Patients with ST-segment elevation myocardial infarction (STEMI) who are treated by primary percutaneous coronary intervention (PPCI) have an increased risk of developing contrast-induced nephropathy (CIN) when compared with patients undergoing elective percutaneous coronary intervention (PCI). However, CIN prevention measures are less frequently applied in PPCI than in elective PCI. At present, no preventive strategy has been recommended by the current guidelines for patients with STEMI undergoing PPCI. Published research was scanned by formal searches of electronic databases (PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials) from 1966 to July 2018. Internet-based sources of information on the results of clinical trials in cardiology were also searched. A total of three randomized trials involving 924 patients were included in the present meta-analysis, of whom 462 received hydration with isotonic saline (hydration group) and 462 received no hydration (control group). Periprocedural hydration with isotonic saline was associated with a significant decrease in the rate of CIN (16.9% in the hydration group versus 26.4% in the control group; summary risk ratio: 0.64, 95% confidence interval: 0.50-0.82, P = 0.0005). There was no difference in the rate of postprocedural hemodialysis or death between the groups. Intravenous saline hydration during PPCI reduced the risk of CIN without significantly altering the rate of requirement for renal replacement therapy or mortality.

BACKGROUNDPrevious reports demonstrated a bleeding avoidance potential of angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) and β-blocker. It remains unclear whether guideline-directed medical therapy [GDMT, i.e., the combined use of β-blocker, angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) and statin] confers protection against bleeding in the setting of high-intensity antithrombotic therapy. METHODSWe assessed associations between the use of early (within the rst 24 hours) GDMT and in-hospital major bleeds, ischemic events and mortality among ST-elevation myocardial infarction (STEMI) patients treated with percutaneous coronary intervention (PCI) in the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome project. RESULTSAmong 34,538 STEMI patients without contra-indications to GDMT and eligible for analysis, 35.5% received early GDMT. In a 1-to-2 propensity-score matched cohort, early GDMT was associated with a 28% reduction in major bleeds [odds ratio (OR): 0.72, 95% con dence interval (CI): 0.58 to 0.90], with parallel reductions in ischemic events (OR: 0.60, 95% CI: 0.46 to 0.78) and in-hospital mortality (OR: 0.41, 95% CI: 0.30 to 0.57). GDMT-associated reduction in major bleeds was consistently observed across different major bleeding de nitions and in sensitivity analyses. Additionally, no signi cant interaction was observed in subgroup analyses. CONCLUSIONSIn a large nationwide registry, early initiation of GDMT was associated with reduced risk for in-hospital major bleeds in STEMI patients treated with PCI. To improve the outcome of STEMI, further effort should be made to reinforce the use of GDMT in this patient population. What Is KnownAmong stable and unstable coronary syndrome patients, STEMI patients had the highest risk of post-PCI bleeding due to concomitant administration of high-intensity antithrombotic medications in short duration.ACEI/ARB and β-blocker, as the key component of GDMT, were demonstrated separately to have protective association against bleeding complications.

Background and purpose: The Chest Pain Center accreditation project was launched in 2011 in China as a nationwide effort to improve clinical management of acute chest pain patients. In this study, we summarize the clinical characteristics and in-hospital outcomes of patients undergoing treatment for acute coronary syndrome (ACS) in Chest Pain Centers in China.Methods: Data were based on the Chinese Cardiovascular Association (CCA) Database-Chest Pain Center of 1,745,118 ACS patients admitted at 2,096 accredited Chest Pain Center between January 1, 2016, and December 31, 2021. Patient characteristics, time delays, treatment, and outcomes were analyzed using descriptive analysis.Results: The final analysis included a total of 1,745,118 patients, 699,476 patients (40.1%) with ST segment elevation myocardial infarction (STEMI), 349,572 (20.0%) with non-ST segment elevation myocardial infarction (NSTEMI), and 696,070 (39.9%) with unstable angina (UA). Electrocardiogram (ECG) was conducted in 89.4% of the patients within 10 min after first medical contact. For STEMI patients, the median door-to-wire crossing time was 72.1 (53.1 to 91.9) min and the median first medical contact-to-needle time was 32.3 (23.8 to 58.6) min. In-hospital mortality was 2.0% in the overall analysis, 3.6% for STEMI, 2.1% for NSTEMI, and 0.3% for UA. Primary percutaneous coronary intervention (PCI) was conducted in 62.8% of STEMI patients, with increasing rate in grade I and II hospitals over the 6-year study period. Patients treated with thrombolysis had significantly higher mortality than those treated with PCI and thrombolysis combined with PCI. The development of Chest Pain Centers varied substantially across geographic regions.Conclusions: Based on CCA Database-Chest Pain Center, the current study provided an overall description of the clinical characteristics of ACS patients in China. The results on management pattern and in-hospital outcomes of STEMI patients identified important areas for further improvement in ACS patient management in China.

BACKGROUNDPrevious reports demonstrated a bleeding avoidance potential of angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) and β-blocker. It remains unclear whether guideline-directed medical therapy [GDMT, i.e., the combined use of β-blocker, angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) and statin] confers protection against bleeding in the setting of high-intensity antithrombotic therapy.METHODSWe assessed associations between the use of early (within the first 24 hours) GDMT and in-hospital major bleeds, ischemic events and mortality among ST-elevation myocardial infarction (STEMI) patients treated with percutaneous coronary intervention (PCI) in the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome project.RESULTSAmong 34,538 STEMI patients without contra-indications to GDMT and eligible for analysis, 35.5% received early GDMT. In a 1-to-2 propensity-score matched cohort, early GDMT was associated with a 28% reduction in major bleeds [odds ratio (OR): 0.72, 95% confidence interval (CI): 0.58 to 0.90], with parallel reductions in ischemic events (OR: 0.60, 95% CI: 0.46 to 0.78) and in-hospital mortality (OR: 0.41, 95% CI: 0.30 to 0.57). GDMT-associated reduction in major bleeds was consistently observed across different major bleeding definitions and in sensitivity analyses. Additionally, no significant interaction was observed in subgroup analyses. CONCLUSIONSIn a large nationwide registry, early initiation of GDMT was associated with reduced risk for in-hospital major bleeds in STEMI patients treated with PCI. To improve the outcome of STEMI, further effort should be made to reinforce the use of GDMT in this patient population.