ST Elevation Myocardial Infarction

Research into the protective effects of two anti-inflammatory molecules, transforming growth factor-beta1 (TGF 1) and Heligmosomoides polygyrus TGM (HpTGM), following heart attack found that both proteins reduced the inflammatory response within the injured heart and reduced mature scarring. Anti-inflammatory therapy to treat patients following acute myocardial infarction is an exciting prospect that deserves further translational studies, report investigators. Research into the protective effects of two anti-inflammatory molecules, transforming growth factor-beta1 (TGFβ1) and Heligmosomoides polygyrus TGM (HpTGM), following heart attack found that both proteins reduced the inflammatory response within the injured heart and reduced mature scarring. Anti-inflammatory therapy to treat patients following acute myocardial infarction is an exciting prospect that deserves further translational studies, report investigators in The American Journal of Pathology, published by Elsevier. Patients with acute heart attacks (ST elevation myocardial infarction, or STEMI) are very likely to survive if they undergo timely reopening of the occluded coronary artery (coronary reperfusion) in specialized clinical centers. Despite the given survival rates and major improvements in treatment, progression to heart failure still represents a major clinical problem. The patients' longer-term outcomes depend on the extent of the damage to their heart tissue. Lead investigator Helen M. Arthur, PhD, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, explains: "Coronary reperfusion after STEMI is standard therapy to salvage ischemic heart muscle. However, evidence suggests that the subsequent inflammatory response that the body initiates to repair the damaged heart tissue can also cause further loss of viable heart muscle. The more muscle that is lost, the greater the risk of subsequent progression to heart failure. The reason for this study was to investigate the potential protective effects of TGFβ1as a possible intervention to minimize this additional damage to the heart beyond the ischemic damage caused by the heart attack itself." The research team found that levels of an important anti-inflammatory protein TGFβ1 in the blood of STEMI patients 24 hours after reperfusion correlated with a reduction in infarct size after three months. To investigate this further they used an established mouse model of a heart attack to test the protective effects of TGFβ1, a protein known to be released in the body in response to tissue injury. They also studied its mimic HpTGM, a protein produced by a parasitic worm to help evade the immune response and thereby enable the worm to live within the tissue lining the gut. Intravascular delivery of either of these naturally occurring anti-inflammatory proteins reduced the injurious inflammatory response within the heart and importantly, the extent of heart injury as evidenced by reduced mature scar size. The investigators were surprised to find almost identical beneficial effects of TGFβ1 and HpTGM treatment. Although TGFβ1 and HpTGM are evolutionarily unrelated, both these molecules interact with cells in a similar manner by activating the same signalling pathway. The dose of anti-inflammatory therapy was given at the time of reperfusion, which corresponds to a clinically useful time for a therapeutic intervention in humans. Investigators could attribute the beneficial outcomes to the protective effect of these molecules on endothelial cells -- the cells lining the blood vessels that help to regulate the exit of proinflammatory white blood cells from the circulation and enter the injured tissue. TGFβ1 has well-established anti-inflammatory properties, whereas HpTGM is a parasitomimetic with great clinical potential. Recent work in the Maizels laboratory at the University of Glasgow has also shown that delivery of HpTGM has a major anti-inflammatory effect in mouse models of colitis or airway inflammation, taking advantage of the product evolved by a parasite to quell the immune response to its presence. Dr. Arthur concluded: "The current study shows that exogenous delivery of HpTGM at the time of coronary artery reperfusion dampens the proinflammatory response of coronary endothelial cells and reduces cardiac injury, leading to increased myocardial salvage and reduced scar size with the corollary of improved prospects for long-term cardiac function. The use of HpTGM as an anti-inflammatory therapy in treating heart attack patients is clearly an exciting prospect that requires further translational studies."

