RESUMEN
OBJECTIVES: This study aims to identify the risk factors contributing to in-hospital mortality in patients with acute ST-elevation myocardial infarction (STEMI) who develop acute heart failure (AHF) post-percutaneous coronary intervention (PCI). Based on these factors, we constructed a nomogram to effectively identify high-risk patients. METHODS: In the study, a collective of 280 individuals experiencing an acute STEMI who then developed AHF following PCI were evaluated. These subjects were split into groups for training and validation purposes. Utilizing lasso regression in conjunction with logistic regression analysis, researchers sought to pinpoint factors predictive of mortality and to create a corresponding nomogram for forecasting purposes. To evaluate the model's accuracy and usefulness in clinical settings, metrics such as the concordance index (C-index), calibration curves, and decision curve analysis (DCA) were employed. RESULTS: Key risk factors identified included blood lactate, D-dimer levels, gender, left ventricular ejection fraction (LVEF), and Killip class IV. The nomogram demonstrated high accuracy (C-index: training set 0.838, validation set 0.853) and good fit (Hosmer-Lemeshow test: χ2 = 0.545, p = 0.762), confirming its clinical utility. CONCLUSION: The developed clinical prediction model is effective in accurately forecasting mortality among patients with acute STEMI who develop AHF after PCI.
Asunto(s)
Técnicas de Apoyo para la Decisión , Insuficiencia Cardíaca , Mortalidad Hospitalaria , Nomogramas , Intervención Coronaria Percutánea , Valor Predictivo de las Pruebas , Infarto del Miocardio con Elevación del ST , Humanos , Infarto del Miocardio con Elevación del ST/mortalidad , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/terapia , Infarto del Miocardio con Elevación del ST/sangre , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/diagnóstico , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/mortalidad , Masculino , Femenino , Medición de Riesgo , Anciano , Persona de Mediana Edad , Factores de Riesgo , Resultado del Tratamiento , Reproducibilidad de los Resultados , Factores de Tiempo , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Volumen Sistólico , Función Ventricular Izquierda , Estudios Retrospectivos , Ácido Láctico/sangre , Factores SexualesRESUMEN
Background: Previous studies have suggested that adequate myocardial reperfusion after percutaneous coronary intervention (PCI) can improve the inhomogeneity of myocardial repolarization. However, it remains unclear whether no-reflow (NR) following emergency PCI involves disadvantages related to ventricular repolarization indices. The present study aimed to determine the effect of NR on QT dispersion (QTd) in patients with ST-segment elevation myocardial infarction (STEMI) and to evaluate the prognostic value of the relative reduction of QTd on ventricular arrhythmia events (VAEs). Methods: A prospective case-control study was conducted. According to the inclusion criteria, 275 patients with STEMI who underwent primary PCI treatment at the First People's Hospital of Anqing affiliated to Anhui Medical University from January 2020 to May 2023 were enrolled. According to whether NR occurred during PCI, these patients were divided into two groups: an NR group and a non-NR group. Subsequently, the QT intervals were measured before and at 12 hours after PCI. Afterward, the QTd, corrected QTd (QTcd), and the relative reduction of QTd and QTcd 12 hours pre- and postprocedure (ΔQTd-R and ΔQTcd-R, respectively) were calculated. Finally, multivariable logistic regression analysis was performed to predict the risk of VAE occurrence. Results: In the non-NR group, there was a significant decrease from baseline in postprocedure QTd (48±17 vs. 73±22 ms; P=0.009) and QTcd (54±19 vs. 80±23 ms; P=0.01); in contrast, the NR group showed no significant difference in QTd (64±20 vs. 75±23 ms; P=0.58) or QTd (70±22 vs. 82±26 ms; P=0.45). Furthermore, the ΔQTd-R and ΔQTcd-R were both lower in the NR group than in the non-NR group (P<0.05); however, the rate of VAEs was higher in the NR group than in the non-NR group (15.2% vs. 6.2%; P=0.02). The multivariable logistic regression analysis results revealed that each increase of 12% in ΔQTcd-R was an independent predictor of VAEs (odds ratio: 0.547; 95% confidence interval: 0.228-0.976). Conclusions: The NR phenomenon following primary PCI in patients with STEMI leads to the defective recovery of QTd and QTcd. Furthermore, ΔQTcd-R can be viewed as an effective indicator for evaluating the myocardial repolarization inhomogeneity, and short-term clinical outcomes.
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Mercury (Hg) is detrimental to human health, but its impact on lipid biomarkers remains a subject of controversy. This study sought to delineate a clear link between blood Hg and lipid biomarkers correlated with cardiovascular disease (CVD), including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG), in hypertensive adults in the USA. METHODS: This cross-sectional research gathered data from a total of 4415 participants sourced from the National Health and Nutrition Examination Survey (NHANES). The Holm-Bonferroni stepdown procedure was utilized to control the type I error rate in multiple comparisons. We employed multivariable linear regression models to assess the correlation between blood Hg and lipid biomarkers. Subsequently, subgroup analyses were conducted, categorized by both gender and race. Additionally, we used smooth curve fittings and generalized additive models to confirm the presence of non-linear relationships. When non-linearity was detected, we applied a recursive algorithm to calculate the inflection points. Finally, we established a weighted two-piecewise linear regression model to illustrate the associations on either side of the inflection point. RESULTS: In our multivariable linear regression models, clear associations emerged. Specifically, positive correlations were observed between blood mercury and TC (ß = 0.025; 95% CI 0.009 to 0.041; corrected P = 0.011), LDL-C (ß = 0.022; 95% CI 0.007 to 0.036; corrected P = 0.012), and HDL-C (ß = 0.007; 95% CI 0.001 to 0.013; corrected P = 0.058). However, there was no significant correlation with TG (ß = - 0.007; 95% CI - 0.018 to 0.004; corrected P = 0.526). Notably, it has been demonstrated that distinct inverted U-shaped and U-shaped curves exist when stratified by gender in our analysis. CONCLUSIONS: Blood Hg exhibited a positive correlation with TC, LDL-C, and HDL-C in hypertensive adults in the USA. Nonetheless, no significant association was observed with TG.
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OBJECTIVE: To observe the effect of Wenxin Granule (WG) on brain natriuretic peptide (BNP) and heart rate variability (HRV) of acute coronary syndrome (ACS) patients. METHODS: Totally 65 ACS patients were randomly assigned to the treatment group (35 cases) and the control group (30 cases). All patients were treated with routine therapies such as angiotensin conversing enzyme inhibitors (ACEI) and metoprolol. Those in the treatment group took WG, 9 g each time, three times daily. All were treated for 90 days. Plasma samples of BNP and HRV were determined before treatment and after treatment. RESULTS: There was no statistical difference in pre-treatment plasma BNP (P > 0.05). Plasma BNP significantly decreased after treatment in the two groups when compared with before treatment (P < 0.05). The decrease was more obvious in the treatment group (P < 0.05). There was no statistical difference in pre-treatment HRV (P > 0.05). Compared with before treatment in the same group, RMSSD, PNN50%, and high frequency (HF) obviously increased, while low frequency (LF) and LF/HF ratio significantly decreased in the two groups, showing statistical difference (P < 0.05). The aforesaid indices were obviously better in the treatment group than in the control group (P < 0.05). CONCLUSION: Additional administration of WG could improve short-term clinical prognosis by down-regulating plasma BNP level (via improving myocardial ischemia) and modulating HRV.