Objective To analyze the risk factors of myocardial injury in patients with acute coronary syndrome(ACS) after direct percutaneous coronary intervention(PCI), and to construct a risk prediction model based on these risk factors.Methods The clinical data of 126 patients with ACS who underwent direct PCI treatment in the Department of Cardiovascular Medicine of the Sixth Affiliated Hospital of Xinjiang Medical University from March 2019 to April 2023 were retrospectively selected. Patients were divided into myocardial injury group(n=44) and non-myocardial injury group(n=82) based on the occurrence of myocardial injury. Multivariate Logistic regression was used to analyze the influencing factors of myocardial injury in patients with ACS, and the nomogram risk prediction model was drawn using R software and rms package. The correction curve was drawn by the Bootstrap method using the caret package for internal verification, and the receiver operating characteristic(ROC) curve and decision curve(DCA) were used to evaluate the prediction model.Results The proportion of patients aged over 60 years old in the myocardial injury group showed higher levels of high-sensitivity C-reactive protein(hs-CRP), lipoprotein-associated phospholipase A2(Lp-PLA2), galectin-3(GAL3), heart-type fatty acid binding protein(H-FABP), and tissue protease S(CTSS) compared to the non-myocardial injury group(t/P=8.287/0.004, 5.137/<0.001, 7.939/<0.001, 5.243/<0.001, 6.913/<0.001, 4.999/<0.001). Multivariate Logistic regression analysis showed that age >60 years, high Lp-PLA2, high GAL3, high H-FABP, and high CTSS were independent risk factors for myocardial injury in ACS patients after direct PCI [ OR(95% CI)=5.916(1.298-26.967), 1.035(0.743-6.637), 2.270(1.015-1.054), 1.392(1.092-1.774), 1.489(1.044-2.125)]. Based on the risk factors, a risk prediction model was constructed: the column-line diagram model showed that C-index was 0.961, and the internal correction curve and the ideal curve fit well and were highly coincident. ROC curve showed that AUC predicted by the model was 0.961, sensitivity and specificity were 0.846 and 0.939, respectively. The decision curve showed that the clinical net benefit of the model was ideal.Conclusion Age over 60 years old and high levels of Lp-PLA2, GAL3, H-FABP, and CTSS are all risk factors for myocardial injury in ACS patients after direct PCI.Based on these factors, a risk prediction model can be constructed to visualize the risk and have ideal predictive value.

Objective To discuss the impacts of percutaneous coronary intervention(PCI) through the distal transradial artery access(dTRA) in the anatomical snuffbox area on puncture-related conditions and complications in elderly patients.Methods From January 2023 to January 2025, 126 elderly patients requiring PCI were admitted to the First Department of Cardiology of the 901 st Hospital of the Joint Logistic Support Force of the People's Liberation Army of China. They were randomly divided into Group A and Group B, with 63 cases in each group. Group A received d TRA, and Group B received the conventional radial artery approach(cTRA). The puncture situation, surgical condition, vascular ultrasound examination results, complications, and prognosis were compared.Results There were no statistically significant differences between the two groups of patients in terms of the number of punctures, the success rate of the first puncture, the success rate of catheterization, the angiography time, the operation time of percutaneous coronary intervention(PCI), the dosage of contrast agent, the total radiation dose, the diameter of the right radial artery, and the occurrence of complications(P>0.05). Compared with group B, the puncture time of patients in group A was prolonged(t/P=2.713/0.008). The postoperative radial artery compression time was shortened(t/P=10.350/<0.001), and the diameter of the right distal radial artery(t/P=2.175/0.032), VAS score(t/P=9.700/<0.001), and the incidence of postoperative radial artery occlusion were all decreased(χ 2/P=4.308/0.038).Conclusion Performing PCI through d TRA in the anatomical snuffbox area can optimize the puncture situation in elderly patients and reduce complications.

Objective To explore the clinical efficacy of dapagliflozin in the treatment of non-diabetic AMI and its impact on the TLR4/NF-κB signaling pathway.Methods From January 2023 to June 2024, 86 non-diabetic AMI patients admitted to Jinhua Municipal People's Hospital were randomly divided into a control group and an observation group, each consisting of 43 cases. The control group received conventional drug therapy, while the observation group was treated with dapagliflozin in addition to the standard treatment, both for six months. Post-treatment cardiac function indicators(LVEF,LVEDD, NT-pro BNP), inflammatory factor indicators(TNF-α, IL-6, IL-8), and TLR4/NF-κB signaling pathway-related indicators(TLR4, My D88, NF-κB m RNA) were analyzed. Additionally, the incidence of adverse drug reactions and major adverse cardiovascular events during treatment was observed.Results After six months of treatment, the observation group had a higher LVEF than the control group(t/P=13.725/<0.001). The LVEDD, NT-pro BNP, TNF-α, IL-6, IL-8, TLR4 m RNA,My D88 m RNA, and NF-κB m RNA levels were lower in the observation group compared to the control group(t/P=12.732/<0.001,7.369/0.003,4.659/0.005,5.930/<0.001,4.169/0.009,11.949/<0.001,6.594/0.002,8.556/<0.001), with all differences being statistically significant. During follow-up, the incidence of major adverse cardiovascular events(13.95%, 20.93%) and drug adverse reactions(13.95%, 18.60%) between the observation group and the control group did not show statistical significance(P>0.05).Conclusion Dapagliflozin can improve cardiac function in non-diabetic AMI patients, inhibit inflammatory responses, and has good safety. Its mechanism of action may be related to the inhibition of TLR4/NF-κB signaling pathway expression.

