Objective To investigate the characteristics of the serum creatinine change patterns and its clinical signifi cance in patients with acute myocardial infarction(AMI)undergoing emergent percutaneous coronary intervention(PCI). Methods Two hundred and ninety-three consecutive ST elevation myocardial infarction(STEMI) patients who underwent emergent PCI were retrospectively grouped into the descending type,increasing type,stable type,U curve type and converse U curve type according to the dynamic changes serum creatinine in within 72h after PCI. The characteristics of diff erent patterns relationship of the respective pattern to the Mehran risk score,the serum creatinine changes between admission to 1 month after PCI,and the incidence of adverse events were analyzed.Results The proportion of the 5 pattern groups was 9.9%(decending type),17.7(increasing type),47.1%(stable type),4.1%(U curve type)and 21.2%(converse U curve type),respectively. The incidence of adverse events was higher in the increasing type,stable type and converse U curve type compared to the other 2 types in 1 month after PCI. Hypotension before admission and volume expansion therapy were more common in the groups of descending type and U curve type while diuretics were more frequently used in converse U curve type than descending type. The decline of creatinine from admission to 1 month after PCI were 57.9% in descending type and 27.3% in U curve type. Conclusions The dynamic change of serum creatinine presents with multiple patterns in patients undergoing emergent PCI. Hypotension before admission,volume expansion therapy,and the use of diuretics may aff ect the value of serum creatinine. The serum creatinine level at admission seems not suitable for baseline assessment to evaluate the risk of contrast-induced acute kidney injury in some patients.

Aberration of the right coronary artery from the left anterior descending is a very rare congenital anomaly.The anomalous the right coronary artery,as a branch of the septal branch,has not been reported clinically.This article reports such rare case.A 52-year-old female was admitted due to"sudden chest pain and confusion for 4 hours".The ECG showed that the ST-segment of leads(V1-V4,V3R,V4R and V5R)were elevated about 0.1-0.3 mVThe blood pressure was 63/53 mmHg.She was diagnosed as cardiogenic shock second to acute anterior and right ventricular ST-segment elevation myocardial infarction.Emergency coronary angiography was performed after intra-aortic ballon pump was implanted to assist circulation.During the treatment of the culprit vessel,it was accidentally found that the right coronary artery,as a branch vessel,originated from the ostium of the second septal branch of the anterior descending artery.