The Analysis Of The Characteristics Of Acute Coronary Syndrome And The Study Of The Treatment Strategy

Part 1The prevalence of cardiovascular disease(Cardiovascular disease)in China has been rising,and the patient is becoming more younger than before.Cardiovascular disease has been accounted for the largest number of diseases in the country in 2013.And studies showed that there were 2 deaths caused by cardiovascular disease in each of 5 in-patient deaths.Acute coronary syndrome(Acute Coronary Syndrome,ACS)is a group of clinical syndromes of unstable atherosclerotic plaque rupture,thrombosis,and acute myocardial ischemia,ACS has a rapid onset,high risk and high mortality.The combination of cardiovascular disease and other systemic diseases will further aggravate the condition and cause more medical expenses.To deal with the public health problems and social burden caused by cardiovascular disease,it is a long time need to actively respond to the situation,the key is to identify the characteristics of the disease,to find the starting point for prevention and treatment.With the Internet,cloud computing technology and the rapid rise of popularity,were analyzed by using medical records and other data,can assist in clinical decision making,and promote the development of evidence-based medicine,and continuously improvement medical management and to boost the best practice of quality control.For the individual,through the accurate analysis of the patient's medical treatment and cost data,can be targeted for the implementation of chronic disease management,to provide better personalized medical programs,to avoid excessive medical treatment.Study by WHO 2014-2015 project for continuous improvement of medical service monitoring system,which include 3342401 cases of patients with cardiovascular disease(age>=18)in year 2014,from hospital quality monitoring system.Risk groups,patient characteristics,comorbidities,treatment,mortality,readmission rate,remote medical treatment as the main dimensions.According to gender,age,season,urban-rural divide in each dimension.Analyzed all three subtypes of ACS:unstable angina,non ST elevation myocardial infarction,and ST elevation myocardial infarction.Selected hypertension,dyslipidemia,diabetes and abnormal glucose metabolism in patients with chronic kidney disease as 4 kinds of risk of ACS.The results shows that:the morbidity rate in the 4 high risk patient was higher than the average level(2.7%),dyslipidemia 9.6%,hypertension 7.5%,diabetes/abnormal glucose metabolism 6.3%,all of these were significantly higher than the average level.The highest incidence of ACS subtype was unstable angina,followed by ST-elevation myocardial infarction,then non ST-elevation myocardial infarction.The gender characteristics of ACS patients showed that the incidence rate of male(59.9%)was higher than that of female.The incidence rate of ST-elevation myocardial infarction was higher in the male group aged 35-44(9.2%).The main complications of ACS were hypertension,dyslipidemia,diabetes mellitus/metabolic abnormalities,chronic kidney disease,cerebrovascular disease,diabetes mellitus/glucose metabolism abnormalities of up to 55.8%.28.5%in the treatment of ACS patients received revascularization treatment by interventional treatment of all patients accounted for 25.8%,2.7%by surgery of all the patients.Male accepted revascularization(34%)more than female(20.6%).The in-hospital mortality rate was 2.1%in patients with ACS,ST-elevation myocardial infarction mortality rate was higher than that of the control group,and the mortality rate was less than 0.4%in patients with unstable angina pectoris.ACS patients with chronic kidney disease accounted for the highest proportion of 6.1%,followed by high to low are associated with cerebrovascular disease,hypertension,diabetes/glucose metabolism abnormalities,dyslipidemia.The mortality rate of revascularization(0.7%)was significantly lower than that of patients without revascularization(2.6%).From the age group,the mortality rate of patients with acute coronary syndrome in 75-84 years old group was the highest(3.9%).The mortality of patients with acute coronary syndrome was significantly different in different departments of first medical contact.As all in-hospital death of ACS patients,classify with the name of first diagnosis,the most was cardiovascular disease(37.7%),second was respiratory disease(17%),the third was cerebrovascular disease(9.2%).The proportion of ACS re-hospitalization was 5.8%,and the re-hospitalization interval was the most common in 1-15 days,accounting for 26%.From the remote medical treatment flow analysis,Beijing receive more nonlocal patients than other provinces.Conclusion:Metabolic syndrome is a risk factor for ACS,so the prevention and control of metabolic syndrome is an important way to reduce the mortality of ACS.It is of great significance to solve the problem of different death rates in different departments in hospital,so it is necessary to further standardize the emergency treatment of acute myocardial infarction,and gradually narrow the differences between clinical practice and guidelines.Revascularization is an important method to improve the prognosis of patients,it is necessary to further popularize the use of revascularization in practice.There was a significant trend in the treatment of ACS in remote medical treatment,which indicated that the distribution of cardiovascular specialist resources was equal among areas.For FMC time is important in ACS treatment,it was necessary to improve the allocation of cardiovascular specialist resources.Part 2Acute myocardial infarction(AMI)is due to acute