Home Medicine Current situation of acute ST-segment elevation myocardial infarction in a county hospital chest pain center during an epidemic of novel coronavirus pneumonia
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Current situation of acute ST-segment elevation myocardial infarction in a county hospital chest pain center during an epidemic of novel coronavirus pneumonia

  • Feng Li EMAIL logo , Rong Luo , Xiao-Ting Wang , Jun-Feng Jia and Xue-Ying Yu
Published/Copyright: January 9, 2023
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Open Medicine
From the journal Open Medicine Volume 18 Issue 1

Abstract

Our object was to examine how the pre- and post-pandemic COVID-19 impacted the care of acute ST-segment elevation myocardial infarction (STEMI) patients in county hospitals. Using January 20, 2020, as the time point for the control of a unique coronavirus pneumonia epidemic in Jieshou, 272 acute STEMI patients were separated into pre-epidemic (group A, n = 130) and epidemic (group B, n = 142). There were no significant differences between the two groups in terms of mode of arrival, symptom onset-to-first medical contact time, door-to-needle time, door-to-balloon time, maximum hypersensitive cardiac troponin I levels, and in-hospital adverse events (P > 0.05). Emergency percutaneous coronary intervention (PCI) was much less common in group B (57.7%) compared to group A (72.3%) (P = 0.012), and the proportion of reperfusion treatment with thrombolysis was 30.3% in group B compared to 13.1% in group A (P < 0.001). Logistic regression analysis showed that age ≥76 years, admission NT-proBNP levels ≥3,018 pg/ml, and combined cardiogenic shock were independent risk factors for death. Compared with thrombolytic therapy, emergency PCI treatment further reduced the risk of death in STEMI. In conclusion, the county hospitals treated more acute STEMI with thrombolysis during the COVID-19 outbreak.

Keywords: myocardial infarction; COVID-19; primary hospitals; chest pain center; percutaneous coronary intervention

1 Introduction

Acute myocardial infarction (AMI) has an acute onset, severe symptoms, and high mortality, and the death rate of AMI in China has been substantially higher in rural than in urban areas since 2013 [1]. In contrast to a general trend of diminishing AMI incidence and death in industrialized nations [2,3,4,5,6], it is estimated that the number of AMI cases in China would significantly grow from eight million in 2010 to 23 million in 2030 [7].

In the United States, Eberhard and colleagues found that the rate of heart disease mortality was greatest in the South, and rural regions had a rate 25% higher than Southern suburban people [8]. Rural and distant Australians have greater cardiovascular disease (CVD) risk factors, higher rates of CVD-related hospitalization, and are more likely to die from CVD than those in urban regions [9].

Early reperfusion therapy is an important measure for the salvage of acute STEMI patients, and early administration of fibrinolytic therapy and emergency primary percutaneous coronary intervention (PCI) can significantly reduce the mortality of ST-segment elevation myocardial infarction (STEMI) patients [10,11], and the earlier the reperfusion therapy within 12 h of onset, the higher the revascularization rate and the lower the in-hospital mortality [12]. Intravenous thrombolysis, primary angioplasty, intracoronary thrombolysis, or urgent coronary artery bypass grafting operations are examples of initial reperfusion treatment used to restore blood flow through a suspected or known occluded coronary artery shortly after diagnosis.

The choice of STEMI reperfusion treatment measures is influenced by the medical conditions, level of consultation and treatment, and geographical location in the area of consultation, and China Acute Myocardial Infarction studies have shown that the reperfusion ratio is lower in the county hospitals compared with provincial and municipal hospitals [13], but with the creation of chest pain centers in recent years, it has led to a significant improvement in the treatment of acute STEMI in the county hospitals, significantly shortened the rescue time, improved the reperfusion treatment ratio to varying degrees, and significantly improved the prognosis of STEMI patients [14,15]. Primary PCI is the recommended therapeutic method for patients with STEMI when done promptly, according to early randomized studies [16,17,18,19]. According to the most recent European Society of Cardiology recommendation, reperfusion treatment is advised in all STEMI patients with symptoms of ischemia lasting less than 12 h, and primary PCI is preferred over thrombolysis within the timeframes specified [20]. However, with the outbreak and rapid prevalence of the novel coronavirus pneumonia (COVID-19), the country adopted strict control measures for category A infectious diseases in order to control the rapid spread of the epidemic [21,22], taking measures such as travel restrictions, home isolation, and strengthening personal protection. The epidemic control and the psychological and emotional changes brought about by the epidemic, travel restrictions, and fear of hospital infection have affected the treatment of acute STEMI to some extent.

The impact of the COVID-19 pandemic on the management of acute STEMI patients has been reported differently in the domestic and international literature. Two domestic studies reported a decrease in the number of acute STEMI patient visits in high-risk areas, a delay in the symptom onset-to-first medical contact (S2FMC) time, a change in the choice of reperfusion therapy measures for acute STEMI patients, and prolongation of the door-to-balloon (D2B, interval between the patient’s arrival in the emergency department and ends when PCI with a catheter guidewire and balloon inflation crosses the culprit lesion) time during the pandemic [23,24]. Gramegna et al. demonstrate that patients with STEMI have a considerably longer duration from the beginning of symptoms to hospital admission when compared to the same timeperiod in the preceding two years [25], but no significant effect on prognosis has been found [23,24], and few relevant studies have been reported, mostly data from tertiary hospitals in high-risk areas during the pandemic period.

Increased mortality and worsening cardiac outcomes in AMI in the early phase of the epidemic [26]. A German study showed that the number of STEMI saved during the peak of the epidemic decreased significantly, but clinically important indicators such as preadmission ECG, D2B, and in-hospital mortality were not significantly affected, and the existing structure of the regionalized STEMI network ensured a high-quality standard of care [27]. In-hospital death rates were 15.2 versus 11.2% among patients with out-of-hospital STEMI plus COVID-19 versus out-of-hospital STEMI without COVID-19 (absolute difference, 4.1% [95% CI, 1.1−7.0%]; P = 0.007). In-hospital death rates were 78.5% versus 46.1% in patients with in-hospital STEMI plus COVID-19 versus in-hospital STEMI without COVID-19 (absolute difference, 32.4% [95% CI, 29.0−35.9%, P < 0.001) [28].

It is unclear how the COVID-19 pandemic affects the treatment of acute STEMI patients in the county hospitals in low-risk areas of the epidemic. There have been several divergent reports on hospital outcomes, particularly mortality, and cardiogenic shock [29,30,31]. This study aimed to explore the current situation and its impact on the treatment of acute STEMI patients in the chest pain centers of county hospitals before and after the COVID-19 pandemic.

2 Patients and methods

2.1 Study population

Inclusion criteria: 1. patients with STEMI, meeting the diagnostic criteria: ischemic chest pain or its equivalent, dynamic evolution of the AMI electrocardiogram (ECG), dynamic changes in serum myocardial injury marker levels (at least 2 markers); 2. two or more adjacent leads to ST-segment elevation (>0.2 mV in anterior leads and 0.1 mV in limb leads), and early reperfusion therapy within 12 h of the onset of the disease [10].

Exclusion criteria: 1. patients who refused to be hospitalized in our hospital after diagnosis; 2. onset time more than 12 h; 3. patients hospitalized for coronary artery disease with acute in-stent thrombosis resulting in acute STEMI; 4. COVID-19 patients.

