Abstract:Aim To analyze the predictive value of plasma ApoB/ApoA ratio and D-dimer (D-D) levels for left ventricular thrombosis (LVT) after PCI in patients with acute ST-segment elevation myocardial infarction (STEMI), and establish a column chart model. Methods 187 STEMI patients admitted to Fuyang Sixth Peoples Hospital from January 2021 to December 2022 were selected. According to the follow-up results 28 days after surgery, the patients were divided into LVT group and non LVT group. The study conducted univariate and binary Logistic regression analysis on clinical data such as plasma ApoB/ApoA1 ratio and D-D in the two groups of patients, identified independent risk factors for LVT formation in STEMI patients after PCI, established a column chart model, and evaluated the diagnostic efficacy of the column chart model. Results The results showed that an increase in the ApoB/ApoA1 ratio (OR＝1.0,5%CI:1.057～1.648), an increase in D-D levels (OR＝1.1,5%CI:1.020～1.042), a preoperative TIMI of 0 (OR＝4.1,5%CI:1.018～16.849), and a decrease in LVEF (OR＝0.6,5%CI:0.853～0.963) were independent risk factors for LVT formation after PCI (P＜0.05), and the AUC predicted by the above indicators for LVT formation were 0.2,0.0,0.623 and 0.726, respectively. Based on the above indicators, a column chart model was established. ROC curve analysis showed that the consistency index of the model was 0.926, and the calibration curve showed that the model had good discrimination and consistency. Conclusions The increase in plasma ApoB/ApoA1 ratio and D-D levels in STEMI patients is closely related to the formation of LVT after PCI. The column chart model established based on the above indicators has high diagnostic efficacy in predicting LVT, which is beneficial for clinical medical staff to identify high-risk patients.

Abstract:Aim To investigate the association between platelet-derived extracellular vesicles (PEV) and thrombosis events in patients with systemic lupus erythematosus (SLE). Methods A cross-sectional study was used to include 144 patients with SLE who were treated in the Department of Rheumatology and Immunology of Kailuan General Hospital from January 2019 to April 2022. The general situation, laboratory data and thrombotic event data of the selected patients were collected, and the plasma PEV was detected by flow cytometry. Plasma PEV levels between SLE patients with and without thrombotic events were compared, 144 SLE patients were further divided into high level PEV group and low level PEV group. The differences of thrombotic events and coagulation indicators were compared between different PEV level groups. Spearman correlation analysis was used to analyze the correlation between plasma PEV and coagulation indicators, multivariate Logistic regression analysis was used to analyze the correlation between plasma PEV and thrombotic events. Results PEV levels in the SLE patients with thrombosis events was significantly higher than those without thrombosis events (306.65 (150.8,2.75)/μL vs. 227.04 (178.3,1.36)/μL, P＜0.01). Compared with low level PEV group, the high level PEV group had more patients with thrombosis events (38.29% vs. 20.61%, P＜0.05).Spearman correlation analysis showed that PEV was positively correlated with plasma fibrinogen and D-dimer levels in SLE patients (P＜0.05). Multivariate Logistic regression analysis showed that PEV in peripheral blood was significantly correlated with total thrombotic events and arterial thrombotic events in SLE patients (OR＝1.8,2.23, P＜0.1,0.019), but there was no statistical difference between PEV and venous thrombotic events (P＞0.05). Conclusion The increased plasma PEV level in SLE patients with thrombotic events is related to hypercoagulability and thrombotic events, and may be an effective marker of arterial thrombotic events in SLE patients.

