 years.

Background/objectivesThe relative efficacy and safety of limus-eluting stent (LES) versus paclitaxel-eluting stent (PES) in DM patients remain unclear.MethodsThe PubMed, EMBASE, and Cochrane Central Register of Controlled Trials electronic databases were searched from January 2001 to December 2013. Clinical trials that performed head-to-head comparisons of LES versus PES implantation in patients with DM were considered for inclusion.ResultsThis meta-analysis included 28 clinical trials involving 23,678 patients: 9953 who underwent sirolimus-eluting stent (SES) implantation, 4209 underwent everolimus-eluting stent (EES) or zotarolimus-eluting stent (ZES) implantation, and 9516 underwent PES implantation. The short-term target lesion revascularization (TLR) rate was significantly lower after SES implantation than after PES implantation (3.6% vs 6.3%; odds ratio (OR): 0.659; P=0.014), but there were no significant differences in the rates of target vessel revascularization (TVR), stent thrombosis (ST), myocardial infarction (MI), all-cause mortality, or major adverse cardiac events (MACE). There were no differences in the longer-term rates of TLR, TVR, ST, MI, all-cause mortality, or MACE between SES versus PES. Second-generation LES (EES or ZES) implantation resulted in lower rates of ST (2.1% vs 3.3%; OR: 0.586; P<0.001), MI (2.3% vs 4.1%; OR: 0.527; P=0.001), and MACE (8.0% vs 10.3%; OR: 0.796; P=0.007) than PES implantation.ConclusionsIn patients with DM, short- and longer-term MACE rates were similar after first-generation LES and PES implantation. The second-generation LES may be better than PES implantation in rates of ST, MI, and MACE.

揭示了元气-阴阳-五行理论在逻辑上是一个完整、统一的整体，只有按照中国科学传统的基本逻辑规律才能对此求解。基于运动的角度定义五行，以相应的图示解释其逻辑完备性，认为阴阳五行运动模式是自然界物质运动基本的、完备的方式，以此为基础对氢原子的运动行为进行了说明。元气-阴阳-五行理论所形成的逻辑模型，与现代科学所揭示的物质理论、生命理论可以互通，东西方科学传统不存在根本对立性的差异。