2.2 Study method

This retrospective cohort research compared the management of STEMI at Jieshou county hospital chest pain center in China during the COVID-19 and pre-COVID-19 eras. Jieshou is in northwestern Anhui Province, China, covering an area of 667.3 km2, with a population of 834,000 (2019). According to the time point of January 20, 2020, the date of epidemic control in Jieshou City, STEMI patients admitted to Jieshou People’s Hospital from January 20, 2019 to January 20, 2020 were designated as the pre-epidemic group (group A, n = 130). STEMI patients admitted to Jieshou People’s Hospital from January 21, 2020 to January 20, 2021 were designated as the epidemic group (group B, n = 142). Patients’ age, gender, smoking history, history of hypertension, diabetes mellitus, dyslipidemia, new-onset atrial fibrillation, and comorbid other chronic diseases were collected, and patients’ arrival mode, type of infarction and choice of reperfusion therapy, S2FMC (median time), door-to-needle D2N (average time of admission to the emergency department to time that thrombolytics were given) time, door-to-balloon (D2B, median time) time, admission NT-proBNP levels, and highest hs-cTnI levels were retrospectively studied, in addition to thrombolytic recanalization rate, emergency PCI success rate, thrombolysis in myocardial infarction (TIMI) flow after emergency PCI, and multivessel lesions, major in-hospital adverse events, and length of stay.

  1. Ethics approval and consent to participate: This study was approved by the Ethics Committee of Jieshou People’s Hospital (JSLC20210001). The study proceeded to conform to the ethical guidelines of the 1975 Declaration of Helsinki. All participants had signed the written consent forms.

  2. Consent for publication: Written consents to publish the clinical information related to the participants were obtained.

3 Statistical analysis

SPSS 26.0 software was used to analyze the data. The measurement data that conformed to normal distribution was expressed as mean ± standard deviation (SD) with independent sample t-test analysis, and those not conforming to normal distribution was expressed as M(Q1, Q3) with Mann–Whitney test analysis. Count data were expressed as %, and the χ 2 test or fisher exact test was used for comparison between groups. The CUT off-bounds of the quantitative variables were calculated using the Receiver Operator Characteristic (ROC) curve, and the quantitative variables were converted to qualitative variables and included in the binary logistic regression analysis. The dependent variable was death, and the independent variables included age, male, new-onset atrial fibrillation, comorbid chronic disease, admission NT-proBNP, cardiogenic shock, and different treatment modalities. P < 0.05 was considered a statistically significant difference.

4 Results

4.1 General information

At baseline, there were no statistically significant differences in age, gender, hypertension, diabetes, dyslipidemia, new-onset atrial fibrillation, or combined other chronic illnesses between the two groups (P > 0.05). According to electrocardiogram finding, acute STEMI was characterized as anterior or inferior wall infarction, with no statistically significant difference in the kind of infarction between the two groups (P > 0.05) (Table 1).

Table 1

Comparison of baseline characteristics between groups (%, mean ± SD)

Index Group A Group B t/χ² P value
Number of cases 130 142
Age (years) 64.96 ± 11.54 63.75 ± 12.80 0.820 0.420
Sex (male) 93 (71.5%) 108 (76.1%) 0.718 0.397
Smoking history 44 (33.8%) 48 (33.8%) 0.000 0.990
Hypertension 76 (58.5%) 68 (47.9%) 3.046 0.081
Diabetes mellitus 22 (16.9%) 31 (21.8%) 1.042 0.307
Hyperlipidemia 25 (19.2%) 24 (16.9%) 0.249 0.618
New onset atrial fibrillation 10 (7.7%) 6 (4.2%) 1.473 0.225
Other chronic diseases 33 (25.4%) 35 (24.6%) 0.020 0.889

STEMI: ST segment elevation myocardial infarction.

4.2 Comparison of STEMI patient visits between the two groups

The difference between S2FMC in group B and group A was not statistically significant (P > 0.05), but the proportion of thrombolysis after admission was significantly higher than that in group A (30.3 vs 13.1%), while the proportion of emergency PCI treatment was significantly lower than that in group A (57.7 vs 72.3%, P < 0.01, Table 2).

Table 2

Comparison of treatment situations between groups (%, Q1, Q3)

Index Group A Group B χ² P value
S2FMC time (min, median) 120 (60, 180) 120 (64.75, 202.25) 1.086 0.277
Hospital arrival method 130 142
 Self-attendance 88 (67.7%) 103 (72.5%) 1.103 0.85
 First-aid Ambulance 37 (28.5%) 35 (24.6%)
 In-hospital onset 3 (2.3%) 2 (1.4%)
 Outpatient transfer 2 (1.5%) 2 (1.4%)
Treatment 130 142 17.248 0.002
 Thrombolysis 17 (13.1%) 43 (30.3%) 11.685 0.001
 Emergency PCI 94 (72.3%) 82 (57.7%) 6.301 0.012
 Emergency CAG 4 (3.1%) 7 (4.9%) 0.600 0.438
 Elective 2 (1.5%) 5 (3.5%) 1.064 0.302
 Conservative 13 (10%) 5 (3.5%) 3.82 0.051

STEMI, ST-segment elevation myocardial infarction; S2FMC, symptom onset-to-first medical contact; PCI, primary percutaneous coronary intervention; CAG, coronary angiography.

4.3 Comparison of reperfusion therapy in STEMI patients in the two groups

There were no statistically significant differences in reperfusion treatment, D2N time, thrombolysis recanalization rate, post-thrombolysis PCI rate, number of successful emergency PCI cases, D2B time, post-procedure TIMI flow grade III rate, and proportion of multivessel lesions between the two groups (Table 3).

Table 3

Comparison of reperfusion treatments between groups (%, Q1, Q3, mean ± SD)

Index Group A Group B Z, t/χ² P value
Reperfusion therapy 115 (88.5%) 132 (93%) 1.644 0.200
Thrombolytic therapy 17 43
 Recanalization rate 14 (82.4%) 32 (74.4%) 0.446 0.504
 Post-thrombolysis PCI rate 9 (52.9%) 28 (65.1%) 0.764 0.382
 Post-procedure TIMI flow grade III rate 7 (77.8%) 19 (67.9%) 0.334 0.563
 D2N time 61.88 ± 40.32 40.98 ± 16.49 2.070 0.053
Proposed emergency PCI 98 89
Number of successful emergency PCI cases 94 (95.92%) 82 (92.13%) 1.206 0.272
 D2B time (median) 87 (68.75,110.5) 83.5 (70,107.5) 0.332 0.740
 Number of stents implanted 1.24 ± 0.61 1.43 ± 0.80 1.807 0.073
 Multivessel lesions 75 (79.7%) 60 (73.17%) 1.073 0.300
 Post-procedure TIMI flow grade III rate 93 (98.9%) 82 (100%) 1.000

STEMI, ST segment elevation myocardial infarction; TIMI, thrombolysis in myocardial infarction; PCI, primary percutaneous coronary intervention; D2B, door to balloon; D2N, door to needle.

4.4 Comparison of cardiac function indexes and adverse events between two groups of STEMI patients

The admission NT-proBNP levels in group B was lower than that in group A, and the difference was statistically significant (P < 0.05), but the differences in bleeding, heart failure, cardiogenic shock, highest hs-cTnI (ng/ml) levels, adverse events and length of stay were not statistically significant compared with group A (P > 0.05, Table 4).

Table 4

Comparison of heart function parameters and adverse events between groups (%, Q1, Q3)

Index Group A Group B Z/χ² P value
Admission NT-proBNP (pg/ml) 392 (123, 1,628) 193 (70.5, 944) 2.455 0.014
Highest hs-cTnI (ng/ml) 4.9 (0.32, 25.1) 4.13 (0.56, 24.93) 0.375 0.708
Total adverse cardiovascular events 32 (24.6%) 28 (19.7%) 0.947 0.331
Bleeding 2 (1.5%) 8 (5.6%) 3.463 0.063
Heart failure 15 (11.5%) 19 (13.4%) 0.210 0.646
Malignant arrhythmia 15 (11.5%) 10 (7.0%) 1.644 0.200
Cardiogenic shock 16 (12.3%) 19 (13.4%) 0.070 0.792
Death 15 (11.5%) 12 (8.5%) 0.724 0.395
Length of hospitalization (days) 6.34 ± 3 6.57 ± 3.4 0.598 0.550

STEMI, ST-segment elevation myocardial infarction; NT-proBNP, N-terminal pro-brain natriuretic peptide; hs-cTnI, hypersensitive cardiac troponin I.

