Efficacy Of Drug Therapy In Patients With Acute Myocardial Infarction And Analysis Of The Reasons For Drug Therapy

Objective: To observe the short-term and long-term clinical efficacy of drug therapy in patients with acute myocardial infarction(AMI),to analyze the causes of drug therapy in emergency patients with acute myocardial infarction,and to explore the causes of major adverse cardiovascular events in patients with acute myocardial infarction.Methods: AMI-diagnosed acute myocardial infarction(STEMI)and acute non-acute myocardial infarction(NSTEMI)were performed from January 2013 to September 2016 in the First Affiliated Hospital of Guangxi Medical University.ST-elevation myocardial infarction and non-st-elevation myocardial infarction patients admitted to our hospital(including hospital emergency)cases,sub-drug treatment group of 126 cases,drug treatment group was divided into simple drug treatment group(115 cases)and simple drug and thrombolysis group(n=11 cases),and 211 cases of percutaneous coronary intervention(PCI)were selected as the control group in our hospital at the same period.We compared the three groups of patients with short-term efficacy and long-term efficacy-including comparing the three groups of patients with all-cause mortality,acute left heart failure or cardiogenic shock,NT-proBNP changes,cardiac echocardiography Left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),left ventricular end-diastolic diameter(LVEDD),Left ventricular end-systolic diameter(LVESD)and the incidence of MACE events.Briefly analysis of the causes of AMI emergency patients who adhere to the choice of drug therapy.According to whether the MACE event occurred in the drug treatment group,it was divided into MACE event group and no MACE event group.The multivariate logistic regression analysis showed the related factors of the total MACE event in the drug treatment group.Results: 1.The total number of deaths in the drug treatment group was 33cases(26.19%).The number of all deaths in the emergency PCI group was 18cases(8.53%).The all-cause mortality was higher in the drug-treated group than in the emergency PCI(26.19% vs 8.53%,P<0.05).The incidence of acute left heart failure or cardiogenic shock was significantly higher in acute drug group than in emergency PCI group(33.91% vs 16.11%,P<0.05).2.Compared with the emergency PCI group,the Killip classification of the cardiopulmonary bypass group was statistically higher[(194.49 vs 153.29),(203.91 vs 153.29),P<0.05].3.The median NT-pro BNP level was higher in the simple drug-treated group than in the emergency PCI group [(1120.50,1748.40)pg / ml VS(820.00,1591.30)pg / ml,P>0.05].There was no difference in NT-proBNP between the simple drug and intravenous thrombolysis group and the emergency PCI group [(572.60,2081)pg /ml VS(820.00,1591.30)pg/ml,P>0.05].After treatment,the levels of NT-proBNP the patients in the drug group were still higher than the emergency PCI group[(448.50,401.30)pg/ml VS(98.00,130)pg/ml,P<0.05].LVESD[(36.88 ± 6.75)mm vs(34.94 ± 6.39)mm,P<0.05]was larger and the LVEF was lower in the drug group than in the emergency PCIgroup[(55.44±9.8)% vs(58.26±8.30)%,P < 0.05].The level of NT-proBNP[(189.00,229.75)pg/ml vs(98.00,130.00)pg/ml,P > 0.05] 、 LVEF [(56.5 ±7.78)% vs(58.26 ± 8.30)%,P>0.05]、LVEDV [(134.37 ± 25.83)mm vs(128.56± 35.16)mm,P>0.05]、LVEDD [(37.5 ± 3.86)mm vs(34.94 ± 6.39)mm,P>0.05)]、LVESD [(37.25 ± 3.86)mm vs(34.94 ± 6.39)mm,P>0.05).LVEF[(55.65±8.66)%vs(62.78±7.27)%,P < 0.05],there was no significant difference between the drug and intravenous thrombolysis group and the emergency PCI group.The level of NT-pro BNP [(653.20,984.50)pg/ml vs(109.00,49.50)pg/ml,P<0.05]in the drug-treated group was significantly higher than that in the emergency PCI group before discharge.In the drug treatment group and the emergency PCI group,comparing the level of NT-proBNP [(653.20,984.50)pg/ml vs(109.00,49.50)pg/ml,P < 0.05] 、 LVEF [(55.65±8.66)%vs(62.78±7.27)%,P<0.05],LVEDV [(153.29 ± 56.52)mm vs(131.08 ± 33.44)mm,P<0.05),LVEDD [(56.01 ± 7.15)mm vs(51.52 ± 5.49)mm,P<0.05],LVESD [(38.82 ± 7.93)mm vs(33.58 ± 5.81)mm,P<0.05].(957.30,1035.00)pg / ml vs(109,49.50)pg/ml,P <0.05],there was significant difference.The level of NYHA cardiac function was significantly higher in the patients with simple drug therapy group and simple drug and intravenous thrombolysis group than in the emergency PCI group(mean value was 180.04vs117.30,151.56vs117.30,P<0.05).The incidence of MACE was signifi-cantly higher in the patients with simple drug treatment than in the emergency PCI group(66.96% vs 19.91%,45.45% vs 19.91%,P<0.05).The incidence of MACE events in drug and thrombolysis group was significantly higher than that in emergency PCI group(66.96% vs 19.91%,45.45% vs 19.91%,P<0.05).4.Comparison of drug treatment subgroups in short-term and in the long-term,NT-proBNP was significantly higher than that of long-term NT-proBNP atadmission[(1641.50,4177.48)pg / mlvs(652.10,949.58)pg/ml,P<0.05].Compared with the short-term in drug and intravenous thrombolysis group,NT-proBNP was higher than that of the long-term NT-proBNP(445.00,264.40)pg/mlvs(142.60,100.00)pg/ml.Compared with the short-term in the drug group,the long-term LVEDV and LVEDD was significantly higher(140.26 ± 42.14)ml vs(153.26 ± 58.50)ml,(54.46 ± 6.16)mm vs(56.18 ± 7.28)mm,P<0.05).Respectively,there was a significant difference between the short-term and long-term LVEF values [(51.43 ± 6.29)% vs(61.71 ± 6.89)%,P<0.05)in drug and intravenous thrombolysis group.5.Can not receive the risk of emergency surgery,emergency intervention indications but have missed the best timing of surgery,patients too old to tolerate emergency surgery,economic difficulties and so on are the the main reasons of local AMI patients choosing for drug treatment.6.Through multivariate logistic regression analysis found that age>75 years old,combined with acute left heart failure or cardiogenic shock is AMI drug treatment of patients with MACE incident occurred independent risk factors.Conclusion: 1.Although AMI patients with simple drugs or simple drugs and thrombolytic therapy is acceptable;but the emergency treatment of PCI less mortality,short-term and long-term improvement of cardiac function better,better efficacy.Therefore,in emergency hospitals where emergency PCI can be developed,emergency PCI should be the preferred treatment for emergency AMI patients.2.Can not accept the risk of emergency surgery,missed the best timing of surgery,family members that the elderly can not tolerate emergency surgery and family financial difficulties are the local AMI patients and their families choose the main reason for drug treatment.3.Age>75 years old,combined with acute left heart failure / cardiogenic shock at admission is thelocal AMI drug treatment patients MACE incident occurred independent risk factors.