Analysis Of Clinical Characteristics And Short-term Prognosis Of Patients With Acute Myocardial Infarction In Emergency Department

Background and ObjectiveAcute myocardial infarction(AMI)is a disease caused by coronary artery stenosis or occlusion due to certain reasons,leading to myocardial ischemic necrosis,and it is the most severe type of coronary heart disease.AMI patients have a sudden onset,poor prognosis,high mortality and morbidity rates,seriously threatening the health of citizens,and bringing a heavy burden to society and families.With the further development of China’s aging society,the number of elderly patients with cardiovascular disease continues to rise;due to social development and changes in people’s lifestyles,traditional cardiovascular risk factors such as smoking,overweight/obesity,diabetes,dyslipidemia,hypertension,etc.are decreasing in age of exposure,and the age of onset of AMI is becoming younger.With the deepening of research,people have found significant differences in clinical characteristics,treatment plans and prognosis of AMI patients in different age groups.Age is an important factor affecting the clinical characteristics,diagnosis and treatment,and prognosis of AMI patients.There have been few previous studies on the clinical characteristics and prognosis factors of AMI patients who visit the emergency department.This article analyzes the clinical characteristics and short-term outcomes of AMI patients who visit the emergency department in different age groups,and explores the independent influencing factors for major adverse cardiac and cerebrovascular events(MACCE)within 30 days after emergency treatment,in order to provide a basis for the clinical diagnosis,treatment and prognosis judgment of emergency AMI patients.Materials and MethodsFrom January 1,2016 to October 30,2017,a total of 706 AMI patients in the emergency department of Qilu Hospital were collected.According to the age criteria defined by the World Health Organization,patients were classified into two groups:the young and middle-aged group(<65 years old)and the elderly group(≥65 years old).The clinical features(socio-demographic characteristics,previous medical history,patient behavior,clinical characteristics at presentation,diagnostic classification,symptoms at onset,examination results,medication,and intervention)and 30-day outcomes of AMI patients in both groups were compared.Furthermore,factors independently associated with the short-term prognosis at day 30(MACCE)were analyzed using a multivariate Logistic regression analysis.MACCE included all-cause death,new-onset or reoccurrence of myocardial infarction,emergency revascularization,cardiogenic shock,cardiac arrest/ventricular fibrillation,and new-onset stroke.The statistical analysis was performed using SAS 9.4 software.Count data were expressed as numbers(percentages)and compared between groups using chi-square tests or Fisher’s exact probability test.Normally distributed continuous data were presented as mean±standard deviation and compared between groups using t-tests,while non-normally distributed data were presented as median and quartiles and compared using Wilcoxon rank-sum tests.Logistic regression analysis was used to identify independent factors associated with 30-day major adverse cardiovascular and cerebrovascular events(MACCE),with odds ratios(ORs)and 95%confidence intervals(CIs)calculated.Variables were selected for multivariate regression analysis based on their clinical significance and univariate Logistic analysis results(P<0.20).Independent factors associated with 3 0-day MACCE in emergency department AMI patients were explored,with P<0.05 indicating statistical significance.Receiver operating characteristic(ROC)curves were plotted based on the results of the multivariate analysis,and the area under the curve(AUC)was used to evaluate the predictive value of the factors.Restricted cubic spline(RCS)analyses were used to explore the relationship between the multivariate variables and 30-day MACCE.Results1.Clinical characteristics:Among the 706 emergency AMI patients included,there were 460 males and 246 females.332 middle-aged and young patients,and 374 elderly patients.1.1 Baseline characteristicsCompared with the young and middle-aged group,the elderly age group had a lower proportion of male patients(53.2%vs.78.6%,P<0.001),lower body mass index(24.9±3.2 kg/m2 vs.25.9±3.3 kg/m2,P<0.001),lower proportion of smokers(13.6%vs.41.3%,P<0.001).The elderly age group had a higher prevalence of diabetes history,hypertension history,myocardial infarction history,heart failure history and stroke history(P<0.05).The young and middle-aged group had a higher probability of early-onset coronary heart disease family