4.5 Binary logistic regression analysis of the risk of death in STEMI patients

A binary logistic regression analysis with whether the death was the dependent variable and age, male, new-onset atrial fibrillation, comorbid chronic disease, positive admission NT-proBNP, cardiogenic shock, and different treatment modality factors as independent variables revealed that age ≥76 years, admission NT-proBNP levels ≥3,018 pg/ml and comorbid cardiogenic shock were independent risk factors for death in primary care STEMI patients.

Compared with thrombolytic therapy, emergency PCI further reduced the risk of death in older adults (76 years and older) with high NT-proBNP levels (where age and admission NT-proBNP levels were divided into two groups using ROC cutoff values of patients’ age of 76 years and admission NT-proBNP levels of 3,018 pg/ml, and treatment modalities were divided into three groups: thrombolysis, emergency PCI and others, Table 5).

Table 5

Logistic regression analysis of mortality risks in STEMI patients

Variables B SE Wald P value OR 95% CI
Lower bond Upper bond
Cardiogenic shock 2.376 0.666 12.726 0 10.761 2.917 39.696
Admission NT-proBNP 1.883 0.676 7.745 0.005 6.571 1.745 24.743
Age ≥76 years 1.336 0.664 4.052 0.044 3.804 1.036 13.973
Treatment modality 14.438 0.001
Treatment modality (emergency PCI) −2.04 0.756 7.282 0.007 0.13 0.03 0.572
Treatment modality (other) 0.907 0.738 1.513 0.219 2.477 0.584 10.517

STEMI, ST-segment elevation myocardial infarction; PCI, primary percutaneous coronary intervention; OR, odds ratio; CI, confidence interval; NT-proBNP, N-terminal pro-brain natriuretic peptide.

5 Discussion

With the popularization of the core concept of “time is myocardium, time is life” in primary hospitals and the guidance of acute STEMI guidelines [10], more and more primary hospitals have created primary or standard versions of chest pain centers, which standardize the diagnosis and treatment process of acute STEMI patients and improve the efficiency and shorten the total ischemic time, diagnosis and treatment process, improving the efficiency of treatment, shortening the total ischemic time, and significantly improve the prognosis of STEMI patients [32]. The COVID-19 outbreak lockdown, including access restrictions and traffic restrictions, was the primary prevention and control measure taken early on in most parts of China, which will inevitably have an impact on the emergency care of acute STEMI patients.

The results of this study found no statistically significant differences yet in the number of admissions and S2FMC in primary hospital chest pain centers, unlike earlier national and international studies. Data from Hangzhou, China, showed that the S2FMC time, D2B time, and catheterization laboratory activation time were significantly longer during the COVID-19 epidemic than before the epidemic, with a higher cumulative mortality rate at 28 days after surgery and longer inpatient consultation time [24]; the international studies on the impact of the COVID-19 epidemic on the treatment time of STEMI patients found a significant delay in the S2FMC time [33,34,35]. The reason for this may be the delay in going to the hospital for fear of infection during the pandemic.

The avoidance of medical care by ACS patients has led to severe clinical presentations and poor prognosis [36]. Delayed calls to the emergency medical services (EMS) system in STEMI patients despite having developed symptoms of myocardial infarction, with the time between symptom onset and call to the EMS system being three times longer than before the epidemic, is also the main reason for the delay between symptom onset and PPCI [37]. In addition, the post-visit epidemiological collection and protective measures in the emergency room and catheterization laboratory also contributed to a certain extent to the delay in treatment.

There was no difference in the way STEMI patients came to the hospital in low-risk areas during the epidemic compared with the pre-epidemic period, and the mode of access to the hospital was still dominated by self-access, with only 24.6% choosing ambulance access, indicating that although the awareness of “call an ambulance for chest pain” has been popularized to some extent in the chest pain centers of primary hospitals, most patients are reluctant to choose ambulance consultation due to the low cultural and economic level of the primary group and the lack of awareness of the disease, which is also an important reason for the delay in the treatment of acute STEMI [38]. The proportion of patients who chose thrombolytic therapy during the epidemic increased significantly and the proportion of emergency PCI decreased, with no statistically significant differences between the two groups in terms of adverse events such as bleeding complications, heart failure, shock, malignant arrhythmias, and death. These are in agreement with the study by Zhu et al. [39]. Emergency PCI is currently recognized by guidelines as the most effective life-saving measure for patients with acute STEMI. However, in recent years, an increasing number of studies on the efficacy and prognostic impact of early PCI after thrombolysis compared with emergency PCI have shown that thrombolysis combined with early PCI during an epidemic can further reduce the duration of myocardial ischemia in patients with acute STEMI, and thrombolysis did not increase poor clinical outcomes compared with emergency PCI [40].

It was shown that a strategy of thrombolysis-first during the epidemic was associated with lower rates of timely coronary reperfusion and increased incidence of recurrent ischemia and cardiogenic shock and exacerbated heart failure, but there was no increase in primary endpoint events such as composite death compared with 2019 [41]. Further studies of specific measures of reperfusion therapy found no differences between reperfusion therapy rates, thrombolytic recanalization rates, post-thrombolysis PCI rate, emergency PCI success rates, number of stents implanted, D2N time, D2B time, post-procedure TIMI flow grade III rate, and percentage of multivessel lesions in acute STEMI patients within 12 h of onset in the county hospitals during the epidemic. The reperfusion levels in our acute STEMI patients were slightly higher than the mean reperfusion levels of 83.2% in the 2020 Chest Pain Center Quality Control Report [42], and the D2B time met the requirement of less than 90 min chest pain center, but the D2N time was a little delayed from the chest pain center requirement within 30 min, but the overall trend was continuous improvement.

The first-to-treat principle was followed during COVID-19, and the emergency PCI process was the same as it was prior to the epidemic because we were in a low-risk area, so the D2B and S2FMC were not prolonged. Our results showed that the D2N time was shorter during the epidemic due to the priority given to thrombolysis during the epidemic, which shortened the communication time with the patients. Furthermore, during this time, the patient’s travel time to our hospital was not considerably impacted; hence, the findings of this study did not lead to a major change in S2FMC time. It is important to note that the majority of patients at primary care facilities have relatively low literacy and socioeconomic levels. Additionally, the first-choice STEMI treatment method during an outbreak, thrombolysis, is quite affordable. The increased rate of reperfusion during the epidemic was attributed to an increased rate of thrombolysis compared to emergency PCI [43], and the impact of the COVID-19 epidemic did not result in more severe adverse cardiovascular outcomes in primary care county hospitals that followed guidelines and consensus for the management of acute STEMI patients under a strict form of epidemic prevention and control during the COVID-19 epidemic.

Under the normalized epidemic prevention and control, improving the emergency PCI treatment rate and level is an important measure to reduce the mortality rate of STEMI patients in county hospitals. Therefore, under the normalized epidemic prevention and control, the chest pain center of the county hospital should still increase the publicity of AMI-related knowledge, improve the public’s awareness of AMI emergency treatment, shorten the treatment time, and improve the emergency PCI treatment rate and level is a key measure to reduce the mortality of acute STEMI patients. Because the initial stage in the STEMI chain of events is the identification of symptoms and rapid activation of the 9–1–1 system, community participation is critical. The difficulties of living in the country are self-evident. Ambulance staffing and crew training are recurring difficulties in the prehospital context, where EMS employees are frequently volunteers. It’s less probable that the providers are paramedics; as a result, sophisticated life support may not be widely available [44]. In this study, the mortality rate of acute STEMI patients was reported as 8.5%, which was significantly higher than the average in-hospital mortality rate of 3.77% for STEMI patients mentioned in the quality control report of the Chest Pain Center in 2020 [42], and logistic regression analysis found that patients’ age ≥76 years, admission NT-proBNP levels ≥3,018 pg/ml and combined cardiogenic shock were independent risk factors. Compared with thrombolytic therapy, emergency PCI treatment further reduced the risk of death.

