Inferior myocardial infarction is an acute ischemic heart disease with high mortality, which is easy to induce life-threatening complications such as arrhythmia, heart failure and cardiogenic shock. Therefore, it is of great clinical value to carry out accurate and efficient early diagnosis of inferior myocardial infarction. Electrocardiogram is the most sensitive means for early diagnosis of inferior myocardial infarction. This paper proposes a method for detecting inferior myocardial infarction based on densely connected convolutional neural network. The method uses the original electrocardiogram (ECG) signals of serially connected Ⅱ, Ⅲ and aVF leads as the input of the model and extracts the robust features of the ECG signals by using the scale invariance of the convolutional layers. The characteristic transmission of ECG signals is enhanced by the dense connectivity between different layers, so that the network can automatically learn the effective features with strong robustness and high recognition, so as to achieve accurate detection of inferior myocardial infarction. The Physikalisch Technische Bundesanstalt diagnosis public ECG database was used for verification. The accuracy, sensitivity and specificity of the model reached 99.95%, 100% and 99.90%, respectively. The accuracy, sensitivity and specificity of the model are also over 99% even though the noise exists. Based on the results of this study, it is expected that the method can be introduced in the clinical environment to help doctors quickly diagnose inferior myocardial infarction in the future.
ObjectiveTo explore the effect of continuous improvement of quality control system on the emergency treatment efficiency for patients with acute ST segment elevation myocardial infarction (STEMI) after the establishment of Chest Pain Center. MethodsWe retrospectively analyzed the differences of theory examination scores acquired by the Chest Pain Center staff one month before and after they got the system training. Moreover, we designated the STEMI patients treated between May and August 2015 after the establishment of Chest Pain Center but before optimization of process to group A (n=70), and patients treated from September to December 2015 after optimization of process to group B (n=55). Then we analyzed the differences between these two groups in terms of the time from patients' arriving to registration, the time from arriving to first order, the length of stay in Emergency Department, and even the time from door to balloon (D2B). ResultsThe scores acquired by Chest Pain Center staff before and after system training were 69.89±6.34 and 87.09±4.39 respectively, with a significant difference (P＜0.05). All the time indicators of both group A and group B were shown as median and quartile. The time from patients' arriving to registration of group A and group B was 6.0 (0.0, 11.0) minutes and 1.0 (0.0, 3.0) minutes (P＜0.05); the time from arriving to first order was 12.8 (9.0, 18.0) minutes and 5.0 (3.0, 9.0) minutes (P＜0.05); the length of stay in Emergency Department was 54.0 (44.0,77.0) minutes and 33.0 (20.0, 61.0) minutes (P＜0.05); and the time of D2B was 107.5 (89.0, 130.0) minutes and 79.0 (63.0, 108.0) minutes (P＜0.05). ConclusionAfter taking measures such as drawing lessons from the past, training staff and optimizing process continuously, we have significantly shortened the acute STEMI patients' length of stay in the Emergency Department, which has saved more time for the following rescue of STEMI patients.
Objective To determine the benefits of an invasive compared to a conservative strategy for treating unstable anguba (UA)/ non-ST-elevation myocardial infarction (NSTEMI). Methods We searched The Cochrane Library (Issue 4, 2009), MEDLINE (1996 to September 2009), EMbase (1974 to September 2009), CBM (1989 to 2009), CNKI (1997 to 2009), and VIP (1989 to 2009). The quality of the included studies was critically evaluated. Data analyses were performed using the Cochrane Collaboration’s RevMan 5.0 software. Results Seven randomized controlled trials involving 11 394 patients met the inclusion criteria. The results meta-analyses showed the incidence of all-cause mortality at six months follow-up was lower in the early invasive group compared with the conservative group (RR=0.75, 95%CI 0.61 to 0.92, P=0.007); the relative risk of myocardial infarction was significantly decreased in the early invasive group (RR=0.74, 95%CI 0.63 to 0.87); there was a reduction in rehospitalization for unstable angina in the invasive group (RR=0.66, 95%CI 0.61 to 0.73, Plt;0.000 01); the invasive strategy was associated with a two-fold increase in the relative risk of PCI-related myocardial infarction (as variably defined). There was not a significant increase in bleeding by an invasive strategy at six months follow-up, but, a routine invasive strategy was associated with a significantly higher bleeding rate at 1-year follow-up (RR=2.22, 95%CI 1.55 to 3.17, Plt;0.000 1). Patients with elevated cardiac biomarker levels at baseline benefited more from routine intervention, with no significant benefit observed in patients with negative baseline marker levels. Conclusion An early invasive strategy is preferable to a conservative strategy in the treatment of UA/NSTEMI, especially higher-risk patients with elevated cardiac biomarker benefit more from invasive strategy. In addition, complications such as procedure-MI and bleeding must be paid great attention to.