Contract awarded for products that bring improvement to cardiovascular care CHELMSFORD, Mass.--(BUSINESS WIRE)-- Zoll, LLC®, an Asahi Kasei company that manufactures medical devices and related software solutions, announced today that it has received an Innovative Technology contract from Vizient, Inc., the nation’s largest provider-driven healthcare performance improvement company. The contract was awarded based on the recommendation of hospital experts who serve on one of Vizient’s customer-led councils, and it signifies unique qualities that potentially bring improvement to patient cardiovascular care. Innovative Technology contracts are recommended after review and interaction with products submitted through Vizient’s Innovative Technology Program. Vizient customer-led councils identify technologies that have the potential to enhance clinical care, patient safety, healthcare worker safety, or improve business operations of healthcare organizations. “Each year, more than 258,000 patients in the U.S. access emergency rooms as a result of heart attacks,1” said Matt Rochner, TherOx General Manager. “SSO2 therapy can benefit patients facing the most lethal of heart attacks, the LAD-STEMI.2 ZOLL is very pleased to work with Vizient to offer this new, innovative technology to Vizient customer hospitals.” Patients with left anterior descending ST-elevation myocardial infarction (LAD STEMI) heart attacks have higher mortality rates than other types of heart attacks. SSO2 Therapy is the first and only FDA-approved treatment that has been clinically proven to significantly reduce damage to cardiac muscle in heart attack patients after coronary angioplasty with stenting.3 The extent of damaged cardiac muscle is a strong predictor of future outcomes like rehospitalization and the development of heart failure.4 SSO2 Therapy is indicated for patients who suffer a LAD STEMI — also known as "widowmaker" heart attacks due to the high mortality rate — and are treated with stenting within six hours of symptom onset. The therapy delivers high levels of dissolved oxygen at 7–10 times the normal amount directly to the damaged heart muscle immediately after the coronary artery has been successfully opened via angioplasty and stenting. Multiple clinical trials have demonstrated the safety and efficacy of SSO2 Therapy to reduce infarct size.3, 5 - 8 “A product receives this type of contract when it demonstrates a unique quality that differentiates it from other products on the market,” said Kelly Flaharty, senior director of contract services for Vizient. “Our customer-led council determined that TherOx SuperSaturated Oxygen (SSO2) Therapy met this standard and recognizes its potential to improve quality outcomes.” Vizient represents a diverse customer base that includes academic medical centers, pediatric facilities, community hospitals, integrated health delivery networks, and non-acute healthcare providers and has a portfolio that represents more than $130 billion in annual purchasing volume. Through its Innovative Technology Program, Vizient works with customer-led councils and task forces to evaluate products for their potential to bring real innovation to healthcare. Vizient may award a contract to products deemed worthy of the Innovative Technology designation outside of the competitive bid cycle. About ZOLL ZOLL, an Asahi Kasei company, develops and markets medical devices and software solutions that help advance emergency care and save lives, while increasing clinical and operational efficiencies. With products for defibrillation and cardiac monitoring, circulation enhancement and CPR feedback, supersaturated oxygen therapy, data management, ventilation, therapeutic temperature management, and sleep apnea diagnosis and treatment, ZOLL provides a comprehensive set of technologies that help clinicians, EMS and fire professionals, as well as lay rescuers, improve patient outcomes in critical cardiopulmonary conditions. For more information, visit . About Asahi Kasei The Asahi Kasei Group contributes to life and living for people around the world. Since its foundation in 1922 with ammonia and cellulose fiber businesses, Asahi Kasei has consistently grown through the proactive transformation of its business portfolio to meet the evolving needs of every age. With more than 48,000 employees worldwide, the company contributes to a sustainable society by providing solutions to the world's challenges through its three business sectors of Material, Homes, and Health Care. Its health care operations include devices and systems for acute critical care, dialysis, therapeutic apheresis, and manufacture of biotherapeutics, as well as pharmaceuticals and diagnostic reagents. For more information, visit . Asahi Kasei is also dedicated to sustainability initiatives and is contributing to reaching a carbon neutral society by 2050. To learn more, visit . 1 Ahuja KR, Saad AM, Nazir S, Ariss RW, Shekhar S, Isogai T, Kassis N, Mahmood A, Sheikh M, Kapadia SR. Trends in Clinical Characteristics and Outcomes in ST-Elevation Myocardial Infarction Hospitalizations in the United States, 2002-2016. Curr Probl Cardiol. 2022 Dec;47(12):101005. doi: 10.1016/j.cpcardiol.2021.101005. Epub 2021 Oct 7. PMID: 34627825. 2 What is a STEMI Heart Attack? (clevelandclinic.org) 3 Stone GW, et al. Circ Cardiovasc Intervent 2009;2:366-75. 4 Stone GW et al. J Am Coll Cardiol. 2016;67(14):1674–83. 5 O’Neill WW, et al. Jour of Am Coll Cardiol. 2007;50: 5:397-405. 6 David SW, et al. Catheter Cardiovasc Interv. 2018;1–9. 7 8 Chen S, et al. Catheter Cardiovasc Interv. 2020; 1–7. Copyright © 2024 ZOLL Medical Corporation. All rights reserved. ZOLL and TherOx are registered trademarks of ZOLL Medical Corporation and/or its subsidiaries in the United States and/or other countries. Asahi Kasei is a registered trademark of Asahi Kasei Corporation. All other trademarks are the property of their respective owners.

