Background: Data on the association of subclinical hypothyroidism (SCH) with the severity of coronary artery disease and major adverse cardiovascular and cerebral events (MACCE) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) after percutaneous coronary intervention (PCI) are limited and conflicting. Objective: We established the baseline rate of SCH and followed the trajectory of thyroid-stimulating hormone (TSH) values during and after hospitalisation for PCI for up to six months and determined whether persistent SCH was associated with the severity of coronary artery disease and MACCE in patients with NSTE-ACS after PCI. Design: Population-based prospective cohort study. Patients: We included patients with NSTE-ACS who underwent PCI with simple balloon angioplasty or stent implantation for coronary heart disease. Measurements: Thyroid function tests of patients before PCI and 1 day, 1 week, 1 and 6 months after PCI were performed. Cases showing transient SCH were excluded. Patients were divided into two groups based on the results of four TSH tests: 0.27-4.2 mIU/L (n = 1472, 89.7%) and >4.2 mIU/L (n = 170, 10.4%). The risk factors for the severity of coronary artery lesions were estimated using multinomial logistic regression analysis. Univariate and multivariate Cox regression analyses were used to study the relationship between TSH and MACCE.Results: Among 1642 patients, there were 1070 males (65.2%) and 572 females (34.8%), with an average age of 62.5 ± 9.6 years. SCH patients had a wider range of diseased vessels and a higher number of diseased vessels (p < .05). TSH level was an
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.
Backgroud: Elevated lipoprotein(a) [Lp(a)] and thyroid stimulating hormone (TSH) are both associated with coronary artery disease (CAD), but it was controversial in ACS patients. Moreover, patients with elevated plasma TSH tend to have higher levels of lipoprotein. We supposed that patients with elevated LP (a) and TSH may have a adverse prognosis after coronary angiography.Methods: We consecutively recruited 1756 patients who underwent coronary angiography, of which 1473 patients with ACS were eventually enrolled. Major adverse cardiovascular events (MACEs) contained a complex of non-fatal stroke, non-fatal myocardial infarction, ischemic cardiovascular events, and cardiovascular death. According to the occurrence of end events within 27.4 months, the patients were split into two groups: non-endpoint event group (n = 1288) and endpoint event group (n = 185). The date between the two groups were compared. Serum LP (a) was measured by latex agglutination immunoassay (Roche Diagnostics GmbH, Mannheim, Germany).Results: During a median follow-up of 27.4 months, 185 (12.56%) MACEs occurred. Compared with the non-endpoints group,patients in the end-points group had higher level of preoperative LP (a), LDL and TSH (all P<0.05). Multivariate Cox proportional hazard model showed that LP (a) was an independent risk factor for adverse prognosis after coronary angiography in ACS patients, LP (a) > 53.8nmol/L (highest tertile ) predicted 1.704-fold risk for adverse prognosis of ACS (95%CI 1.194~2.433;P<0.05); Interestingly, patients with elevated LP (a) and TSH concomitantly conferred the highest risk for adverse prognosis OR=3.090 95%CI 1.657~5.765;P<0.001).Conclusion: LP (a) was an independent risk factor for adverse prognosis after coronary angiography in ACS patients, and the predictive efficacy was enhanced by TSH.
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