The reasons for the high mortality rate of patients with acute STEMI in primary hospitals are considered as follows: 1. The success rate of emergency PCI in the county hospitals is lower than that in tertiary hospitals, due to the complexity of the lesion and the limitation of the technical level of the personnel performing emergency PCI to successfully open the vessel, which delays the rescue time and may cause a poor prognosis. 2. The level of reperfusion therapy is still a certain gap compared to tertiary hospitals, and the rate of emergency PCI is lower [45], the post-thrombolysis PCI rate is low, the average level in this study is 61.7%, according to the guidelines after thrombolysis all patients are recommended to perform early interventional intervention within 2–24 h or remedial PCI immediately after the failure of thrombolysis, but in the county hospitals, due to the low literacy and economic level of patients, a small number of patients refuse further interventional treatment due to symptom relief or old age. 3. Patients with indications for reperfusion therapy have a severe poor prognosis due to inadequate knowledge of the severity of the disease or delayed consultation for financial reasons [46] or refusal of any reperfusion therapy measures. 4. The overall level of a medical emergency in primary care hospitals is limited, and the advanced age of patients at the time of consultation, heart failure, and cardiogenic shock are independent risk factors for high mortality in patients with acute STEMI. The results of this study showed that a higher rate of thrombolytic therapy in patients with acute STEMI in the county hospitals during the COVID-19 epidemic did not increase the incidence of adverse events. However, in STEMI patients aged 65 and above, TT and primary PCI have similar results [47]. Patients with STEMI in Thailand had more PCI access, and PCI was linked with decreased mortality when compared to thrombolysis alone [48].

It is difficult to treat STEMI patients during a pandemic. While thrombolysis may be a useful option in some cases, many patients have contraindications, and thrombolysis would consume additional resources in these limited hospital settings. Furthermore, given the high likelihood of normal coronary arteries on coronary angiograms during acute infections and pandemics, clinicians should employ primary PCI as the first line of treatment rather than thrombolytics in these stressful conditions. To distinguish actual STEMIs from imitators, non-invasive diagnostic tests may be effective. In addition, cardiac catheterization staff must be trained on how to utilize personal protective equipment to reduce the risk of infection [49].

6 Limitation

This is a single-center retrospective observational study with small sample size and only in-hospital prognosis, which has limitations. Furthermore, because this trial was conducted over a long period of time in a low-risk pandemic locale, and the principles of treating STEMI were not altered, the timing of S2MFC was not dramatically altered. Although this study analyzed the comparability of the two groups by comparing age, sex, and comorbidities at baseline (all P > 0.05), the subjects were not randomized, so propensity score matching should be done in future studies to reduce the bias arising from the non-randomized treatment of the subjects. Another limitation is that even though none of the enrolled patients were mechanically ventilated, a detailed assessment of the patients’ respiratory impairment should be performed during the COVID-19 epidemic. Future large-scale, multicenter, and prospective clinical trials are needed to further demonstrate the impact of early PCI and direct PCI after thrombolysis on the salvage of patients with acute STEMI.

7 Conclusion

During the COVID-19 epidemic, the county hospitals provided thrombolytic treatment to more acute STEMI patients, but the frequency of adverse outcomes such bleeding complications, heart failure, shock, malignant arrhythmias, and death remained constant. Because emergency PCI lowered the risk of mortality in older persons, we should reconsider the optimal STEMI treatment approach and if PCI should retain the present pre-defined STEMI care strategy in rural areas.

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Acknowledgments

Not applicable.

  1. Funding information: None.

  2. Author contributions: FL contributed to the overall concept and study design. All authors acquired study data. RL, XW, and JJ did the data analysis and interpretation of the study data. FL and XY drafted the first draft of the manuscript. All authors critically reviewed and revised the manuscript to confirm accuracy. All authors gave final approval on the final draft for submission.

  3. Conflict of interest: None.

  4. Data availability statement: The analyzed data sets generated during the study are available from the corresponding author on reasonable request.

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Received: 2022-09-28
Revised: 2022-11-24
Accepted: 2022-11-26
Published Online: 2023-01-09

