| Background:Coronary heart disease is the abbreviation of coronary atherosclerotic heart disease,which is harmful to the life and health of human beings.There are more than 7 million coronary deaths in the world.Ranking the first in the cause of death among 235 single diseases.According to experts predict that in the next 20 years,coronary heart disease will continue to be the leading cause of global death.In 2015,a Chinese scholar Zhou published the study in the Lancet showing that coronary heart disease is the leading cause of death in China.Acute ST segment elevation myocardial infarction is the most critical type of coronary heart disease.Acute ST segment elevation myocardial infarction is characterized by acute onset,high morbidity and high mortality.It has attracted more and more attention.Emergency percutaneous coronary intervention is the most safe and effective treatment for patients with STEMI.PCI as soon as possible treatment,full and sustained opening of the infarct related artery is the best treatment for the treatment of STEMI patients currently accepted.Although the application of emergency PCI operation can greatly improve the survival of STEMI patients and the prognosis,but some of the factors in patients with some basic diseases and related treatment measures still will lead to some adverse outcomes.Although the absolute number of patients with acute myocardial infarction undergoing direct PCI therapy has increased significantly over the past 10 years,the in-hospital mortality and long-term prognosis of AMI patients have not improved significantly.What causes such a result,this study is a preliminary study of this issue.Objective : This study analyzed the clinical data of STEMI patients undergoing emergency PCI.To identify the risk factors for in-hospital and long-term mortality in STEMI patients,to increase predictability of risk factors,to improve the treatment and rescue measures,to strengthen clinical follow-up,the aim is to reduce the in-hospital and long-term mortality of STEMI patients.Method:The clinical data of 360 patients with STEMI who underwent emergency PCI from January 2008 to December 2012 in the Department of Cardiology,the First Affiliated Hospital of Anhui Medical University were analyzed retrospectively.Patients were divided into survival group(326 patients)and death group(34 patients)according to whether or not the patient died after emergency PCI.The clinical features,surgical procedures and cardiovascular events were compared between the two groups.Logistic regression analysis was used to identify risk factors for death during hospitalization.The ROC work characteristic curve is used to determine the weights of these risk factors.326 survivors were followed up for an average of 3 years,and data of patients who died during the follow-up period were analyzed.Survival rates of survivors were calculated by Kaplan Meier analysis.A multivariate Cox proportional hazards model was used to identify the risk factors for death in the survival group during follow-up SPSS 21 statistical software was used for statistical analysis.P < 0.05 is considered statistically significant.Result:(1)A total of 360 patients were enrolled,of whom 236 were male and 124 were female.The proportion of male patients was higher than that of female patients(65.56% vs 34.44%).The proportion of male patients in the death group was higher than that in the survival group(70.58% vs 65.03%),but the difference between the two groups was not statistically significant(P>0.05).(2)Baseline data of survival and death groups: Patients in the two groups in gender,drinking history,history of hypertension,cerebral infarction,admission heart rate,admission systolic blood pressure,admission diastolic blood pressure,HGB,RDW,PLT,PDW,MPV,TG,LDL-C,HDL-C,fasting GLU,ALB,UA,PA had no significant difference(P>0.05).Two groups of patients in the history of smoking,history of diabetes,anterior wall myocardial infarction,heart function Killip ≥III,age,per hospital delay time,GRACE score,γ-GGT,WBC,TC,CRP,CK-MB peak were statistically different(P < 0.05).(3)The comparison of the operation and cardiovascular events is in the survival group and the death group: Two groups of patients are using thrombus aspiration during operation,no reflow or slow flow,intracoronary injection tirofiban during operation,intracoronary injection of nitroglycerin during operation,postoperative acute heart failure was no statistically significant differences(P>0.05).There were significant differences between the two groups in the use of IABP,the occurrence of cardiogenic shock,and the occurrence of postoperative malignant arrhythmia(P < 0.05).(4)Logistic regression analysis showed: Cardiogenic shock(OR=5.770,95% CI 1.411~23.592,P=0.015),heart function Killip≥III(OR=5.339,95%CI 1.531~18.620,P=0.009),anterior wall myocardial infarction(OR=4.000,95%CI 1.154~14.071,P=0.029),CK-MB peak(OR=1.232,95% CI 1.136~1.336,P(27)0.001),γ-GGT(OR=1.063,95% CI 1.017~1.110,P=0.007)and high GRACE score(OR=1.046,95%CI 1.028~1.066,P < 0.001)is the risk factors for hospital mortality in STEMI patients undergoing PCI operation(P < 0.05).(5)ROC curve analysis of death factors during hospitalization:The peak value of CK-MB(AUC=0.855,P<0.001),high GRACE score(AUC=0.809,P<0.001),anterior myocardial infarction(AUC=0.711,P<0.001),cardiogenic shock(AUC=0.709,P<0.001),Killip ≥III(AUC=0.705,P<0.001),γ-GGT(AUC=0.698,P<0.001),has a good predictive value for the STEMI patients undergoing emergency PCI who died during hospitalization.(6)Survival rates of survivors were calculated by Kaplan Meier analysis:326 patients were followed up for an average of 3 years.The shortest survival time was 1 month during follow-up.The mean survival time was 33.34±7.33 months.Kaplan Meier survival curve analysis shows:The survival rates of 1,2,and 3 years in patients with STEMI undergoing emergency PCI were 96.01%,90.80% and 84.05% respectively.(7)The Cox proportional hazard model showed mortality factors of the survival group during follow-up:Anterior wall myocardial infarction(OR=2.685,95% CI 1.826~3.946,P<0.001),cardiogenic shock(OR=2.921,95% CI 1.923~4.437,P<0.001),Killip ≥III(OR=1.939,95% CI 1.317~2.856,P=0.001)and high GRACE score(OR=1.009,95% CI 1.004~1.014,P<0.001)are risk factors for death during follow-up in patients with survival group.Conclusion:(1)Based on the clinical data of 360 cases with emergency PCI in STEMI patients were analyzed and found that anterior wall myocardial infarction,cardiogenic shock,γ-GGT,CK-MB peak,heart function Killip≥III level and high GRACE score were risk factors for hospital mortality in STEMI patients.Which also have good predictive value for the death of STEMI patients during hospitalization.For patients with high risk factors,we should closely observe the disease changes and intervene early.(2)We also found that the anterior wall myocardial infarction,cardiogenic shock,heart function Killip≥III level and high GRACE score are the long-term risk factors of death for STEMI patients with emergency PCI.For these patients,we need to strengthen clinical follow-up,improve patient compliance,and guide postoperative rehabilitation. |
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