Analysis Of The Occurrence And Treatment Of Acute Myocardial Infarction With ST Segment Elevation In Hospital

Objective: The aims of this study were to retrospectively analyze the occurrence and treatment of ST-segment elevation acute myocardial infarction(STEMI)in our hospital,statistically analyze the key indicators of diagnosis and treatment,and to compare with the requirements of China Chest Pain Center certification standard(version 6),so as to provide reference for optimizing the treatment process of STEMI in our hospital and reaching the guideline standard.Methods: We collected the clinical data of 383 AMI patients in the non-cardiovascular ward of the First Affiliated Hospital of Guangxi Medical University,from May 1,2014 to April 30,2019.After screening of inclusion criteria and exclusion criteria,66 cases were selected.Checking patient’s information,analyzing clinical characteristics,and counting important data during the treatment process,including S2 FMC,FMC2ECG,the proportion of long-distance ECG transmission,time from ECG to diagnosis,FMC2 DAPT,the proportion of direct access to the catheter room,D2 B,TIT,the immediate recanalization rate,the proportion of 24-hour intensive statin treatment,the proportion of β-blockers used,the mortality rate,and compared separately with the date of the Chest Pain Center in our hospital and the quality control data of China Chest Pain Center(CCPC)from 2016 to 2018.Result:1.Basic information:In this study,there were 45 males(68.2%)and21 females(31.8%),with a ratio of 2.1:1.The average age was 68.48 ± 14.51 years old,there were 3 cases(4.5%)aged <45 years old,24 cases(36.4%)aged45-65 years old,16 cases(24.2%)between 65 and 75 years old,and 23 cases(34.8%)aged >75 years old.31 patients(47.0%)had dyslipidemia,and 39patients(59.1%)had hypertension,17 patients had diabetesrespiratory system diseases(21 cases,31.8%)and neurological diseases(18 cases,27.3%)were the most common;the department where the disease occurred was mostly internal medicine(37 cases,56.1%),16 patients(24.2%)occurred insurgical and 13patients(19.7%)occurred in intensive care units.2.Examination on admission: 33 cases(30%)were able to detect both myocardial enzyme and supersensitive troponin in the first examination on admission,only 27 cases(40.9%)of myocardial enzyme items,and 6 cases(9.1%)did not perform any enzyme examination;all patients underwent electrocardiogram examination within 24 hours after admission,20 patients(30.3%)were admitted to the electrocardiogram,which indicated ST-T changes or T wave changes,6 patients(9.1%)showed abnormal Q waves,the electrocardiogram of the 40 patients(60.6%)was normal on admission.STEMI attack: 9 patients(13.6%)had single chest pain,chest distress or both,17patients(25.8%)had other symptoms related to or not related to the primary disease,Only 16 cases(24.2%)had symptoms related to or unrelated to the primary disease,such as fever,shortness of breath,dyspnea,abdominal pain,vomiting,and restlessness.10 patients(15.2%)progressed rapidly with immediate hypotension and disturbance of consciousness.14 patients(20.4%)showed no symptoms.Abnormalities were found during monitoring of cardiac markers or electrocardiogram monitoring during hospitalization indicated rapid heart rate,ventricular arrhythmia and ST segment changes in ECG.3.Treatment time comparison: Compared with pre-hospital and CCPC,S2 FMC of in-hospital has obvious advantages(3.2 ± 2.2min vs 75.4 ± 87.0min,162.6min),while FMC2ECG(20.0 ± 24.1min vs 2.9 ± 4.0min,6.6min),the time from the first ECG to the diagnosis(39.4 ± 65.9min vs 1.5 ± 3.3min,3.2min),FMC2DAPT(205.4 ± 173.9min vs 18.5 ± 43.7min,39.3min),D2 B time(316.0 ± 238.6min vs 79.6 ± 23.7min,77.7min)compared with pre-hospital and CCPC average levels,there was obvious delay,the difference was statistically significant(P<0.05).Its TIT(317.7 ± 238.9min vs 216.2 ±131.2min,289.4min)was not statistically different from pre-hospital and CCPC(P>0.05).Treatment index comparison: the proportion of STEMI in-hospital to the catheterization room was 61.54%,which was significantly higher than the pre-hospital 6.9%;while the proportion of long-distance ECG transmission,24-hour intensive statin treatment,and the β-blockers used were lower than pre-hospital,the difference was statistically significant(P<0.05).There was no statistically significant difference in recanalization rate between in-hospital and pre-hospital(P>0.05).The mortality rate of in-hospital was 16.67%,and it was only 1.60% in the pre-hospital.The difference was statistically significant(P<0.05).The key indicators of STEMI in the hospital were directly compared with the average level of CCPC data,and the proportion of direct catheterization was higher than CCPC,β-blockers were used in similar proportions.The proportion of long-distance ECG transmission,the immediate recanalization rate and 24-hour intensive statin treatment rate were slightly lower than the average level of CCPC.The STEMI mortality rate of in-hospital was higher than the average level of CCPC.4.Treatment effect: In this study,33 patients(50.0%)were not treated with dual antiplatelet therapy,among them,8 patients had hemorrhagic diseases(7cerebral hemorrhage,1 urinary tract hemorrhage),12 patients had high bleeding risk(9 postoperative,3 thrombocytopenia),2 patients were difficult to diagnose,3 patients died of ineffective rescue on the day of rapid progress,8 patients did not record the cause during the course of the disease.Among 59 patients(89.4%)who did not receive reperfusion treatment,20 patients had reperfusion contraindications,9 patients died of ineffective rescue in the ward,while 30 patients refused PCI and chose conservative treatment or were discharged from hospital due to economic reasons,surgical risks,poor prognosis of primary disease and other reasons.11 cases(16.67%)died of STEMI in hospital.The direct cause of death was cardiac arrest in 6 cases and cardiogenic shock in 5cases.Conclusion: The complex basic diseases and atypical symptoms of STEMI patients in the non-cardiovascular ward lead to delayed diagnosis,low reperfusion rate and high mortality.It is necessary to strengthen the training of non-cardiovascular professionals,improve the early identification of STEMI in the hospital,and improve the treatment level.