© 2023 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  171. D-dimer trends predict COVID-19 patient’s prognosis: A retrospective chart review study
  172. WTAP affects intracranial aneurysm progression by regulating m6A methylation modification
  173. Using of endoscopic polypectomy in patients with diagnosed malignant colorectal polyp – The cross-sectional clinical study
  174. Anti-S100A4 antibody administration alleviates bronchial epithelial–mesenchymal transition in asthmatic mice
  175. Prognostic evaluation of system immune-inflammatory index and prognostic nutritional index in double expressor diffuse large B-cell lymphoma
  176. Prevalence and antibiogram of bacteria causing urinary tract infection among patients with chronic kidney disease
  177. Reactive oxygen species within the vaginal space: An additional promoter of cervical intraepithelial neoplasia and uterine cervical cancer development?
  178. Identification of disulfidptosis-related genes and immune infiltration in lower-grade glioma
  179. A new technique for uterine-preserving pelvic organ prolapse surgery: Laparoscopic rectus abdominis hysteropexy for uterine prolapse by comparing with traditional techniques
  180. Self-isolation of an Italian long-term care facility during COVID-19 pandemic: A comparison study on care-related infectious episodes
  181. A comparative study on the overlapping effects of clinically applicable therapeutic interventions in patients with central nervous system damage
  182. Low intensity extracorporeal shockwave therapy for chronic pelvic pain syndrome: Long-term follow-up
  183. The diagnostic accuracy of touch imprint cytology for sentinel lymph node metastases of breast cancer: An up-to-date meta-analysis of 4,073 patients
  184. Mortality associated with Sjögren’s syndrome in the United States in the 1999–2020 period: A multiple cause-of-death study
  185. CircMMP11 as a prognostic biomarker mediates miR-361-3p/HMGB1 axis to accelerate malignant progression of hepatocellular carcinoma
  186. Analysis of the clinical characteristics and prognosis of adult de novo acute myeloid leukemia (none APL) with PTPN11 mutations
  187. KMT2A maintains stemness of gastric cancer cells through regulating Wnt/β-catenin signaling-activated transcriptional factor KLF11
  188. Evaluation of placental oxygenation by near-infrared spectroscopy in relation to ultrasound maturation grade in physiological term pregnancies
  189. The role of ultrasonographic findings for PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor-2-negative breast cancer
  190. Construction of immunogenic cell death-related molecular subtypes and prognostic signature in colorectal cancer
  191. Long-term prognostic value of high-sensitivity cardiac troponin-I in patients with idiopathic dilated cardiomyopathy
  192. Establishing a novel Fanconi anemia signaling pathway-associated prognostic model and tumor clustering for pediatric acute myeloid leukemia patients
  193. Integrative bioinformatics analysis reveals STAT2 as a novel biomarker of inflammation-related cardiac dysfunction in atrial fibrillation
  194. Adipose-derived stem cells repair radiation-induced chronic lung injury via inhibiting TGF-β1/Smad 3 signaling pathway
  195. Real-world practice of idiopathic pulmonary fibrosis: Results from a 2000–2016 cohort
  196. lncRNA LENGA sponges miR-378 to promote myocardial fibrosis in atrial fibrillation
  197. Diagnostic value of urinary Tamm-Horsfall protein and 24 h urine osmolality for recurrent calcium oxalate stones of the upper urinary tract: Cross-sectional study
  198. The value of color Doppler ultrasonography combined with serum tumor markers in differential diagnosis of gastric stromal tumor and gastric cancer
  199. The spike protein of SARS-CoV-2 induces inflammation and EMT of lung epithelial cells and fibroblasts through the upregulation of GADD45A
  200. Mycophenolate mofetil versus cyclophosphamide plus in patients with connective tissue disease-associated interstitial lung disease: Efficacy and safety analysis
  201. MiR-1278 targets CALD1 and suppresses the progression of gastric cancer via the MAPK pathway
  202. Metabolomic analysis of serum short-chain fatty acid concentrations in a mouse of MPTP-induced Parkinson’s disease after dietary supplementation with branched-chain amino acids
  203. Cimifugin inhibits adipogenesis and TNF-α-induced insulin resistance in 3T3-L1 cells
  204. Predictors of gastrointestinal complaints in patients on metformin therapy
  205. Prescribing patterns in patients with chronic obstructive pulmonary disease and atrial fibrillation
  206. A retrospective analysis of the effect of latent tuberculosis infection on clinical pregnancy outcomes of in vitro fertilization–fresh embryo transferred in infertile women
  207. Appropriateness and clinical outcomes of short sustained low-efficiency dialysis: A national experience
  208. miR-29 regulates metabolism by inhibiting JNK-1 expression in non-obese patients with type 2 diabetes mellitus and NAFLD
  209. Clinical features and management of lymphoepithelial cyst
  210. Serum VEGF, high-sensitivity CRP, and cystatin-C assist in the diagnosis of type 2 diabetic retinopathy complicated with hyperuricemia
  211. ENPP1 ameliorates vascular calcification via inhibiting the osteogenic transformation of VSMCs and generating PPi
  212. Significance of monitoring the levels of thyroid hormone antibodies and glucose and lipid metabolism antibodies in patients suffer from type 2 diabetes
  213. The causal relationship between immune cells and different kidney diseases: A Mendelian randomization study
  214. Interleukin 33, soluble suppression of tumorigenicity 2, interleukin 27, and galectin 3 as predictors for outcome in patients admitted to intensive care units
  215. Identification of diagnostic immune-related gene biomarkers for predicting heart failure after acute myocardial infarction
  216. Long-term administration of probiotics prevents gastrointestinal mucosal barrier dysfunction in septic mice partly by upregulating the 5-HT degradation pathway
  217. miR-192 inhibits the activation of hepatic stellate cells by targeting Rictor
  218. Diagnostic and prognostic value of MR-pro ADM, procalcitonin, and copeptin in sepsis
  219. Review Articles
  220. Prenatal diagnosis of fetal defects and its implications on the delivery mode
  221. Electromagnetic fields exposure on fetal and childhood abnormalities: Systematic review and meta-analysis
  222. Characteristics of antibiotic resistance mechanisms and genes of Klebsiella pneumoniae
  223. Saddle pulmonary embolism in the setting of COVID-19 infection: A systematic review of case reports and case series
  224. Vitamin C and epigenetics: A short physiological overview
  225. Ebselen: A promising therapy protecting cardiomyocytes from excess iron in iron-overloaded thalassemia patients
  226. Aspirin versus LMWH for VTE prophylaxis after orthopedic surgery
  227. Mechanism of rhubarb in the treatment of hyperlipidemia: A recent review
  228. Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach
  229. The progress of autoimmune hepatitis research and future challenges
  230. METTL16 in human diseases: What should we do next?
  231. New insights into the prevention of ureteral stents encrustation
  232. VISTA as a prospective immune checkpoint in gynecological malignant tumors: A review of the literature
  233. Case Reports
  234. Mycobacterium xenopi infection of the kidney and lymph nodes: A case report
  235. Genetic mutation of SLC6A20 (c.1072T > C) in a family with nephrolithiasis: A case report
  236. Chronic hepatitis B complicated with secondary hemochromatosis was cured clinically: A case report
  237. Liver abscess complicated with multiple organ invasive infection caused by hematogenous disseminated hypervirulent Klebsiella pneumoniae: A case report
  238. Urokinase-based lock solutions for catheter salvage: A case of an upcoming kidney transplant recipient
  239. Two case reports of maturity-onset diabetes of the young type 3 caused by the hepatocyte nuclear factor 1α gene mutation
  240. Immune checkpoint inhibitor-related pancreatitis: What is known and what is not
  241. Does total hip arthroplasty result in intercostal nerve injury? A case report and literature review
  242. Clinicopathological characteristics and diagnosis of hepatic sinusoidal obstruction syndrome caused by Tusanqi – Case report and literature review
  243. Synchronous triple primary gastrointestinal malignant tumors treated with laparoscopic surgery: A case report
  244. CT-guided percutaneous microwave ablation combined with bone cement injection for the treatment of transverse metastases: A case report
  245. Malignant hyperthermia: Report on a successful rescue of a case with the highest temperature of 44.2°C
  246. Anesthetic management of fetal pulmonary valvuloplasty: A case report
  247. Rapid Communication
  248. Impact of COVID-19 lockdown on glycemic levels during pregnancy: A retrospective analysis
  249. Erratum
  250. Erratum to “Inhibition of miR-21 improves pulmonary vascular responses in bronchopulmonary dysplasia by targeting the DDAH1/ADMA/NO pathway”
  251. Erratum to: “Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p”
  252. Retraction
  253. Retraction of “Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients”
  254. Retraction of “circ_0062491 alleviates periodontitis via the miR-142-5p/IGF1 axis”
  255. Retraction of “miR-223-3p alleviates TGF-β-induced epithelial-mesenchymal transition and extracellular matrix deposition by targeting SP3 in endometrial epithelial cells”
  256. Retraction of “SLCO4A1-AS1 mediates pancreatic cancer development via miR-4673/KIF21B axis”
  257. Retraction of “circRNA_0001679/miR-338-3p/DUSP16 axis aggravates acute lung injury”
  258. Retraction of “lncRNA ACTA2-AS1 inhibits malignant phenotypes of gastric cancer cells”
  259. Special issue Linking Pathobiological Mechanisms to Clinical Application for cardiovascular diseases
  260. Effect of cardiac rehabilitation therapy on depressed patients with cardiac insufficiency after cardiac surgery
  261. Special issue The evolving saga of RNAs from bench to bedside - Part I
  262. FBLIM1 mRNA is a novel prognostic biomarker and is associated with immune infiltrates in glioma
  263. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part III
  264. Development of a machine learning-based signature utilizing inflammatory response genes for predicting prognosis and immune microenvironment in ovarian cancer
https://doi.org/10.1515/med-2022-0621
Keywords for this article
myocardial infarction; COVID-19; primary hospitals; chest pain center; percutaneous coronary intervention
Creative Commons
BY 4.0

