| Objective:Analyze the etiological composition,epidemiology,risk factors,visit time,location and nature of chest pain,accompanying symptoms,diagnosis,treatment and outcomes of patients with acute chest pain,improve the public’s cognition of acute chest pain,optimize the diagnosis and treatment process of patients with acute chest pain,improve the diagnosis rate of this disease,and reduce the mortality rate.Methods:The general data,biochemical indexes,imaging examinations and coronary angiography results of patients admitted to the emergency department of the First Hospital of Shanxi Medical University for acute chest pain on October 16,2019 solstice and October 15,2020 were collected retrospectively.1.According to the cause of chest pain,the patients were divided into cardiogenic chest pain group and non-cardiogenic chest pain group,and the differences in general data,biochemical indexes and imaging between the two groups were compared.2.According to the results of different coronary angiography,the patients were divided into single vessel lesion group,multi-vessel lesion group and no lesion group.The differences between the groups were compared and the related risk factors were summarized.Results:A total of 436 patients were admitted to the emergency department of the First Hospital of Shanxi Medical University due to acute chest pain on October 15,2020.1.Etiological composition :(1)A total of 40 diseases were involved,including361(82.80%)patients with cardiogenic chest pain,mainly acute coronary syndrome(79.50%),75(17.20%)patients with non-cardiogenic chest pain,and respiratory infection(76%).(2)Coronary angiography results: In emergency PCI patients,there were 26 cases(19.85%)with single-vessel lesions,42 cases(32.06%)with double-vessel lesions,58 cases(44.27%)with three-vessel lesions,and 5 cases(3.82%)without lesions.There were 64 cases of anterior descending artery(50.79%),47 cases of right coronary artery(37.31%),14 cases of circumflex artery(11.11%),and 1 case of left main artery(0.79%)related to acute cardiogenic chest pain.27 cases of hospitalized patients with vascular disease into a single lesions(20.77%),double branch lesions in 35 cases(26.92%),three lesions in 33 cases(25.38%),36 cases(26.93%),(3)without pathological changes of coronary lesions: 86 cases of coronary artery occlusion(65.65%),severe stenosis arteries 40 cases(30.53%),blood clots coronary angiography visible 52 cases(39.69%),serious coronary calcification 18cases(13.74%),stent restenosis 7 cases(5.34%),coronary artery in patients with no reflow or slow reflow 6 cases(4.58%).2.General data :(1)Heart rate of patients in cardiogenic chest pain group was lower than that in non-cardiogenic chest pain group(P < 0.05),while systolic blood pressure,oxygen saturation and body mass index were higher than those in non-cardiogenic chest pain group(P > 0.05).(2)The average heart rate in the two-vessel coronary artery disease group was 77 beats/min,which was lower than 84beats/min in the three-vessel coronary artery disease group(P < 0.05).3.Age and gender:(1)in patients with acute chest pain in general,most young patients,middle-aged patients followed,minor,at least in patients with cardiac chest pain in patients with an age with the same overall,rather than the youth of 53 patients with cardiac chest pain(70.67%)cases,8(10.67%)patients with middle-aged and young patients with 7 cases(9.33%),7 cases of elderly patients(9.33%).(2)In the cardiogenic chest pain group,the onset age of male patients was significantly lower than that of female patients(P < 0.001).The age of patients with cardiogenic chest pain was significantly higher than that of patients without cardiogenic chest pain(P <0.001).The proportion of juvenile patients in the cardiogenic chest pain group was significantly lower than that in the non-cardiogenic chest pain group(P < 0.001),but the proportion of middle-aged patients was higher than that in the non-cardiogenic chest pain group(P < 0.05).(3)There were overall differences among different coronary artery disease groups(P < 0.05),and age was positively correlated with the number of lesions.4.Risk factors :(1)The incidence of cardiogenic chest pain in male patients was significantly higher than that in female patients(P < 0.05);Patients with previous coronary heart disease,hyperlipidemia,hypertension,old myocardial infarction and smoking preference had a higher proportion of cardiogenic chest pain(P < 0.05).Two groups of patients in diabetes and drinking preferences have no obvious difference(P > 0.05),(2)for different coronary lesion group as a whole,in the history of high blood pressure,diabetes,hyperlipidemia,smoking and other risk factors,there is a gap between each integral scale(P < 0.05),while no significant differences in gender,history of drinking(P > 0.05).In terms of multiple comparisons,hypertension,hyperlipidemia,diabetes,smoking preference and other risk factors were positively correlated with the number of coronary artery lesions(P < 0.05),while there was no significant difference between gender and drinking preference groups(P > 0.05).5.Outbreak,time of treatment and mode of admission :(1)The number of patients visiting the hospital was the largest in spring,followed by winter and the least in autumn.The number of visits in the cardiogenic chest pain group was the same as that in the whole group,while the number of visits in the non-cardiogenic chest pain group was the highest in winter,followed by spring and the lowest in autumn.