Abstract:Aim To investigate clinical characteristics, outcome analysis and related factors of early left ventricular thrombosis (LVT) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods With a retrospective study, from January 2019 to December 1,7 patients with acute anterior wall myocardial infarction were enrolled in the Cardiovascular Department of Shenzhen Hospital, Fuwai Hospital, Chinese Academy of Medical Sciences.Among them, 53 patients with early LVT were selected as the STEMI＋LVT group, and 244 patients without LVT were selected as the STEMI group. Collect and compare basic clinical data, occurrence of embolic events, echocardiography and cardiac magnetic resonance imaging data, ventricular morphological characteristics of LVT, coronary angiography, interventional therapy, and medication plans between two groups of patients. Multivariate Logistic regression analysis was used to investigate the related factors of early LVT formation in acute STEMI patients. Results There was no significant difference between the two groups in age, hypertension, diabetes, smoking, multi vessel disease, high sensitivity C-reactive protein (hs-CRP), serum creatinine (SCr), total cholesterol (TC), triglyceride (TG), N-terminal pro-brain natriuretic peptide (NT-proBNP), and the proportion of patients receiving antiplatelet therapy (P＞0.05). The STEMI＋LVT group had a history of previous myocardial infarction, early ventricular aneurysm formation, concomitant shock (SCAI classification), and higher support rates for intra-aortic balloon pump (IABP) or extracorporeal membrane oxygenation (ECMO) compared to the STEMI group (P＜0.05). Left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) in the STEMI＋LVT group were higher than those in the STEMI group, LVEF in the STEMI＋LVT group was obviously lower than that in the STEMI group (P＜0.05). Multivariate Logistic regression analysis showed that a history of previous myocardial infarction (OR＝3.6,5%CI:1.069～10.592, P＝0.036), early ventricular aneurysm formation (OR＝3.0,5%CI:1.025～8.864, P＝0.047), and concomitant shock (OR＝3.1,5%CI:1.215～9.031, P＝0.017) were associated with an increased risk of early LVT formation in acute STEMI, while LVEF＞40% (OR＝0.3,5%CI:0.054～0.669, P＝0.011) and emergency PCI (OR＝0.4,5%CI:0.089～0.678, P＝0.008) were associated with a reduced risk of early LVT formation in STEMI. Conclusion Early LVT formation in acute STEMI patients is more common in the left ventricular apex, the combination of shock, previous history of myocardial infarction, early ventricular aneurysm, emergency PCI and baseline LVEF＞40% may be independent influencing factors for early LVT formation in acute STEMI patients.

Abstract:Aim To compare the clinical efficacy of dabigatran and warfarin in acute myocardial infarction with left ventricular thrombosis (LVT). Methods A total of 116 patients diagnosed with acute myocardial infarction and LVT who were hospitalized in Liaoning Provincial Peoples Hospital from september 2015 to march 2020 were collected and randomly divided into warfarin group and dabigatran group. Stroke rate, bleeding event rate, coagulation function indexes before and after 3 months of treatment, liver function indexes before and 1 month and 3 months after treatment were observed, and the disappearance time of thrombosis, new thromboembolic events and bleeding events during treatment were compared between the two groups. Results During the treatment, the dabigatran group had fewer total embolization events than the warfarin group (3.4% vs 24.1%, P＝0.002), of which cerebral embolism (1.7% vs 15.5%, P＝0.016) was statistically significant (P＜0.05); There was no statistically significant difference in prothrombin time(PT), thrombin time(TT) and fibrinogen(FIB) between the two groups (P＞0.05), activated partial thromboplastin time(APTT) was higher in the dabigatran group than that in warfarin group (P＜0.05). There was no statistically significant difference in liver function indexes of patients 1 month and 3 months after treatment between the two groups (P＞0.05). Compared with the warfarin group, the patients in the dabigatran group had a shorter thrombus disappearance time ((47.00±5.30) days vs (69.10±7.90) days, P＜0.01). The number of cases of left ventricular thrombus disappearance in dabigata group was significantly more than that in warfarin group(77.6% vs 39.7%, P=0.032). The incidence of bleeding in dabigatran group was lower than that of warfarin group (3.4% vs 17.2%, P＜0.05). Conclusion Dabigatran is safer and more effective than warfarin in the treatment of patients with acute myocardial infarction and left ventricular thrombosis.

Abstract:Patients with coronavirus disease 2019 (COVID-19) are often associated with hypercoagulability as well as some cardiovascular disease requiring antithrombotic treatment including acute coronary syndrome, atrial fibrillation, veinous thrombosis and so on. During antithrombotic therapy for patients with COVID-19, the particularity of COVID-19, effectiveness of antithrombotic therapy and interaction of special drugs should be considered. This requires individualized treatment in combination with the characteristics of COVID-19 and cardiovascular disease, the risk assessment of thrombosis and hemorrhage and the patients own situation. On this condition, antithrombotic treatment of cardiovascular diseases may need to be adjusted on the basis of conventional treatment norms to achieve higher treatment safety and effectiveness. A safe and effective antithrombotic strategy will be of great significance to the prognosis of patients with COVID-19.