Articles in the same Issue

  1. Research Articles
  2. Exosomes derived from mesenchymal stem cells overexpressing miR-210 inhibits neuronal inflammation and contribute to neurite outgrowth through modulating microglia polarization
  3. Current situation of acute ST-segment elevation myocardial infarction in a county hospital chest pain center during an epidemic of novel coronavirus pneumonia
  4. circ-IARS depletion inhibits the progression of non-small-cell lung cancer by circ-IARS/miR-1252-5p/HDGF ceRNA pathway
  5. circRNA ITGA7 restrains growth and enhances radiosensitivity by up-regulating SMAD4 in colorectal carcinoma
  6. WDR79 promotes aerobic glycolysis of pancreatic ductal adenocarcinoma (PDAC) by the suppression of SIRT4
  7. Up-regulation of collagen type V alpha 2 (COL5A2) promotes malignant phenotypes in gastric cancer cell via inducing epithelial–mesenchymal transition (EMT)
  8. Inhibition of TERC inhibits neural apoptosis and inflammation in spinal cord injury through Akt activation and p-38 inhibition via the miR-34a-5p/XBP-1 axis
  9. 3D-printed polyether-ether-ketone/n-TiO2 composite enhances the cytocompatibility and osteogenic differentiation of MC3T3-E1 cells by downregulating miR-154-5p
  10. Propofol-mediated circ_0000735 downregulation restrains tumor growth by decreasing integrin-β1 expression in non-small cell lung cancer
  11. PVT1/miR-16/CCND1 axis regulates gastric cancer progression
  12. Silencing of circ_002136 sensitizes gastric cancer to paclitaxel by targeting the miR-16-5p/HMGA1 axis
  13. Short-term outcomes after simultaneous gastrectomy plus cholecystectomy in gastric cancer: A pooling up analysis
  14. SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways
  15. Molecular mechanism by which the Notch signaling pathway regulates autophagy in a rat model of pulmonary fibrosis in pigeon breeder’s lung
  16. lncRNA TPT1-AS1 promotes cell migration and invasion in esophageal squamous-cell carcinomas by regulating the miR-26a/HMGA1 axis
  17. SIRT1/APE1 promotes the viability of gastric cancer cells by inhibiting p53 to suppress ferroptosis
  18. Glycoprotein non-metastatic melanoma B interacts with epidermal growth factor receptor to regulate neural stem cell survival and differentiation
  19. Treatments for brain metastases from EGFR/ALK-negative/unselected NSCLC: A network meta-analysis
  20. Association of osteoporosis and skeletal muscle loss with serum type I collagen carboxyl-terminal peptide β glypeptide: A cross-sectional study in elder Chinese population
  21. circ_0000376 knockdown suppresses non-small cell lung cancer cell tumor properties by the miR-545-3p/PDPK1 pathway
  22. Delivery in a vertical birth chair supported by freedom of movement during labor: A randomized control trial
  23. UBE2J1 knockdown promotes cell apoptosis in endometrial cancer via regulating PI3K/AKT and MDM2/p53 signaling
  24. Metabolic resuscitation therapy in critically ill patients with sepsis and septic shock: A pilot prospective randomized controlled trial
  25. Lycopene ameliorates locomotor activity and urinary frequency induced by pelvic venous congestion in rats
  26. UHRF1-induced connexin26 methylation is involved in hearing damage triggered by intermittent hypoxia in neonatal rats
  27. LINC00511 promotes melanoma progression by targeting miR-610/NUCB2
  28. Ultra-high-performance liquid chromatography-tandem mass spectrometry analysis of serum metabolomic characteristics in people with different vitamin D levels
  29. Role of Jumonji domain-containing protein D3 and its inhibitor GSK-J4 in Hashimoto’s thyroiditis
  30. circ_0014736 induces GPR4 to regulate the biological behaviors of human placental trophoblast cells through miR-942-5p in preeclampsia
  31. Monitoring of sirolimus in the whole blood samples from pediatric patients with lymphatic anomalies
  32. Effects of osteogenic growth peptide C-terminal pentapeptide and its analogue on bone remodeling in an osteoporosis rat model
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  34. WGCNA-based identification of potential targets and pathways in response to treatment in locally advanced breast cancer patients
  35. Radiomics model using preoperative computed tomography angiography images to differentiate new from old emboli of acute lower limb arterial embolism
  36. Dysregulated lncRNAs are involved in the progress of myocardial infarction by constructing regulatory networks
  37. Single-arm trial to evaluate the efficacy and safety of baclofen in treatment of intractable hiccup caused by malignant tumor chemotherapy
  38. Genetic polymorphisms of MRPS30-DT and NINJ2 may influence lung cancer risk
  39. Efficacy of immune checkpoint inhibitors in patients with KRAS-mutant advanced non-small cell lung cancer: A retrospective analysis
  40. Pyroptosis-based risk score predicts prognosis and drug sensitivity in lung adenocarcinoma
  41. Upregulation of lncRNA LANCL1-AS1 inhibits the progression of non-small-cell lung cancer via the miR-3680-3p/GMFG axis
  42. CircRANBP17 modulated KDM1A to regulate neuroblastoma progression by sponging miR-27b-3p
  43. Exosomal miR-93-5p regulated the progression of osteoarthritis by targeting ADAMTS9
  44. Downregulation of RBM17 enhances cisplatin sensitivity and inhibits cell invasion in human hypopharyngeal cancer cells
  45. HDAC5-mediated PRAME regulates the proliferation, migration, invasion, and EMT of laryngeal squamous cell carcinoma via the PI3K/AKT/mTOR signaling pathway
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  47. Myostatin silencing inhibits podocyte apoptosis in membranous nephropathy through Smad3/PKA/NOX4 signaling pathway
  48. A novel long noncoding RNA AC125257.1 facilitates colorectal cancer progression by targeting miR-133a-3p/CASC5 axis
  49. Impact of omicron wave and associated control measures in Shanghai on health management and psychosocial well-being of patients with chronic conditions
  50. Clinicopathological characteristics and prognosis of young patients aged ≤45 years old with non-small cell lung cancer
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  52. The dose limits of teeth protection for patients with nasopharyngeal carcinoma undergoing radiotherapy based on the early oral health-related quality of life
  53. miR-30b-5p targeting GRIN2A inhibits hippocampal damage in epilepsy
  54. Long non-coding RNA AL137789.1 promoted malignant biological behaviors and immune escape of pancreatic carcinoma cells
  55. IRF6 and FGF1 polymorphisms in non-syndromic cleft lip with or without cleft palate in the Polish population
  56. Comprehensive analysis of the role of SFXN family in breast cancer
  57. Efficacy of bronchoscopic intratumoral injection of endostar and cisplatin in lung squamous cell carcinoma patients underwent conventional chemoradiotherapy
  58. Silencing of long noncoding RNA MIAT inhibits the viability and proliferation of breast cancer cells by promoting miR-378a-5p expression
  59. AG1024, an IGF-1 receptor inhibitor, ameliorates renal injury in rats with diabetic nephropathy via the SOCS/JAK2/STAT pathway
  60. Downregulation of KIAA1199 alleviated the activation, proliferation, and migration of hepatic stellate cells by the inhibition of epithelial–mesenchymal transition
  61. Exendin-4 regulates the MAPK and WNT signaling pathways to alleviate the osteogenic inhibition of periodontal ligament stem cells in a high glucose environment
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  63. The function of lncRNA EMX2OS/miR-653-5p and its regulatory mechanism in lung adenocarcinoma
  64. Tectorigenin alleviates the apoptosis and inflammation in spinal cord injury cell model through inhibiting insulin-like growth factor-binding protein 6
  65. Ultrasound examination supporting CT or MRI in the evaluation of cervical lymphadenopathy in patients with irradiation-treated head and neck cancer
  66. F-box and WD repeat domain containing 7 inhibits the activation of hepatic stellate cells by degrading delta-like ligand 1 to block Notch signaling pathway
  67. Knockdown of circ_0005615 enhances the radiosensitivity of colorectal cancer by regulating the miR-665/NOTCH1 axis
  68. Long noncoding RNA Mhrt alleviates angiotensin II-induced cardiac hypertrophy phenotypes by mediating the miR-765/Wnt family member 7B pathway
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  72. NECAB3 promotes the migration and invasion of liver cancer cells through HIF-1α/RIT1 signaling pathway
  73. The poor performance of cardiovascular risk scores in identifying patients with idiopathic inflammatory myopathies at high cardiovascular risk
  74. miR-2053 inhibits the growth of ovarian cancer cells by downregulating SOX4
