Cross-sectional Survey Of 5539 Patients With Acute Myocardial Infarction And Construction Of Risk Prediction Model

Background and ObjectiveThe prevalence rate of cardiovascular diseases in China is still at a stage of continuous increase.China Cardiovascular Disease Report 2018 points out that it is estimated that there are 290 million patients with cardiovascular diseases,including 11 million patients with coronary heart disease.The "2017 Global Burden of Disease System Analysis" pointed out that the disability-adjusted life-years of ischemic heart disease reached 170 million years in 2017.In the United States,about every 40 seconds,an American suffers from an acute myocardial infarction.Throughout Europe,coronary heart disease can cause 1.8 million deaths every year.At the same time,the death rate of cardiovascular diseases in China continues to occupy the first place,higher than that of tumors and other diseases.Acute myocardial infarction(AMI)is the most serious manifestation of coronary heart disease,while the incidence and mortality of AMI in rural areas have exceeded those in cities.There are many risk factors that affect the prognosis of AMI.In recent years,the United States has achieved initial results in the control of risk factors such as smoking,insufficient physical activity,obesity,and hypertension,but it has not yet reached the ideal state;a European study showed almost all the risks factors such as high blood pressure,diabetes,obesity,high-salt and high-sugar diet,etc.,have an upward trend in recent years,and it was the upward trend of these risk factors that hinder the further reduction of the mortality rate for coronary heart disease in Europe.In recent years,the related risk factors of AMI have not been effectively controlled,and the treatment level varies greatly between regions and between urban and rural areas.There were few researches on risk factors of AMI in rural areas,and China has a vast territory.Residents in different areas have different living habits,economic basis,cognition of diseases,and treatment ability of local hospitals.In recent years,with the development of society,traditional risk factors,such as hyperlipidemia,smoking and obesity,have been proved to be protective factors for AMI patients during hospitalization by the recent Multicenter China Acute Myocardial Infarction Registration Study(CAMI Study).To sum up,it is very necessary to construct an AMI risk assessment model with regional characteristics,which can enable clinicians to identify high-risk patients at an early stage and select the best diagnosis and treatment plan.Linyi City is the largest and most populous city in Shandong Province,with a resident population of about 2.6 million at the end of 2019.Linyi People's Hospital is the largest first-class hospital in the area,which is representative of the prevalence of various diseases(including AMI)in the region.This study takes AMI inpatients from Linyi People's Hospital as the research object,and expects to accomplish the following three goals:1.Investigation of the diagnosis and treatment status of single-center AMI,observing its clinical characteristics,treatment measures,length of stay and prognosis;2.Determine the impact Related risk factors for the short-term mortality of AMI patients;3.Establish a simple and effective risk prediction model to provide reference for clinical decision-making.The rural population in this study accounts for about 77.9%of the patients.Therefore,the results of this study can make up for the lack of research and research in rural areas in my country.It is crucial for reducing the mortality of coronary heart disease in my country and making the inflection point appear early.This study found independent risk factors related to short-term death of AMI patients,and these independent risk factors were used to construct a risk assessment model,which could assist clinicians to identify high-risk patients as early as possible and give differentiated treatment.At the same time,this research also clarified the advantages and disadvantages of AMI diagnosis and treatment in our hospital,provided direction for the development of the cardiology department of our hospital,and provided evidence-based medicine for more and larger studies in the future.Chapter 1 Clinical characteristics and change trend analysis of rural patients with acute myocardial infarctionObjective:This study took in-patients in rural area as research objects,in order to investigate the clinical characteristics and their change trend of rural patients.Methods:Rural and urban patients with acute myocardial infarction(AMI)hospitalized in Linyi People's Hospital from 2013 to 2017 were included in the study.The general situation,relevant medical history,laboratory test results,in-hospital treatment and discharge conditions of the patients were collected.Furthermore,the baseline characteristics and the change trend of hospitalization of rural patients in recent years were further analyzed longitudinally.Results:1.Compared with urban patients,the proportion of Killip II-IV patients in rural patients is higher,and the proportion of patients receiving PCI treatment is lower.There was no statistical difference in short-term mortality between the two groups.2.from 2013 to 2017,the age of patients in the rural group gradually increased,and the proportion of NSTEMI significantly increased.The proportion of patients with KILL IP class ?-? and the proportion of patients with AMI complicated with cerebral infarction,hypertension,diabetes,arrhythmia and previous myocardial infarction had an upward trend.3.From 2013 to 2017,the short-term mortality rate of patients in rural group(NSTEMI patients)gradually increased.However,the proportion of these patients receiving PCI,aspirin,clopidogrel and low molecular weight heparin gradually decreased.4.Compared with STEMI patients,the short-term mortality rate of NSTEMI patients increased by 20.6%.Conclusion:1.Compared with the urban group,the AMI patients in rural group had a higher severity of the disease and a lower proportion of PCI patients.There was no statistical difference in short-term mortality between the two groups.2.From 2013-2017,the complications of AMI patients in rural group have increased gradually in recent years,PCI and drug treatment were insufficient,and the short-term mortality of NSTEMI patients had an upward trend,which should be paid more attention.Chapter 2 Risk factors related analysis for death of patients with acute myocardial infarctionObjective:We aimed to observe the clinical characteristics of died patients with acute myocardial infarction(AMI)in this study,and to analyze the risk factors of short-term death.Methods:A retrospective analysis of 6303 patients with AMI admitted to Linyi People's Hospital from January 2013 to December 2017 was conducted.The general conditions,related medical history,laboratory results,hospital treatment and discharge were collected.According to whether they died within 6 months,they were divided into death group and survival group,clinical characteristics were observed,and COX regression analysis was used to summarize the risk factors related to death.Results:1.