| BackgroundThe 2004 Guidelines for the management of patients with ST-elevation myocardial infarction has been reported for about 4 years.The early reperfusion therapy and the secondary prevention after myocardial infarction were emphasized once and again.But real state of the therapy, especially of resent two years in China were still absevce.Objective1.to observe the early reperfusion therapy state of acute myocardial infarction and the time in the therapy in Huashan hospital in the resent 3 years.2.to observe the medication both in hospital and out of hospital in Huashan hospital in the resent 3 years.3.to find the difference among the state of our hospital and in or out of the country and the requirement of the 2004 guidelines.4.to provide the evidence to evaluate the state of acute myocardial infarction and find out the space to improve.MethodsWe collected the history of the patients who left or died in Huashan hospital from 2005.1.1 to 2007.8.31.We analysed their early reperfution therapy and medication in our hospital and investigated their medication after they had left the hospital for a long time.Setted up a database by Access 2003 and analyse the date by Stata 7.0.Results1.A total of 176 patients were included.Female was 22.2%when male was 77.8%.Male with female was about 3.5:1.The mean age of total patients was 68.9±12.7 years old,the patients over 75 years old were 37.5%,the mean age of male was nearly 10 years younger than female(67 vs 76).The patients with hypertension were 68.8%.Diabetes patients in female were more than in male(33.3%vs 17.5%,P＜0.05).Smoke patients in male were 54% when none in female.Patients of STEMI or KillipⅢ/Ⅳin male were similar to that in female.The median duration of hospital stay was 10 day.2.Reperfusion was performed in 50.3%of the total patients,33.7% receive intravenous thrombolysis and 16.6%were treated with primary percutaneous coronary intervention.Among the patients of STEMI the rate of reperfution was 62.1%,43.1%received intravenous thrombolysis and 19.0%were treated with primary percutaneous coronary intervention.The rate of reperfution in the patients of STEMI arriving at our hospital in 12 hours was 75%,when thrombolysis was 52.7%,primary percutaneous coronary intervention was 22.3%.The rate of reperfution in the patients who are suitable for thrombolysis was 77.1%,when thrombolysis was 56.2%, primary percutaneous coronary intervention was 20.9%.3.Age≥75 years(OR=5.5) and the time used from symptom onset to arriving at our hospital(OR=1.2) were found to be the facts that would influence the use of reperfution therapy among other possible facts ssuch as sex,killip,hypertension,diabete and hyperlipidemia,by the use of Logistic stepwise regression model.Patients with early reperfution used less time from symptom onset to arriving at the hospital.The group with early reperfution had less patients age≥75 years.4.The median time from symptom onset to arriving at the hospital in 137 STEMI patients was 2 hours.Patients who arrived at the hospital in 2 hours were 39.4%,74.4%of the patients arrived at the hospital in 6 hours.5.Nothing was found to be the facts that would influence the time from symptom onset to arriving at the hospital among age,sex,hypertension, diabete,hyperlipidemia,fatness,smoke,history of angina or myocardial infarction,stroke and killipⅢ/Ⅳ,by the use of Logistic stepwise regression model.6.The median time from symptom onset to needle in the patients with thrombolysis therapy was 4.25 hours.Only 10.2%of the patients could receive the thrombolysis therapy in 2 hours,64.4%in 6 hours and 98.3% in 12 hours.The median time from symptom onset to arrived at the hospital was 1.5 hours,54.2%arrived at the hospital in 2 hours.The median time of door-to-needle was 2.42 hours,only 1.7%could receive the thrombolysis therapy in 30 minutes,the rate of delay was 98.3%.The median time of delay was 1.92 hours.The median time from door-to-ward and ward-to-needle was 2 hours and 0.625 hours.7.The median time from symptom onset to balloon in the STEMI patients with primary percutaneous coronary intervention was 5 hours.The median time from symptom onset to door was 2 hours when the median time of door-to-balloon was 1.5 hours.53.8%of the patients could receive the primary percutaneous coronary intervention therapy in 90 minutes,the rate of delay was 46.2%.The median time of dalay was 1.2 hours.8.The delay of thrombolysis therapy was in the delay of perhospital as it was in the delay of inhospital in the patients with primary percutaneous coronary intervention.9.The antiplatelet therapy in hospital:the rate of using asprine was 98.9%,clopidogrel was 76.7%,ticlopidine was 20.5%.Clopidogrel/ ticlopidine was 97.2%.Over half of the patients used ticlopidine in 2005 but it was completely substituted with clopidogrel in 2006 and 2007.4% of the patients only used asprine or clopidogrel,the others used both asprine and clopidogrel or ticlopidine.10.The use of low molecular weight heparin was 93.2%.Though there was not a clear difference among 3 years,the use rate of low molecular weight heparin ascended gradually.11.The rate of beta-blocker was 76.7%,the rate of suitability was 83.5%,real/suitability was 91.8%.About 29.3%of the patients without using beta-blocker had no reason.Though there was a clear difference among 3 years,the rate of real/suitability descended clearly in 2007.12.The rate of ACEI was 71.6%,the rate of suitability was 86.9%.About 20%of the patients without using ACEI had no reason and 34%used ARB. The real rate of ACEI/ARB was 81.3%and the real rate/suitability rate of ACEI/ARB was 93.7%.13.The rate of using statinswas 92%.Age≥75 years was the fact that would influence the use of statins among other facts,such as female, diatbete,hypertension,hyperlipidemiaand killip,by the use of Logistic stepwise regression model.14.The use rates of nitrate,calcium antagonist,diuretic and digitalis were 76.7%,9.7%,31.3%,24.4%.15.The patients that we touched at least 6 months after myocardial infarction was 131.The use rates of asprine,clopidogrel/ ticlopidine, beta-blocker,ACEI/ARB,statin all descended gradually.Except asprine,the rates of other medicine had clearly difference between in and out of hospital.The use rate of ARB and calcium antagonist ascented clearly.The use rate in and out of hospital for 6 months was:asprine 99.2%vs 95.4%;clopidogrel 75.6%vs 62.6%;ticlopidine 22.1%vs 8.4%; clopidogrel/ ticlopidine 97.7%vs 71.0%;beta-blocker 80.2%vs 69.5%; ACEI 77.1%vs 48.1%;ARB 9.9%vs 20.6%;ACEI/ARB 87.0%vs 68.7%;statin 93.1%vs 61.8%.16.The use rate of asprine ws similar in both stent implantation/CABG group and no operation group.Operation group used more clopidogrel/ ticlopidine than no operation group.There were still 5.5%of operation group treat without clopidogrel or ticlopidine and 12.5%of no operation group treat with both asprine and clopidogrel or ticlopidine.Conclusion1.The rate of reperfusion in acute myocardial infarction in our hospital in the resent 3 years was higher than that in the country,but lower than some reports in Europe and America.2.Reducing the time from symptom onset to door and asecnting the rate of reperfusion in age≥75 years will elevate the rate of early reperfusion.3.Over half of the patients with primary percutaneous coronary intervention arrived at the hospital in the time required in 2004 guidelines.There was serious delay in the patients with thrombolysis.The delay of thrombolysis therapy was in the delay of perhospital as it was in the delay of inhospital in the patients with primary percutaneous coronary intervention.4.The rate of antiplatelet therapy was close to the requirement of 2004 guidelines.The suitability rate of beta-blocker and ACEI/ARB and the rate of low molecular weight heparin and statin were all over 90%,higher than the rate before. 5.Except asprine,the long-term use rate of beta-blocker,ACEI and statin was lower than that in hospital.There was still large place to improve it. |
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