Objective To investigate the correlation of serum laminin(LN) and high molecular weight fibroblast growth factor-2(Hi-FGF-2) levels with the severity and prognosis of patients with chronic heart failure complicated with atrial fibrillation(CHF-AF).Methods A total of 235 patients with CHF-AF admitted to the Department of Cardiology of Inner Mongolia People's Hospital from January 2022 to June 2024 were prospectively enrolled as the CHF-AF group. According to NYHA cardiac function classification, patients were divided into class Ⅰ(n=43), class Ⅱ(n=57), class Ⅲ(n=61), and class Ⅳ(n=74). Based on 6-month prognosis, patients were categorized into poor prognosis subgroup(n=62) and good prognosis subgroup(n=173). Meanwhile, 58 healthy volunteers undergoing physical examination during the same period were included as the control group. Serum LN and Hi-FGF-2 levels were measured by enzyme-linked immunosorbent assay. Spearman correlation analysis was used to evaluate the relationship between serum LN, Hi-FGF-2 levels and NYHA classification. Multivariate logistic regression was performed to identify risk factors for poor prognosis in CHF-AF patients. Receiver operating characteristic(ROC) curve analysis was conducted to assess the predictive value of serum LN and Hi-FGF-2 for poor prognosis.Results Serum LN and Hi-FGF-2 levels were significantly higher in the CHF-AF group than in the control group(t/P=26.273/<0.001,17.252/<0.001). Both LN and Hi-FGF-2 levels increased progressively with NYHA class(F/P=42.349/<0.001,80.620/<0.001) and were positively correlated with NYHA classification(r s/P=0.670/<0.001,0.682/<0.001). The 6-month poor prognosis rate in CHF-AF patients was 26.38%(62/235). The poor prognosis subgroup had higher serum LN and Hi-FGF-2 levels than the good prognosis subgroup(t/P=8.885/<0.001,6.645/<0.001). Multivariate logistic regression showed that NYHA class Ⅲ–Ⅳ, elevated NT-pro BNP, higher LN, and higher Hi-FGF-2 were independent risk factors for poor prognosis [ OR(95% CI)=2.173(1.034-4.568),1.001(1.000-1.001),1.038(1.024-1.053),1.049(1.031-1.067)].The AUCs of LN, Hi-FGF-2,and their combination in predicting poor prognosis were 0.809, 0.801, and 0.911, respectively, with the combined model outperforming either marker alone(Z/P=3.803/<0.001,4.300/<0.001).Conclusion The levels of serum LN and Hi-FGF-2 in patients with CHF-AF are increased, which are related to the aggravation of the disease and poor prognosis. The combination of the two has a higher predictive efficiency for prognosis.

Objective To evaluate the predictive value of serum tissue inhibitor of metalloproteinase-2(TIMP-2),histone deacetylase 4(HDAC4), and uric acid(UA)/albumin(ALB) ratio(UAR) for acute kidney injury(AKI) in patients with acute Stanford type A aortic dissection(ATAAD) after surgery.Methods From December 2021 to December 2024, 133 ATAAD patients who underwent Sun's surgery and 133 heart healthy examinees in our hospital were selected as the study subjects and included in the ATAAD group and heart healthy group, respectively. Among them, 55 patients in the ATAAD group developed AKI after surgery and were included in the postoperative AKI group, while the remaining 78 patients were included in the postoperative normal group. The serum TIMP-2, HDAC4, and UAR were compared. Multivariate logistic regression was performed to analyze the influencing factors of AKI in ATAAD patients after Sun' s surgery. The relative risk was performed to discuss the risk of AKI in high expression of TIMP-2, HDAC4, and UAR compared to low expression.ROC curve was used to analyze the value of TIMP-2, HDAC4, and UAR in predicting AKI in ATAAD patients after surgery.Results The ATAAD group had higher serum TIMP-2, HDAC4, and UAR than the heart healthy group(t/P=11.469/<0.001,10.311/<0.001,12.235/<0.001). The postoperative AKI group had higher proportion of cases involving renal artery dissection,TIMP-2, HDAC4, UAR, and longer total extracorporeal circulation time than the postoperative normal group, and all of them were risk factors for AKI [ OR(95% CI)=3.125(1.795-5.442),2.674(1.651-4.330),2.831(1.691-4.740),3.335(1.824-6.099),2.749(1.661-4.549)].Relative risk analysis showed that the risk of developing AKI after surgery in patients with high TIMP-2,HDAC4, and UAR was 2.343 times, 2.269 times, and 3.457 times higher than that in patients with low levels. The AUCs of TIMP-2, HDAC4, UAR and the combination of the three for predicting AKI after Sun's surgery in patients with ATAAD were 0.833, 0.847, 0.832 and 0.963, respectively. The combination of the three was superior to the AUCs of TIMP-2, HDAC4 and UAR alone(Z=3.366, 3.236, 3.391, P=0.001,0.001,0.001).Conclusion Serum TIMP-2, HDAC4, and UAR are elevated,and their union has high value in predicting postoperative AKI in ATAAD patients.