history(23.8%vs.9.9%,P<0.001).The average time from symptom onset to arrival at the emergency department and the average time from symptom onset to decision to seek medical care were longer in the elderly age group than in the young and middle-aged group,and the proportion of using home medication was higher(68.2%vs.53.6%,P<0.001)in the elderly age group.The elderly age group had higher systolic blood pressure at the time of the visit(146±30 mmHg vs.142±30 mmHg,P=0.045),higher proportion of abnormal heart auscultation,lung auscultation rales and lower extremity edema(P<0.05);the young and middle-aged group had a higher proportion of ST-elevation myocardial infarction(STEMI)diagnosis(49.7%vs.36.4%,P<0.001).1.2 Incidence characteristics:The elderly group had a high proportion of non inducing factors(63.1%vs 55.4%,P=0.038),and had a greater sense of fatigue during the onset of chest pain(5.1%vs 1.5%,P=0.009),while the young and middle-aged group was more likely to be induced by fatigue(30.1%vs 20.3%,P=0.003).Chest pain often manifested as crushing pain(11.7%vs 5.9%,P=0.006)and colic(5.7%vs 2.7%,P=0.042),with symptoms accompanied by sweating(44.3%vs 36.9%,P=0.046).1.3 Inspection resultsLaboratory examination results:In the elderly group,the glomerular filtration rate(eGFR)value(69.4±24.8 mL/min vs 110.0 ± 32.0 mL/min,P<0.001)and the left ventricular ejection fraction(LVEF)(51%vs 57%,P<0.001)in the elderly group were lower than those in the young and middle-aged group;The first blood glucose(9.1 ± 4.7 mmol/L vs 8.4±3.7 mmol/L,P=0.024),BNP/NT-proBNP(URL multiple)(0.8 vs 0.5,P<0.001),and TnI(URL multiple)(4.0 vs 2.9,P=0.024)were higher than those in the young and middle-aged group.In the elderly group,the proportion of coronary angiography(59.6%vs 83.2%,P<0.001)and the proportion of single vessel stenosis≥50%(LAD,LCX,RCA)(10.4%vs 29.8%,P<0.001)were lower,while the proportion of three vessel stenosis≥50%(54.2%vs 32.7%,P<0.001)was higher.1.4 Drugs and Interventional Therapies:The proportion of ADP receptor antagonists(73.8%vs 87.0%,P<0.001),statins(52.7%vs 63.9%,P=0.003),low molecular weight heparin(65.0%vs 73.8%,P=0.011),and emergency percutaneous coronary intervention(PCI)within 24 hours in the elderly group was lower(45.4%vs 67.1%,P<0.001).2.PrognosisThe incidence of MACCE in the elderly group was 20.1%,while the incidence of MACCE in the young and middle-aged group was 11.4%.There was a statistically significant differences between the two groups(P=0.002).In the elderly group,the highest proportion of all cause deaths was 12.6%;The highest incidence of cardiac arrest/ventricular fibrillation was 6.6%in young and middle-aged patients.The proportion of all cause deaths(12.6%vs 3.3%,P<0.001),new/recurrent myocardial infarction(2.7%vs 0.3%,P=0.011),and cardiogenic shock(10.2%vs 3.3%,P<0.001)were higher in the elderly group.In emergency AMI patients,using whether MACCE events occurred within 30 days of enrollment as the dependent variable,multivariate Logistic regression analysis found that elderly age(OR=1.05),120 visits(OR=2.52),low systolic blood pressure(OR=0.98)at the time of arrival at the emergency,a heart rate of 80 to 100 beats per minute(OR=2.07)at the time of arrival at the emergency,a heart rate of>100 beats per minute(OR=2.39),and high blood glucose for the first time(OR=1.06)A large BNP/NT proBNP(URL multiple)value(OR=1.05)is an independent risk factor for 30-day MACCE in emergency AMI patients(P<0.05).The area under the working characteristic curve for the entire population,the elderly group,and the young and middle-aged group were 0.7753,0.7568,and 0.7802,respectively.RCS analysis found that there was a linear relationship between systolic blood pressure,first blood glucose,NT-proBNP,and 30-day MACCE,while a U-shaped relationship between heart rate and 30-day MACCE.Conclusions1.The elderly patients with emergency AMI have many complications and poor prognosis;more prone to heart failure;the proportion of patients receiving coronary intervention treatment is low;coronary artery lesions are complex,with a high proportion of three branch lesions.2.Elderly age,120 visits,heart rate>80 beats/min when arriving at the emergency department,low systolic blood pressure when arriving at the emergency department,high blood glucose for the first time,and high BNP/NT-proBNP(URL multiple)values are independent risk factors that affect the occurrence of 30-day MACCE in patients with emergency AMI.3.The incidence of MACCE increased with the increase of first blood glucose and NT-proBNP value,and decreased with the increase of systolic blood pressure;There is a U-shaped relationship between heart rate and 30-day MACCE,and the incidence of MACCE first decreases and then increases with the increase of heart rate.