Objective To explore the effect of first aid mode based on intelligent chest pain center on the rescue effect of patients with acute myocardial infarction (AMI). Methods AMI patients treated in the Second Hospital of Baoding between May 2020 and September 2023 were retrospectively selected. Patients who received traditional chest pain emergency mode between May 2020 and January 2022 were selected as the control group, and patients who received intelligent chest pain center model between February 2022 and September 2023 were selected as the study group. The first aid success rate, first aid time (first visit time, 120 arrival time, triage evaluation time, venous channel opening time, and electrocardiogram time), treatment timeliness [first medical contact to balloon time (FMC-to-B), door to balloon time (D-to-B), stent placement time, emergency stay time, and hospitalization time], basic vital signs (systolic blood pressure, heart rate, and respiratory rate), incidence of complications and family first aid satisfaction were compared between the two groups. Results A total of 98 patients were included, including 50 in the study group and 48 in the control group. There was no significant difference in the success rate of first aid between the study group and the control group (96.0% vs. 83.3%, P>0.05). The first visit time [(203.15±33.82) vs. (260.71±41.05) min], 120 arrival time [(10.45±1.61) vs. (14.02±2.31) min], triage evaluation time [(1.07±0.21) vs. (1.71±0.33) min], venous channel opening time [(1.31±0.16) vs. (2.95±0.42) min], electrocardiogram time [(5.52±1.08) vs. (6.89±1.38) min], FMC-to-B [(115.82±31.74) vs. (145.29±46.15) min], D-to-B [(78.15±30.41) vs. (112.53±34.12) min], stent placement time [(45.01±8.36) vs. (71.85±9.67) min], emergency stay time [(38.24±9.81) vs. (59.46±11.05) min] and hospitalization time [(12.98±1.27) vs. (15.31±1.80) d] were shorter in the study group than those in the control group (P<0.05). After first aid, the systolic blood pressure [(133.49±13.16) vs. (142.69±12.58) mm Hg (1 mm Hg=0.133 kPa)], heart rate [(90.26±18.25) vs. (103.69±17.49) beats per minute], respiratory rate [(22.15±2.87) vs. (24.87±3.08) breaths per minute] and complication rate (10.4% vs. 27.5%) in the study group were lower than those in the control group (P<0.05). The first aid satisfaction of family members was higher in the study group than that in the control group (97.9% vs. 82.5%, P<0.05). Conclusion The first aid model based on intelligent chest pain center can improve the success rate of first aid treatment for AMI patients, shorten the first aid treatment time, enhance the time effectiveness of treatment, stabilize the basic vital signs of patients, reduce the incidence of complications, and improve the satisfaction of family members with first aid treatment.
Cardiogenic shock (CS) describes a physiological state of end-organ hypoperfusion characterized by reduced cardiac output in the presence of adequate intravascular volume. Mortality still remains exceptionally high. Veno-arterial extracorporeal membrane oxygenation (VA ECMO) has become the preferred device for short-term hemodynamic support in patients with CS. ECMO provides the highest cardiac output, complete cardiopulmonary support. In addition, the device has portable characteristics, more familiar to medical personnel. VA ECMO provides cardiopulmonary support for patients in profound CS as a bridge to myocardial recovery. This review provides an overview of VA ECMO in salvage of CS, emphasizing the indications, management and further direction.
