Objective To investigate the effect of evolocumab combined with levocarnitine after emergency percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myo-cardial infarction(STEMI).Methods A total of 120 STEMI patients were selected and randomly di-vided into treatment group(60 cases)and control group(60 cases).The control group was given STEMI basic treatment plus levocarnitine,and the treatment group was given evolocumab on the basis of the control group.The therapeutic effectiveness,coronary artery microcirculation[B-type natriuretic peptide(BNP),left ventricular ejection fraction(LVEF)],coronary arteriole status[Thrombolysis in Myocardial Infarction(TIMI)risk score,preprotein converting enzyme subtilysin 9(PCSK9)and low density lipoprotein cholesterol(LDL-C)]and incidence of adverse reactions were compared between the two groups before and after treatment.Results After treatment,the total effective rate of treat-ment group was significantly higher than that of control group(P＜0.05).After treatment,BNP level in two groups was significantly lower than before treatment,and the level in the treatment group was significantly lower than that in the control group(P＜0.05);LVEF in the two groups was significantly higher than before treatment,and the treatment group was significantly higher than the control group(P＜0.05).After treatment,the TIMI risk score of the two groups was significantly decreased,and the treatment group was significantly lower than the control group(P＜0.05).The levels of PSCK9 and LDL-C in the two groups were significantly lower than before treatment,and the treatment group was significantly lower than the control group(P＜0.05).After treatment,there was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Evolocumab combined with levocarnitine can improve cardiac function and coronary microcirculation in STEMI patients after emergency PCI,and has high safety.

Objective To explore the characteristics of myocardial injury in patients with acute myocardial infarction(AMI)complicated by pleural effusion and its effect on long-term prognosis.Methods It was a prospective single-center study.Patients with AMI who were admitted to hospital within 15 days from symptom onset and performed echocardiography and cardiac magnetic resonance imaging(CMR)during hospitalization were consecutively enrolled and assigned to the with-pleural effusion group and the without-pleural effusion group according to the echocardiography result.Baseline data,cardiac magnetic resonance myocardial injury index and echocardiography characteristics were compared between the two groups.The occurrence of major adverse cardiovascular and cerebrovascular events(MACCE)was recorded through outpatient follow-up and telephone follow-up,including all-cause death,re-infarction,revascularization,rehospitalization for congestive heart failure and stroke.Cox regression analysis was performed to analyze influencing factors of all-cause death.Results Among 211 patients,31(14.7%)patients had pleural effusion and 180(85.3%)had no pleural effusion.Compared with the group without pleural effusion,the left ventricular end-diastolic diameter was larger,and left ventricular ejection fraction assessed by echocardiography was lower in the group with pleural effusion(P＜0.05).There were no significant differences in infarct size,left ventricular end-diastolic volume,left ventricular end-systolic volume,left ventricular ejection fraction and the presence of microvascular obstruction and intramyocardial hemorrhage between the two groups in CMR(all P＞0.05).At a median follow-up of 31 months,MACCE occurred in 43(20.4%)patients,and there was no significant difference between the two groups(χ2=3.160,P=0.075).Six cases(2.8%)had all-cause death.The incidence of all-cause death was higher in the group with pleural effusion than that in the group without pleural effusion(9.7%vs.1.7%,P<0.05).There was no significant difference in the incidence of other adverse events between the two groups(P＞0.05).Multivariate Cox regression analysis showed that advanced age and presence of pleural effusion were independent risk factors of all-cause death during follow-up.Conclusion Patients with AMI combined with pleural effusion have more severe myocardial injury and higher all-cause mortality.

Objective To investigate the effect of evolocumab combined with levocarnitine after emergency percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myo-cardial infarction(STEMI).Methods A total of 120 STEMI patients were selected and randomly di-vided into treatment group(60 cases)and control group(60 cases).The control group was given STEMI basic treatment plus levocarnitine,and the treatment group was given evolocumab on the basis of the control group.The therapeutic effectiveness,coronary artery microcirculation[B-type natriuretic peptide(BNP),left ventricular ejection fraction(LVEF)],coronary arteriole status[Thrombolysis in Myocardial Infarction(TIMI)risk score,preprotein converting enzyme subtilysin 9(PCSK9)and low density lipoprotein cholesterol(LDL-C)]and incidence of adverse reactions were compared between the two groups before and after treatment.Results After treatment,the total effective rate of treat-ment group was significantly higher than that of control group(P＜0.05).After treatment,BNP level in two groups was significantly lower than before treatment,and the level in the treatment group was significantly lower than that in the control group(P＜0.05);LVEF in the two groups was significantly higher than before treatment,and the treatment group was significantly higher than the control group(P＜0.05).After treatment,the TIMI risk score of the two groups was significantly decreased,and the treatment group was significantly lower than the control group(P＜0.05).The levels of PSCK9 and LDL-C in the two groups were significantly lower than before treatment,and the treatment group was significantly lower than the control group(P＜0.05).After treatment,there was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Evolocumab combined with levocarnitine can improve cardiac function and coronary microcirculation in STEMI patients after emergency PCI,and has high safety.