(1)In death group,the average age and the number of male patients of the were larger;the proportion of patients with extensive anterior myocardial infarction,and hospitalized ventricular arrhythmia was greater;but the proportion of patients treated with PCI was smaller.(2)The patients of death group had higher rate of heart rate,lower systolic blood pressure and diastolic blood pressure,and more patients with Killip II-IV classification.(3)White blood cell(WBC)and blood glucose,the level of creatinine in the death group was higher than those of the survival group.(4)The patients in the death group had more comorbidities(including Cerebral infarction,arrhythmia,Diabetes,heart failure),higher pulmonary systolic pressure,larger left anteroposterior diameter,and lower LVEF.2.COX regression analysis showed that the following six indicators were independent factors influencing short-term death in patients with AMI:age,PCI,Killip ? classification,blood glucose,serum creatinine level and PASP.Conclusion:Age,PCI,Killip ? classification,blood glucose,serum creatinine and PASP were independent risk factors related to short-term death of AMI patients.Chapter 3 Effect of different pulmonary artery systolic pressure on Short-term prognosis in patients with acute myocardial infarctionObjective:Pulmonary artery systolic pressure(PASP)may increase because of cardiac alterations that result in increased filling pressures after acute myocardial infarction(AMI).This study was conducted to determine the effect of PASP on the short-term prognosis of patients with AMI.Methods:After excluding previous diseases that can affect PASP,we studied 5,401 patients with AMI.PASP was estimated using transthoracic echocardiography within 48 hours after administration of patients.All patients were divided into three groups according to their PASP levels:Group A(PASP?30mmHg),Group B(30<PASP?50mmHg)and Group C(PASP>50mmHg)respectively.COX regression analysis was used to evaluate the 6-month mortality-related risk factors,and risk curves of the different groups were also mapped.Results:1.From group A to group C,the age of patients gradually increased;the proportion of men and STEMI patients gradually decreased;the proportion of Killip I patients gradually decreased,while the proportion of Killip II-IV patients gradually increased;GRACE score,blood glucose,urea nitrogen,and creatinine levels Gradually increased,the LVEF value gradually decreased;the proportion of PCI treatment gradually decreased;the short-term mortality rate gradually increased.2.COX regression analysis showed that PASP level was an independent risk factor for short-term death of AMI patients.Compared with group A,the risk of short-term death for group B increased by 38.7%;while the risk of short-term death for group C increased by 55.9%.3.PASP was positively correlated with GRACE score.The PASP levels of KilliP?-? patients were higher than those of KilliP ?-? patients.4.In the ROC curve of PASP predicting short-term death,the area under the curve is 0.621(95%confidence interval:0.601-0.641;P<0.001).The Cut-off value of PASP was 30mmHg(sensitivity 59.8%,specificity 62.5%).Conclusion:PASP within 48 hours after admission of AMI patients had a significant correlation with short-term death,that was,the short-term mortality risk of AMI patients rised with the increase of PASP.Chapter 4 Construction of mortality risk prediction model for patients with acute myocardial infarctionObjective:Applying the independent risk factors obtained from multivariate COX regression analysis in this study,we aimed to explore a new risk prediction model that can predict the short-term mortality of AMI patients.Methods:Patients with AMI hospitalized in Linyi People's Hospital from 2013 to 2017 were included as the derivation cohort.AMI patients admitted from January to December 2018 were included as the validation cohort.The general situation of patients,hospital treatment and discharge status were collected.In the derivation cohort,the hazard ratio(HR^)value of independent risk factors were applied to explore the calculation method of the risk prediction model(we named it "optimized score"),which was verified in the validation cohort.The general linear model is used to construct a risk prediction model.Then AMI patients were stratified according to the optimized score,and the ability of the optimized score method to distinguish the severity of the disease was evaluated.Results:1.Six independent risk factors,including age,blood sugar,creatinine,pulmonary artery systolic pressure(PASP),Killip classification and PCI treatment or not,were applied to obtain this new risk prediction model that can predict short-term death.2.In the derivation cohort,the area under the curve(AUC value)predicted by the optimization scoring method for short-term death of AMI patients was 0.816(95%CI:0.779-0.844),and in the validation cohort was 0.811(95%CI:0.776-0.846),both of which were better than GRACE score(AUC=0.76 in the derivation cohort and AUC=0.75 in the validation cohort).3.According to the optimization score,patients were divided into four groups:low risk group(optimization score:<84),moderate risk group(optimization score:84-110),high risk group(optimization score:111-152),and extremely high risk group(optimized score range:>152).There were significant differences in short-term mortality risk among the four risk groups(P<0.05).Conclusion:The multi-index optimization scoring method established in this study can quantitatively evaluate the condition of patients with AMI and predict short-term death,and has important reference value for the early risk stratification of AMI patients and the selection of optimal diagnosis and treatment strategies.