  75. Nucleophosmin 1 associating with engulfment and cell motility protein 1 regulates hepatocellular carcinoma cell chemotaxis and metastasis
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  78. Identification of key enzalutamide-resistance-related genes in castration-resistant prostate cancer and verification of RAD51 functions
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  80. Outcomes of low-risk birth care during the Covid-19 pandemic: A cohort study from a tertiary care center in Lithuania
  81. Vitamin D protects intestines from liver cirrhosis-induced inflammation and oxidative stress by inhibiting the TLR4/MyD88/NF-κB signaling pathway
  82. Integrated transcriptome analysis identifies APPL1/RPS6KB2/GALK1 as immune-related metastasis factors in breast cancer
  83. Genomic analysis of immunogenic cell death-related subtypes for predicting prognosis and immunotherapy outcomes in glioblastoma multiforme
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  85. An economic evaluation of fine-needle cytology as the primary diagnostic tool in the diagnosis of lymphadenopathy
  86. Midazolam impedes lung carcinoma cell proliferation and migration via EGFR/MEK/ERK signaling pathway
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  90. lncRNA OIP5-AS1 attenuates the osteoarthritis progression in IL-1β-stimulated chondrocytes
  91. Overexpression of LINC00607 inhibits cell growth and aggressiveness by regulating the miR-1289/EFNA5 axis in non-small-cell lung cancer
  92. Subjective well-being in informal caregivers during the COVID-19 pandemic
  93. Nrf2 protects against myocardial ischemia-reperfusion injury in diabetic rats by inhibiting Drp1-mediated mitochondrial fission
  94. Unfolded protein response inhibits KAT2B/MLKL-mediated necroptosis of hepatocytes by promoting BMI1 level to ubiquitinate KAT2B
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  96. circNFATC3 facilitated the progression of oral squamous cell carcinoma via the miR-520h/LDHA axis
  97. Prone position effect in intensive care patients with SARS-COV-2 pneumonia
  98. Clinical observation on the efficacy of Tongdu Tuina manipulation in the treatment of primary enuresis in children
  99. Dihydroartemisinin ameliorates cerebral I/R injury in rats via regulating VWF and autophagy-mediated SIRT1/FOXO1 pathway
  100. Knockdown of circ_0113656 assuages oxidized low-density lipoprotein-induced vascular smooth muscle cell injury through the miR-188-3p/IGF2 pathway
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  103. Potential protective effects of Huanglian Jiedu Decoction against COVID-19-associated acute kidney injury: A network-based pharmacological and molecular docking study
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  105. Clinical features of varicella-zoster virus caused neurological diseases detected by metagenomic next-generation sequencing
  106. Collagen treatment of complex anorectal fistula: 3 years follow-up
  107. LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through down-regulating SP-A by sponging to miR-424
  108. Efficacy analysis of empirical bismuth quadruple therapy, high-dose dual therapy, and resistance gene-based triple therapy as a first-line Helicobacter pylori eradication regimen – An open-label, randomized trial
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  111. circRNA THBS1 silencing inhibits the malignant biological behavior of cervical cancer cells via the regulation of miR-543/HMGB2 axis
  112. hsa_circ_0000285 sponging miR-582-3p promotes neuroblastoma progression by regulating the Wnt/β-catenin signaling pathway
  113. Long non-coding RNA GNAS-AS1 knockdown inhibits proliferation and epithelial–mesenchymal transition of lung adenocarcinoma cells via the microRNA-433-3p/Rab3A axis
  114. lncRNA UCA1 regulates miR-132/Lrrfip1 axis to promote vascular smooth muscle cell proliferation
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  116. Hsa-miR-223-3p participates in the process of anthracycline-induced cardiomyocyte damage by regulating NFIA gene
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  119. Hsa_circ_0028007 regulates the progression of nasopharyngeal carcinoma through the miR-1179/SQLE axis
  120. Variations in sexual function after laparoendoscopic single-site hysterectomy in women with benign gynecologic diseases
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  122. Analysis of heroin effects on calcium channels in rat cardiomyocytes based on transcriptomics and metabolomics
  123. Risk factors of recurrent bacterial vaginosis among women of reproductive age: A cross-sectional study
  124. Alkbh5 plays indispensable roles in maintaining self-renewal of hematopoietic stem cells
  125. Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients
  126. Correlation between microvessel maturity and ISUP grades assessed using contrast-enhanced transrectal ultrasonography in prostate cancer
  127. The protective effect of caffeic acid phenethyl ester in the nephrotoxicity induced by α-cypermethrin
  128. Norepinephrine alleviates cyclosporin A-induced nephrotoxicity by enhancing the expression of SFRP1
  129. Effect of RUNX1/FOXP3 axis on apoptosis of T and B lymphocytes and immunosuppression in sepsis
  130. The function of Foxp1 represses β-adrenergic receptor transcription in the occurrence and development of bladder cancer through STAT3 activity
  131. Risk model and validation of carbapenem-resistant Klebsiella pneumoniae infection in patients with cerebrovascular disease in the ICU
  132. Calycosin protects against chronic prostatitis in rats via inhibition of the p38MAPK/NF-κB pathway
  133. Pan-cancer analysis of the PDE4DIP gene with potential prognostic and immunotherapeutic values in multiple cancers including acute myeloid leukemia
  134. The safety and immunogenicity to inactivated COVID-19 vaccine in patients with hyperlipemia
  135. Circ-UBR4 regulates the proliferation, migration, inflammation, and apoptosis in ox-LDL-induced vascular smooth muscle cells via miR-515-5p/IGF2 axis
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  138. miR-199a-5p inhibits aortic valve calcification by targeting ATF6 and GRP78 in valve interstitial cells
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  142. Identification of cuproptosis-related genes for predicting the development of prostate cancer
  143. Lumican silencing ameliorates β-glycerophosphate-mediated vascular smooth muscle cell calcification by attenuating the inhibition of APOB on KIF2C activity
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  164. The effect of AQP4 on tau protein aggregation in neurodegeneration and persistent neuroinflammation after cerebral microinfarcts
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  166. Analysis of clinical characteristics in proximal and distal reflux monitoring among patients with gastroesophageal reflux disease
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  170. Knockdown of NUPR1 inhibits angiogenesis in lung cancer through IRE1/XBP1 and PERK/eIF2α/ATF4 signaling pathways
  171. D-dimer trends predict COVID-19 patient’s prognosis: A retrospective chart review study
  172. WTAP affects intracranial aneurysm progression by regulating m6A methylation modification
  173. Using of endoscopic polypectomy in patients with diagnosed malignant colorectal polyp – The cross-sectional clinical study
  174. Anti-S100A4 antibody administration alleviates bronchial epithelial–mesenchymal transition in asthmatic mice
  175. Prognostic evaluation of system immune-inflammatory index and prognostic nutritional index in double expressor diffuse large B-cell lymphoma
  176. Prevalence and antibiogram of bacteria causing urinary tract infection among patients with chronic kidney disease
  177. Reactive oxygen species within the vaginal space: An additional promoter of cervical intraepithelial neoplasia and uterine cervical cancer development?
  178. Identification of disulfidptosis-related genes and immune infiltration in lower-grade glioma
  179. A new technique for uterine-preserving pelvic organ prolapse surgery: Laparoscopic rectus abdominis hysteropexy for uterine prolapse by comparing with traditional techniques
  180. Self-isolation of an Italian long-term care facility during COVID-19 pandemic: A comparison study on care-related infectious episodes
  181. A comparative study on the overlapping effects of clinically applicable therapeutic interventions in patients with central nervous system damage
  182. Low intensity extracorporeal shockwave therapy for chronic pelvic pain syndrome: Long-term follow-up
  183. The diagnostic accuracy of touch imprint cytology for sentinel lymph node metastases of breast cancer: An up-to-date meta-analysis of 4,073 patients
  184. Mortality associated with Sjögren’s syndrome in the United States in the 1999–2020 period: A multiple cause-of-death study