引言ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后，手术后抗凝(PPA)经常被应用，尽管没有确凿的数据支持这种做法。2024年2月26日，首都医科大学聂绍平及法国索邦大学Gilles Montalescot共同通讯在Circulation(IF 38)在线发表题为“Postprocedural Anticoagulation After Primary Percutaneous Coronary Intervention for STSegment-Elevation Myocardial Infarction: A Multicenter, Randomized, Double-Blind Trial”的研究论文，该研究进行了一项经皮冠状动脉介入治疗ST段抬高型心肌梗死术后抗凝的多中心、随机、双盲试验。在2019年1月10日至2021年9月18日期间，共有2989名患者被随机分组。PPA组和安慰剂组均有37例患者(2.5%)达到主要疗效终点(风险比为1.00 [95% CI, 0.63至1.57])。PPA组和安慰剂组出血发生率无差异(8例[0.5%]vs 11例[0.7%]);风险比，0.74 [95% CI, 0.30 ~ 1.83])。因此，经皮冠状动脉介入治疗后常规PPA是安全的，但不能减少30天缺血事件。ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后，术后抗凝(PPA)经常用于预防缺血或血栓事件。然而，关于常规PPA的有效性、安全性和最佳方案的数据很少。尽管美国指南没有提到STEMI的PPA治疗，但最近欧洲心脏病学会关于急性冠状动脉综合征管理的指南建议在侵入性手术后停用抗凝剂，但证据为C级，且未提及原发性PCI。先前对比伐卢定的研究表明，PPA(联合比伐卢定或未分离肝素[UFH]，联合或不联合糖蛋白IIb/IIIa抑制剂)并不能减少不良的缺血事件，但会增加出血并发症，而另一项对急性冠状动脉综合征的分析报告称，高剂量比伐卢定给予长达4小时，可能对缺血有益，而不会出血过多。在ATOLL研究中(在短期和长期随访中，急性心肌梗死接受初级血管成形术和静脉注射依诺肝素或未分割肝素治疗以降低缺血和出血事件)，首次PCI术后单剂量40mg每日一次延长依诺肝素抗凝治疗时间，但没有随机评价PPA的效果。使用来自中国心血管疾病改善护理中心(CCC-ACS)的真实数据，研究人员发现PPA与院内死亡率降低相关，且没有过多的大出血并发症RIGHT试验(初次PCI后STEMI患者抗凝延长与不抗凝的比较)旨在测试当代STEMI初次PCI后常规PPA是否优于不抗凝。在所有患者进行首次PCI手术期间使用比伐卢定后，对可用于PPA的3种抗凝药物与各自的安慰剂进行评估。术后抗凝与安慰剂组的主要疗效和安全性结果（Credit: Circulation）在STEMI患者中，首次PCI后至少48小时的低剂量PPA在降低30天缺血结局方面并不优于不抗凝。在一项预先指定的探索性分析中，使用不同的抗凝方案(依诺肝素、UFH和比伐卢定)在主要疗效终点显示出不同的治疗效果，依诺肝素与安慰剂相比可能有益处。PPA患者未出现过量出血，证实了首次PCI术后48小时内减少抗凝剂剂量的安全性。该研究的结果也与之前在比伐卢定研究中获得的结果一致，包括最近的一项试验，在PCI术后相对较短的比伐卢定输注(1.75 mg·kg·h，最多4小时)，研究人员在随机化之前使用了这项试验。与另一项当代试验相比，该研究观察到糖蛋白IIb/ IIIa抑制剂的紧急使用发生率更高，可能是由于研究地点的使用分布不均匀。研究人员也承认抗血栓治疗强度对缺血和出血事件发生率的影响，该研究在使用糖蛋白IIb/IIIa抑制剂后的随机化过程确保了在主要疗效和安全性终点方面评估PPA与安慰剂的可比设计。总的来说，首次PCI术后常规PPA使用低剂量抗凝是安全的，但不能改善30天的缺血结局。数据表明，抗凝剂在预防30天缺血事件方面可能存在差异，但这一发现需要在未来的研究中得到证实。原文链接https://doi.org/10.1161/CIRCULATIONAHA.123.067079责编|探索君排版|探索君文章来源|“iNature”End往期精选围观一文读透细胞死亡(Cell Death) | 24年Cell重磅综述（长文收藏版）热文Nature | 破除传统：为何我们需要重新思考肿瘤的命名方式热文Nature | 2024年值得关注的七项技术热文Nature | 自身免疫性疾病能被治愈吗？科学家们终于看到了希望热文Nature | 癌症与神经系统的致命舞蹈