coronary artery stenosis or occlusion,the blood supply continued to decrease or termination caused by serious myocardial ischemia and necrosis,often causing arrhythmia and cardiac arrest,severe cases can cause sudden death.With the development of the medical science,the clinical diagnosis and treatment technology of AMI has been improved a lot.Early reperfusion therapy such as percutaneous coronary intervention(PCI),could make the blocked coronary vascular recanalization,restoration of myocardial blood supply,reduce infarct size and improve the prognosis.It is an important innovation for the treatment of AMI.Evidence based medicine has also confirmed a variety of drugs that are effective against AMI,including aspirin,clopidogrel,beta blockers,angiotensin converting enzyme inhibitors/angiotensin receptor blockers(ACEI/ARB),etc..Summary and analysis of the status quo of AMI diagnosis and treatment,help to assess the status of AMI treatment,and to find the measure of improvement,to standardize AMI treatment.As the prognosis of AMI depend on FMC time,standard procedure,severity of disease and different treatment methods,it is necessary to follow the guideline of AMI to get better medical quality.The age and distribution of patients,duration of onset,treatment options,and outcomes in patients with MI,including ST-segment elevation myocardial infarction(STEMI)and non-ST segment elevation myocardial infarction(NSTEMI),who were admitted in the general hospitals in 2011 and 2013,were retrospectively analyzed according to the data reported to the Single Disease Quality Control Information System(SDQCIS).All of the data received logical test,integrity check out,and personal information deleted.Finally screened in 2011 2986 cases;4305 cases in 2013.Logistic regression analysis was used to analyze the effect of each process index on the diagnosis and treatment.From the onset characteristics,the high incidence age of patients with AMI was 50?79 years.STEMI compared with NSTEMI,the average age of onset was 3 years old.The most common sites of lesion were the left anterior descending coronary artery,right coronary artery,circumflex artery and left main artery.Compared with NSTEMI,STEMI was mainly located in the anterior wall and inferior wall.Among different treatments,PCI was better than emergency thrombolytic therapy,and drug treatment.Of all the patients with more obvious symptoms,there were 76.29%patients accepted implementation of emergency PCI.Incompared with 2013 and 2011,the FMC time(3.5h vs.3.26h),average time of emergency department to PCI(1.42h vs.1.5h),PCI operation time(1h vs.lh),made no significant difference.Both in 2013 and 201 l,the most popular implementation was PCI,the least was emergency thrombolysis.According to the 2012 single disease quality control standard,the FMC time had no significant difference in 2013 and 2011,the remaining items got better in 2013 completed with 2011(p<0.05).Conclusion:acute myocardial infarction is mostly from the left anterior descending coronary artery disease,which is characterized by high ST segment elevation and high incidence of vascular occlusion,and emergency PCI treatment is the best way to improve the symptoms.Non ST segment elevation myocardial infarction is not easy to determine the location of the initial diagnosis.In recent years,the efficiency of medical treatment has been improved,but the overall rate of completion of the quality control index is not satisfactory.Part 3Bivalirudin is an alternative to heparin in patients undergoing percutaneous coronary intervention(PCI).The goal of this meta-analysis was to assess the safety and efficacy of Bivalirudin versus heparinin patients with ST-elevation myocardial infarction(STEMI).We searched PubMed,EMBASE,Cochrane Library and the CNKI for randomized trials that assessed bivalirudin versus heparin in patients planned for PCI.The data was processed by using softwares of Stata.The primary endpoint was incidence of major adverse cardiac events(MACE)up to 30 days.Secondary efficacy endpoints weredeath,myocardial infarction,ischaemia-driven revascularisation,and stroke.Theprimary safety endpointwas major bleeding up to 30 days.There are four RCTS included involving 9537 patients,of whom 273 experienced MACE and 282 patients had a majors bleeding.The MACEoccurred in 5.96%with bivalirudin and 5.53%with heparin.No difference in the risk of MACK with the two groups(risk ratio 1.08,95%CI 0.92-1.26;p=0.363).The second outcome deathoccurred in 2.61%with bivalirudinand 3.07%with heparin(risk ratio 0.85,95%CI 0.68-1.07;p=0.171),myocardial infarctionoccurred in1.76%with bivalirudin and 1.24%with heparin(risk ratio 1.43,95%CI 1.04-1.96;p=0.029).Bivalirudinlower the risk of major bleeding and occurred in 3.04%with bivalirudinand 5.29%with heparin(risk ratio 0.54,95%CI 0.34-0.85;p=0.008).The stent thrombosis occurredin 1.82%with bivalirudin and 0.96%with heparin,which was primarily due to an increase in acute cases in ST-segment elevationmyocardial infarction(3.52,2.02-6.10;p<0 · 0001),but no difference in subacute stent thrombosis(risk ratio 0.86,95%CI 0.54-1.37;p=0.517).The risk of stent thrombosis is lower in predominantly planned in theheparin arm(risk ratio 1.70,95%CI1.10-2.62;p=0.016).Conclusion:For patients planned PCI,compared with heparin-based regimen,we were unable to demonstrate significant difference in MACE?death and stentthrombosis.The bivalirudin-based regimen decreases the risk of major bleeding,but increases the risk of myocardial infarction and acute stentthrombosis.In predominantly planned in theheparin arm,the risk of stent thrombosis higher the bivalirudin-based regimen.