| Objective:To investigate the trend in the changes of ACS hospitalized patient in Tianjin;to find out the trend in the use of cardiovascular agents and evaluated its rationality among inpatients in our hospital over past 20 years;to provide continuous epidemiological information for normative treatment of Acute Coronary Syndrome; to provide objective evidence for reasonable allocation of medical and health resources.Methods:The retrospective survey was carried out based on the data of ACS inpatients of 5 different periods:1986,1991,1996,2001 and 2006 in our hospital. Altogether there were 1780 cases included.Descriptive statistics were provided for all patients meeting the inclusion criteria.Trend of percentage change was compared using correlation.Cardiovascular agent consumption status was analyzed by calculating utilization rates.Results:(1)The percentage of ACS patients among hospitalized patients in cardiology department was significantly increased during the last 5 periods of time, being 26.7%,33.5%,33.7%,34.2%and 35.0%respectively(P=0.012),reach the peak in 2006;(2)The average age of in hospitalized patients increased from 59.67±9.92 in 1986 to 65.13±11.77 in 2006(P＜0.001).The average age of the STEMI has the trend of increasing,but without statistic significance(P=0.425); (3)Mean in hospital days dropped from 29.02±25.44 days in 1986 to 8.43±5.24 days in 2006(P＜0.001);(4)The average age of in hospitalized male ACS patients is less than the female patients:The average age of the male patients is 62.03±11.64,the average age of the female patients is 66.80±9.94(P＜0.001);(5)In-hospital mortality of ACS patients decreased significantly form 11.2%in the year 1986 to 3.6%in 2006(P＜0.001).Especially the STEMI,dropped from 20.3%in 1986 to 8.5%in 2006(P＜0.001);(6)The percentage of ACS patients with history of hypertension, diabetes mellitus,chronic myocardial infarction,stroke or smoking on admission increased significantly.Especially with diabetes mellitus,hypertension and smoking, increased to 11.73 times,7.22 times and 9.55 times in 2006 compared with the year 1986;(7)The utilization rate of antiplatelet,anticoagulant,βadrenergic receptor blocker,ARB and stains in ACS patients increased significantly.8.3%,2.2%,0, 38.8%respectively in 1986 to 94%,84%,15.4%,65.2%and 83%in 2006.ACE inhibitor increased from 2.2%in 1986 to 91.5%in 1996 then slightly decreased to 71.3%in 2006;(8)The percentage of reperfusion therapy adopted in STEMI patients increased significantly.The percentage of patients who adopted the conservative therapy was 100%,54.3%,48.3%,32.9%and 36.0%respectively(P＜0.001),the percentage of patients who adopted the thrombolytic therapy was 0,45.7%,51.7%, 36.7%and 10.2%respectively,the percentage of patients of patients who adopted the PCI therapy was 0,0,0,30.4%,53.8%(p＜0.001);(9)The inhospital mortality rate was decreased in these patients who adopted the reperfusion therapy:the inhospital mortality rate of the STEMI patients who adopted the PCI therap was 5.3%, the mortality rate of the STEMI patients who adopted the thrombolytic therapy was 8.9%,and the mortality rate of the STEMI patients who adopted the conservative therapy was 16.3%.Also,the mortality rate of the STEMI patients who adopted the conservative therapy was 20.3%,21.7%,17.5%,14.1%and 16.2%,without statistic significance(P=0.229);(10)The in hospital mortality rate of the patients who have the history of smoking was significantly less than the patients who had no history of smoking(UAP,NSTEMI and STEMI).Especially the STEMI patients,the mortality rate of the STEMI patients who had a history of smoking was 9.3%,the mortality rate of the STEMI patients who had no history of smoking was 27.3%(P＜0.001).But at the same time,the patients who had history of smoking also adopted more reperfusion therapy.The mortality rate of the STEMI patients who have the history of smoking after standardized the reperfusion rate is 7.28%while the mortality rate of the patients who have no history of smoking is 17.3%which is also having significant statistic difference.Conclusions:(1)The percentage of ACS patients among hospitalized patients in cardiology department increased significantly.The average age of ACS patients increased in the last 20 years.The inhospital days have shortened during last 20 years.(2)The number of ACS patients with history of hypertension,diabetes mellitus, chronic myocardial infarction,stroke or smoking on admission increased significantly.(3)The utilization rates of many cardiovascular agents have changed significantly,especially the anti-platelet,anticongulant,stains.The use of thrombolytic therapy has the trend increase first and decline.The use of PCI increase rapidly in the last two periods.(4)The in hospital mortality rate of patients with the history of smoking may less than the patients without the history of smoking.(5)The decline of the in hospital mortality rate is mainly due to the reperfusion therapy other than the changes of the drug therapy.
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