Abstract:Aim To investigate the preventive and therapeutic effects of safflower yellow on acute and subacute in-stent thrombosis (IST) after emergency PCI in advanced age patients with ST-elevated myocardial infarction (STEMI). Methods A total of 786 STEMI patients were enrolled from April 2009 to March 2017, and randomly divided into the study group (388 cases) and the control group (398 cases), the study group was treated with safflower yellow on the basis of routine treatment in the control group. Fasting venous blood were taken to detect platelet activating factor (PAF) in all patients at 1,3, 10 and 30 days after PCI. IST events and hemorrhagic events were monitored within 30 days after PCI.Results Compared with the control group, the study group had a significantly decreased level of the serum PAF at 1,3 and 10 days after PCI. 15 cases (3.9%) occurred acute and subacute IST in the control group and 5 cases (1.3%) occurred acute and subacute IST in the study group, there was significant difference in the incidence of IST between the two groups (χ2＝4.948, P＝0.026). Bleeding events occurred in 5 cases (1.3%) of the study group and 7 cases (1.8%)of the control group, there was no significant difference in the incidence of bleeding events between the two groups (χ2＝0.522, P＝0.770). Conclusion Safflower yellow can prevent the occurrence of acute and subacute IST in advanced age patients with STEMI after emergency PCI and does not significantly increase the bleeding event. Safflower yellow is worth applying in clinical practice furtherly.

Abstract:Drug eluting stents (DES) have dramatically decreased the rate of in-stent restenosis, which are widely used in patients with atherosclerosis. However, as research continues, increasing evidences have demonstrated that the risk of DES-related stent thrombosis (ST) has tended to increase, which is closely associated with delayed endothelium coverage. Impaired endothelium could induce platelet adhesion and aggregation, incomplete stent apposition, or neoatherosclerosis development. Thus, we will discuss the detailed mechanisms for the DES-related deendothelialization and ST, and the effects of biodegradable stents on vascular endothelium.

Abstract:Atherosclerosis, which takes place in the walls of arteries, is a long-term progressive inflammatory pathological process. The rupture of atherosclerotic plaque and thus thrombosis may lead to acute cardiovascular events which threaten human health and life seriously. Recently, the role of neutrophils in atherosclerosis is attractted much attention.Activated neutrophils release web-like structures known as neutrophil extracellular traps (NETs). NETs affect the pathologic process in the patients with autoimmune diseases, acute lung injury, deep vein thrombosis, etc. A large number of studies indicate that NETs is associated with the formation of atherosclerosis and thrombosis. NETs, which act as predictive factors in coronary artery diseases, predict the major adverse cardiac events and the prognosis. This article is aimed to review the role of neutrophil extracellular traps in the development of atherosclerosis.

Abstract:As a high incidence of deep vein thrombosis, high-risk disease worthy of research, animal model of deep vein thrombosis lay the foundation for the study of deep vein thrombosis. There are many types of animal thrombosis model, the murine animal models are the most common, while non-murine animal models are relatively few. A review on the thrombus model of the non-murine large animal model, generalizing the production methods, evaluation mechanisms, research progresses, advantages and disadvantages, for future clinical research provide important reference for venous thromboembolic disease.

Abstract:Aim To retrospectively assess the effectiveness and safety of China-made drug eluting stent （CM-DES） implantation for the treatment of mild-to-modest calcified lesions in patients with acute coronary syndrome （ACS）.Methods Three hundred and twenty consecutive patients of ACS with 434 ischemia related lesions were implanted with CM-DES and received 6～12 months angiographic follow-up. The patients were divided into two groups according to whether the calcification exists or not: non-calcification groups （n267） and calcification group （n167）. Lesions treated with CM-DES were subjected to quantitative coronary angiography （QCA） at immediately and 6～12 months following stenting. Results Baseline clinical, demographic or angiographic characteristics were well comparable between the two groups. At follow-up, no differences were found between the two groups regarding in-stent restenosis （ISR） and in-segment restenosis rate （ISRR） （ISR: 3.9% vs. 4.3% P0.079 ISRR: 8.9% vs. 10.7%, P0.449）. The similar result was also observed concerning the target lesion revascularization （5.1% vs. 6.7% P0.401）. Besides, no difference about in-stent late loss （ISLL） and overall thrombosis rate （TR） was detected in both groups （ISLL: 0.18±0.42 mm vs. 0.19±0.43 mm TR: 1.7% vs. 1.4%, P>0.05 respectively）. Conclusion Our results indicated that implantation of CM-DES for patient of ACS with mild-to-modest calcified lesions was effective and conferred to similar outcomes compared with non-calcified coronary arteries without additional increase in major adverse cardiac events.