A Survey Of Current Practice For Non-ST-segment Elevation Acute Coronary Syndromes, An Analysis Of Prognosis Factors And Study Of Treatment In Region Of Liaoning

A Survey of Current Practice for Non-ST-segment elevation Acute coronary syndromes, an Analysis of Prognosis Factors and Study of treatment in region of LiaoningIntroductionThe technical term of Acute coronary syndromes (ACS) was used first time in the therapia guide of Acute myocardial infarction of the ACC/AHA publication in 1996. Modem classification of ACS is ST-elevation Acute coronary syndromes and Non-ST-elevation Acutecoronary syndromes.The former is ST-elevation Acute myocardial infarction (STEMI) and the latter is Unstable angina (UA) and Non-ST-elevation Acute myocardial infarction (NSTEMI).ACS is one of the causes of death and mutilation in the developed country and our country. Because of continue increasing of the number of patients these tendencies request to strengthen for prevention and chang diagnosis and theapia strategies in order to decrease heart-blood dysevents and have many clinical significance to improve prognosis, and meantime these had been investigative hot topics of scholarsWith development of evidence-based medicine's basis and generate mechanism of coronary atherosclerosis more and more studies pay attention for prognosis factors except traditional factors, but there is short of withness of multi- central research,and moreover there are many different views for various factors to affect prognisis degreeThere are two revascularization to patients of non-ST-elevation Acutecoronary syndromes. The first is energetic strategy and the second is conservative strategyWith reinforce of ability of region of Liaoning and popular of interventional therapy more and more hospitals have ability to do interventional therapy and more patients choose this treatment, but we do not know the degree of profit. In this status we develop to study survey of Current Practice for Non-ST-segment elevation Acute coronary syndromes, analyze of Prognosis Factors and study of treatment in region of Liaoning to know ture patiental immediate interests without GPⅡb/Ⅲa.ObjectiveThis test aim to survey of Current Practice for Non-ST-segment elevation Acute coronary syndromes, analyze of Prognosis Factors and study of treatment in region of Liaoning to offer evidence-based medicine's basis while physician make a diagnosis and give treatment to NSTEACS.Methods1,Clinic data: choose successively patients suffered from NSTEACS initially in 14 third-class or second-class hospitals in 10cities from March 2006-January 2007, filled in questionaire and had a follow-up when the patients disdischarged from hospital after 30 days, 100 days, and 180 days, then got complete 900 data. All patients were divided into two groups by different treatment strategies: group of interventional therapy and group of drug treatment. Group of interventional therapy was separated into two groups: group of interventional therapy in 48 hours and group of interventional therapy after 48 hours.2,Observational target: Include the patients' characters of base line, clinical interference measure and end point events. The people whose measurement data were shown as average standard deviation .Enumeration count data is described as constitute ratio. Compared if the characters of base line has the statistical discrepancy of the patient in different groups; Measurement data is checked up as the whole group t test; Enumeration count data is checked up as x~2 test. The key event is death and second events were nonfatal myocardial infarct, reangina pectoris attacks, congestive cardiac failure, in-hospital again because heart disease. 3,Analyzed results of follow-up: Used Kaplan-Meier survival analytical method to estimate survival rate and trace survival curve. Analyzed prognosis factors: Used Cox proportional hazards recreation model to have single factor and multi-factor analysis, and composed regression equation. Adopted multiple factors logistic regression analysis to analyze the influence of various clinical variances to second events. When p≤0.05,there were statistical significance of discrepancy.Result1,Current practice of patients: the patients' characters of base line: mean age of patient was 64.7±11.0 years , and proportion of male patients was 59.1%; the percentage of UA was 81.3%,and NSTEMI was 18.7%. 20.9% of patients had history of myocardial infarct in the past, and 13.7% had history of congestive cardiac failure. there were more patients of high blood pressure, high cholesterol, high triglyceride and hyperglycosemia than other patients in all orthodox risk factors. The status of special check and interventional therapy: 34.2% of patients was checked coronary angiography, and 73.3% in these patients was performed PCI. there were 49.5%of PCI patients were performed in 48 hours after admission. The heart event in follow-up period: Death rate was 4.9% in follow-up six months; The incidence rate of nonfatal myocardial infarct was 2.4%, reangina pectoris attacks 75.6%, congestive cardiac failure 22.2%, in-hospital again because heart disease 16.0%. The status of drug use in different period: The apply rates of antiplatelet drug, nitrate, Low Molecular Heparin,βblock agent and angeial convering enzyme inhibitor were above 50%, but the rate of drug treatment tend to descend out of hospital.2,Prognosis factors analysis : prognosis factors of shorten survival time were high troponin, CK-MB≥2 times than normal, high lencocyte count, high fibrinogen, the fast heartbeats, reangina pectoris attacks in hospital, there were four prognosis factors to lengthen survival time, such as applying common heparin two week before admission, Low Molecular Heparin, using calcium antagonist in hospital, aspillini one month after admission. Survival curve indicate: survival rate decreased with increasing time, and female patients' survival rate was lower than that of male pations in disdischarge 124 days, but higher after 125 days. Risk factors which affected second event by multi variable Logistic regression analysis were fever in hospital : age, history of plasy, congestive cardiac failure and smoking in the past, family history, incidence of cerebral accident, fever, fast heartbeat, congestive cardiac failure, high lencocyte count, high fibrinogen, reangina pectoris attacks in discharge three month;protect factors were interventional therapy at once after admission, using drug such as stain, clopidogrel, calcium antagonist for two week before admission, utilizing common heparin, clopidogrel,βblock agent in hospital and using clopidogrel in discharge three months.3,Compared survival rate in different therapy groups: survival rate in group of interventional therapy in 48 hours was higher than that of, but there was not different between the group of interventional therapy in 48 hours and group of interventional therapy after 48 hours.Conclusion1,The patients of unstable angina were more than that of Non-ST-elevation Acute myocardial infarction. The events of unstable angina and congestive cardiac failure were more than other events2,Incidence rate of high blood pressure, high triglyceride and hyperglycosemia is higher than that of our country。3,High troponin, CK-MB≥2 times than normal, high lencocyte count, high fibrinogen, the fast heartbeat, reangina pectoris attacks in hospital were independent prognosis factors.4,Survival rate decreased with increasing time, and female patients' survival rate was lower than that of male pations in discharge 124 days, but higher after 125 days. 5,Interventional therapy at once reduce incidence rate of myocardial infarct.6,Compliance of patients in interventional therapy group were much better than that durg therapy group.7,There was no effect to survival time of discharge 6 months between the group of interventional therapy in 48 hours and the group of interventional therapy after 48 hours, with feature of local region of Liaoning.and without GPⅡb/Ⅲa, and future results are needed to explorate by going on follow-up.