Objective To estimate the incidence of post-myocardial infarction depression among Chinese acute myocardial infarction (AMI) patients by meta-analysis and to provide references for the management of AMI patients. Methods We searched databases including PubMed, The Cochrane Library (Issue 6, 2016), CNKI, CBM, WanFang Data and VIP from January 2000 to July 2016, to collect literature regarding the incidence of post-myocardial infarction depression among patients with AMI. Two reviewers independently screened literature, extracted data and evaluated the methodological quality of the included studies. Then meta-analysis was performed by using Comprehensive Meta Analysis (CMA) 2.0 software. Results Totally, 22 cross-sectional studies were included, involving 2 986 AMI patients, of which1 239 were post-myocardial infarction depression patients. The overall incidence of post-myocardial infarction depression among the AMI patients was 42.7% (95%CI 36.3% to 49.4%). There was no statistical differences observed when the studies were stratified by sex, regions, scales and years (allP values>0.05). Conclusion In China, the incidence of post-myocardial infarction depression is high and rising year by year roughly among AMI patients. The status should be paid more attention.
Survivors from myocardial infarction (MI) eventually develop heart failure due to the post-infarct ventricular remodeling which could not be suppressed by existing treatments. Currently, coronary heart disease has become the major cause of heart failure instead of rheumatic heart disease in China. For this reason, seeking effective treatment to prevent post-infarct ventricular remodeling is urgent. Intramyocardial injection of hydrogels as a new strategy for MI treatment has made great progress recently. This review discusses the principle, present status, mechanisms and prospects of injectable hydrogel therapies for MI.
In order to construct and express human cardiac troponin C-linker-troponin I(P) fusion protein, detect its activity and prepare lyophilized protein, we searched the CDs of human cTnC and cTnI from GenBank, synthesized cTnC and cTnI(30-110aa) into cloning vector by a short DNA sequence coding for 15 neutral amino acid residues. pColdⅠ-cTnC-linker-TnI(P) was constructed and transformed into E. coli BL21(DE3). Then, cTnC-linker-TnI(P) fusion protein was induced by isopropyl-β-D-thiogalactopyranoside (IPTG). Soluable expression of cTnC-linker-TnI(P) in prokaryotic system was successfully obtained. The fusion protein was purified by Ni2+ Sepharose 6 Fast Flow affinity chromatography with over 95% purity and prepared into lyophilized protein. The activity of purified cTnC-linker-TnI(P) and its lyophilized protein were detected by Wondfo FinecareTM cTnI Test. Lyophilized protein of cTnC-linker-TnI(P) was stable for 10 or more days at 37℃and 4 or more months at 25℃and 4℃. The expression system established in this research is feasible and efficient. Lyophilized protein is stable enough to be provided as biological raw materials for further research.
Objective To evaluate the feasibility and efficacy of emergency percutaneous coronary intervention( PCI) under mechanical ventilation for the treatment of patients with acute myocardial infarction complicated with acute pulmonary edema. Methods The clinical data of 15 patients admitted to the emergency ward for acute pulmonary edema caused by acute myocardial infarction from 2007 to 2009 were retrospectively analyzed. These patients received emergency PCI under mechanical ventilatory support.Parameters involved changes of symptoms, arterial blood gas, left ventricular ejection fraction( LVEF) , plasma concentrations of B-type natriuretic peptide( BNP) , and high sensitivity reactive protein( hs-CRP) . Results All patients showed significant improvements in dyspnea, artery blood gas parameters after PCI( P lt;0. 01) .LVEF increased significantly after PCI compared with before weaning [ ( 37. 36 ±0. 02) % vs ( 47. 41 ±0. 02) % , F =461. 47, P lt; 0. 05] . The concentrations of BNP and hs-CRP returned to lower level 4 weeks after PCI [ ( 99. 34 ±5. 15) fmol /mL vs ( 430. 50 ±96. 08) fmol /mL, ( 8. 35 ±2. 49) ng/mL vs ( 89. 50 ±9. 30) ng/mL, both P lt;0. 01] . Conclusion Emergency PCI under mechanical ventilatory support is a feasible and effective approach for patients with acute myocardial infarction complicated with acute pulmonary edema.