  185. CircMMP11 as a prognostic biomarker mediates miR-361-3p/HMGB1 axis to accelerate malignant progression of hepatocellular carcinoma
  186. Analysis of the clinical characteristics and prognosis of adult de novo acute myeloid leukemia (none APL) with PTPN11 mutations
  187. KMT2A maintains stemness of gastric cancer cells through regulating Wnt/β-catenin signaling-activated transcriptional factor KLF11
  188. Evaluation of placental oxygenation by near-infrared spectroscopy in relation to ultrasound maturation grade in physiological term pregnancies
  189. The role of ultrasonographic findings for PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor-2-negative breast cancer
  190. Construction of immunogenic cell death-related molecular subtypes and prognostic signature in colorectal cancer
  191. Long-term prognostic value of high-sensitivity cardiac troponin-I in patients with idiopathic dilated cardiomyopathy
  192. Establishing a novel Fanconi anemia signaling pathway-associated prognostic model and tumor clustering for pediatric acute myeloid leukemia patients
  193. Integrative bioinformatics analysis reveals STAT2 as a novel biomarker of inflammation-related cardiac dysfunction in atrial fibrillation
  194. Adipose-derived stem cells repair radiation-induced chronic lung injury via inhibiting TGF-β1/Smad 3 signaling pathway
  195. Real-world practice of idiopathic pulmonary fibrosis: Results from a 2000–2016 cohort
  196. lncRNA LENGA sponges miR-378 to promote myocardial fibrosis in atrial fibrillation
  197. Diagnostic value of urinary Tamm-Horsfall protein and 24 h urine osmolality for recurrent calcium oxalate stones of the upper urinary tract: Cross-sectional study
  198. The value of color Doppler ultrasonography combined with serum tumor markers in differential diagnosis of gastric stromal tumor and gastric cancer
  199. The spike protein of SARS-CoV-2 induces inflammation and EMT of lung epithelial cells and fibroblasts through the upregulation of GADD45A
  200. Mycophenolate mofetil versus cyclophosphamide plus in patients with connective tissue disease-associated interstitial lung disease: Efficacy and safety analysis
  201. MiR-1278 targets CALD1 and suppresses the progression of gastric cancer via the MAPK pathway
  202. Metabolomic analysis of serum short-chain fatty acid concentrations in a mouse of MPTP-induced Parkinson’s disease after dietary supplementation with branched-chain amino acids
  203. Cimifugin inhibits adipogenesis and TNF-α-induced insulin resistance in 3T3-L1 cells
  204. Predictors of gastrointestinal complaints in patients on metformin therapy
  205. Prescribing patterns in patients with chronic obstructive pulmonary disease and atrial fibrillation
  206. A retrospective analysis of the effect of latent tuberculosis infection on clinical pregnancy outcomes of in vitro fertilization–fresh embryo transferred in infertile women
  207. Appropriateness and clinical outcomes of short sustained low-efficiency dialysis: A national experience
  208. miR-29 regulates metabolism by inhibiting JNK-1 expression in non-obese patients with type 2 diabetes mellitus and NAFLD
  209. Clinical features and management of lymphoepithelial cyst
  210. Serum VEGF, high-sensitivity CRP, and cystatin-C assist in the diagnosis of type 2 diabetic retinopathy complicated with hyperuricemia
  211. ENPP1 ameliorates vascular calcification via inhibiting the osteogenic transformation of VSMCs and generating PPi
  212. Significance of monitoring the levels of thyroid hormone antibodies and glucose and lipid metabolism antibodies in patients suffer from type 2 diabetes
  213. The causal relationship between immune cells and different kidney diseases: A Mendelian randomization study
  214. Interleukin 33, soluble suppression of tumorigenicity 2, interleukin 27, and galectin 3 as predictors for outcome in patients admitted to intensive care units
  215. Identification of diagnostic immune-related gene biomarkers for predicting heart failure after acute myocardial infarction
  216. Long-term administration of probiotics prevents gastrointestinal mucosal barrier dysfunction in septic mice partly by upregulating the 5-HT degradation pathway
  217. miR-192 inhibits the activation of hepatic stellate cells by targeting Rictor
  218. Diagnostic and prognostic value of MR-pro ADM, procalcitonin, and copeptin in sepsis
  219. Review Articles
  220. Prenatal diagnosis of fetal defects and its implications on the delivery mode
  221. Electromagnetic fields exposure on fetal and childhood abnormalities: Systematic review and meta-analysis
  222. Characteristics of antibiotic resistance mechanisms and genes of Klebsiella pneumoniae
  223. Saddle pulmonary embolism in the setting of COVID-19 infection: A systematic review of case reports and case series
  224. Vitamin C and epigenetics: A short physiological overview
  225. Ebselen: A promising therapy protecting cardiomyocytes from excess iron in iron-overloaded thalassemia patients
  226. Aspirin versus LMWH for VTE prophylaxis after orthopedic surgery
  227. Mechanism of rhubarb in the treatment of hyperlipidemia: A recent review
  228. Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach
  229. The progress of autoimmune hepatitis research and future challenges
  230. METTL16 in human diseases: What should we do next?
  231. New insights into the prevention of ureteral stents encrustation
  232. VISTA as a prospective immune checkpoint in gynecological malignant tumors: A review of the literature
  233. Case Reports
  234. Mycobacterium xenopi infection of the kidney and lymph nodes: A case report
  235. Genetic mutation of SLC6A20 (c.1072T > C) in a family with nephrolithiasis: A case report
  236. Chronic hepatitis B complicated with secondary hemochromatosis was cured clinically: A case report
  237. Liver abscess complicated with multiple organ invasive infection caused by hematogenous disseminated hypervirulent Klebsiella pneumoniae: A case report
  238. Urokinase-based lock solutions for catheter salvage: A case of an upcoming kidney transplant recipient
  239. Two case reports of maturity-onset diabetes of the young type 3 caused by the hepatocyte nuclear factor 1α gene mutation
  240. Immune checkpoint inhibitor-related pancreatitis: What is known and what is not
  241. Does total hip arthroplasty result in intercostal nerve injury? A case report and literature review
  242. Clinicopathological characteristics and diagnosis of hepatic sinusoidal obstruction syndrome caused by Tusanqi – Case report and literature review
  243. Synchronous triple primary gastrointestinal malignant tumors treated with laparoscopic surgery: A case report
  244. CT-guided percutaneous microwave ablation combined with bone cement injection for the treatment of transverse metastases: A case report
  245. Malignant hyperthermia: Report on a successful rescue of a case with the highest temperature of 44.2°C
  246. Anesthetic management of fetal pulmonary valvuloplasty: A case report
  247. Rapid Communication
  248. Impact of COVID-19 lockdown on glycemic levels during pregnancy: A retrospective analysis
  249. Erratum
  250. Erratum to “Inhibition of miR-21 improves pulmonary vascular responses in bronchopulmonary dysplasia by targeting the DDAH1/ADMA/NO pathway”
  251. Erratum to: “Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p”
  252. Retraction
  253. Retraction of “Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients”
  254. Retraction of “circ_0062491 alleviates periodontitis via the miR-142-5p/IGF1 axis”
  255. Retraction of “miR-223-3p alleviates TGF-β-induced epithelial-mesenchymal transition and extracellular matrix deposition by targeting SP3 in endometrial epithelial cells”
  256. Retraction of “SLCO4A1-AS1 mediates pancreatic cancer development via miR-4673/KIF21B axis”
  257. Retraction of “circRNA_0001679/miR-338-3p/DUSP16 axis aggravates acute lung injury”
  258. Retraction of “lncRNA ACTA2-AS1 inhibits malignant phenotypes of gastric cancer cells”
  259. Special issue Linking Pathobiological Mechanisms to Clinical Application for cardiovascular diseases
  260. Effect of cardiac rehabilitation therapy on depressed patients with cardiac insufficiency after cardiac surgery
  261. Special issue The evolving saga of RNAs from bench to bedside - Part I
  262. FBLIM1 mRNA is a novel prognostic biomarker and is associated with immune infiltrates in glioma
  263. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part III
  264. Development of a machine learning-based signature utilizing inflammatory response genes for predicting prognosis and immune microenvironment in ovarian cancer
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