(2)Cardiogenic chest pain group had the largest number of patients in the morning,while non-cardiogenic chest pain group had a more uniform onset time.When the overall peak of patients was 6-24 and the lowest of patients was 0-6,there was no significant difference in the number of patients in each time period of the day between the two groups(P > 0.05).(3)The visiting time of urban patients was significantly lower than that of rural patients(P < 0.05),and the proportion of "120" calling was higher in cardiogenic chest pain group and fatal chest pain group(P < 0.05).6.Chest pain location,nature and accompanying symptoms :(1)cardiogenic chest pain patients chest pain location is located in the anterior heart area,after the sternum,chest pain nature is pressing like,often accompanied by chest holding back,sweating and radiation pain.However,the chest pain site of patients with non-cardiogenic chest pain has no specificity,and its nature is stuffy pain and tearing like,often accompanied by fever,cough and expectoration(P < 0.05).7.Diagnosis and treatment and outcome of:(1)set of cardiac chest pain myocardial enzyme(including creatine kinase,creatine kinase isoenzyme,lactate dehydrogenase),myoglobin,troponin(c Tn I)and b-type natriuretic peptide levels,immediate blood sugar were higher than in non cardiac chest pain patients(P < 0.05),white blood cell count in patients with non cardiac chest pain,calcitonin level higher than that of cardiac chest pain group(P < 0.05).As a whole,there were differences in biochemical data such as creatine kinase,lactate dehydrogenase,myoglobin,troponin,BNP,immediate blood glucose and low density lipoprotein cholesterol among different coronary artery disease groups(P < 0.05).(2)The types of drugs used in patients with acute chest pain were varied,among which the most common drugs were nitrate esters,antiplatelets,lipid-regulating and plaque stabilizing drugs,anticoagulants,antihypertensive drugs,anti-infective drugs,analgesics and psychotropic drugs.(3)The emergency patients were finally transferred to the department of cardiology,surgery,respiratory department and mental health department in order.Among them,2 patients died in the emergency department and 3patients died in the cardiology department.Conclusions:1.In patients with acute chest pain,the proportion of cardiogenic chest pain diseases is relatively high,among which the proportion of coronary heart disease is the highest,followed by respiratory diseases.The high incidence season of chest pain is spring,and due to convenient transportation,urban patients have a shorter time to see a doctor.2.In acute ST-segment elevation myocardial infarction,the anterior wall,inferior wall and inferior posterior wall were the most infarct,and the corresponding lesion vessels were anterior descending branch,right coronary artery and circumferential branch in turn.The number of coronary artery lesions in emergency PCI patients was three vessels,double vessels,single vessels,and no lesions.The conditions of coronary artery lesions included complete occlusion,severe stenosis,thrombus shadow,calcification in stent,no reflux and slow reflux.The number of coronary artery lesions in inpatients was no lesion,double vessel,three vessel and single vessel in turn.3.Heart rate of patients with cardiogenic chest pain was lower than that of patients with non-cardiogenic chest pain,while systolic blood pressure,oxygen saturation and body mass index were higher than those of patients with non-cardiogenic chest pain;Age,male,hypertension,coronary heart disease,diabetes,hyperlipidemia,coronary heart disease,chronic myocardial infarction and so on all is a risk factor for cardiac chest pain disease,cardiac chest pain over the area before the heart and chest pain after the sternum,nature is pressing sex more,often accompanied by chest suppress,sweating,radiation pain,chest pain rather than cardiac chest pain parts have no specificity,nature is torn,stuffy pain more,often accompanied by fever,cough,sputum.4.The myocardial injury markers,B-type natriuretic peptide and immediate blood glucose in patients with cardiogenic chest pain were higher than those in patients with non-cardiogenic chest pain,but the infection indexes were lower than those in patients with non-cardiogenic chest pain.In turn,he was transferred to the department of cardiology,surgery,respiratory department and mental health department for hospitalization.Myocardial injury markers,B-type natriuretic peptide,immediate blood glucose and low density lipoprotein cholesterol in patients with coronary artery disease were higher than those in the non-disease group,and there was a positive correlation between immediate blood glucose and low density lipoprotein cholesterol and the number of lesions.In patients transferred to the Department of Cardiology,adverse cardiovascular events and cardiogenic mortality in patients treated with PCI were lower than those treated with conservative treatment. |
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