Outcome And Influential Factors In Hospitalized Patients With Acute Myocardial Infarction

Objective: To analyze the mortality, the main cause of death,and death-related factors in patients with acute myocardial infarction(AMI) during hospitalization in our hospital, in recent years.Methods: To summarize the clinical data of patients with AMI hospitalized in the Department of Cardiology of our hospital from January 2005 to December 2010, and to analyze the main causes of death, and explore the death-related factors by comparing with the survival of patients.Results: There were total 417 patients for AMI hospitalized in our hospital during the past 6 years. 114 patients (28.1%) died, and 11 patients gave up treatment and discharged. Among them, 28 cases died due to cardiac rupture, 42 cases died because of arrhythmia, and 33 cases because of heart failure/pump failure, and 11 cases with uncertain or non-cardiac causes. Compared with the survivors, dead patients were significantly older, more female, mostly inferior STEMI with poor cardiac function, prone to all kinds of arrhythmia, lower blood pressure, although the treatment in a timely manner, mostly still more died within a week. The proportion of patients with diabetes mellitus, hypertension, old myocardial infarction, stroke, and lung infection were higher; They usually had the liver and kidney dysfunction, and increased leukocyte on admission;There were the lower proportion in dead patients with primary PCI and nitrates, ACEI,βblockers, lipid lowering drugs and antithrombotic drugs, while a higher proportion with the use of digitalis, diuretics and temporary pacemaker.Conclusions: Patients'mortality with AMI was 28.1% during hospitalization in our hospital in the past 6 years, significantly higher than the level reported in the literaturer. Cardiac rupture, arrhythmia and heart failure/pump failure were the main cause of death. These characteristic(solder women,inferior STEMI,heart failure, low blood pressure, diabetes, hypertension, old myocardial infarction, stroke and lung infection, liver, renal function markedly abnormal on admission)suggest poor prognosis, and are the possible risk factors of death. The following treatments (the primary PCI and the use of nitric acid lipids, ACEI,βblockers, lipid lowering drugs, antithrombotic drugs) may improve prognosis of patients with AMI, and reduce the mortality. Objective: To investigate the incidence and cause of cardiac rupture in hospitalized patients with AMI.Methods: To summarize the clinical data of hospitalized patients with cardiac rupture after AMI in the Department of Cardiology of our hospital from January 2005 to December 2010, and to analyze the main causes of cardiac rupture.Results: There were total 417 patients with AMI hospitalized in our hospital during the past 6 years, of which 28 cases died due to cardiac rupture including 26 patients with free wall rupture and 2 patients with ventricular septal rupture. Cardiac rupture always occurred between 3 to 7 days after infarction onset. The mortality in these patients is markedly higher than those without cardiac rupture (100%vs. 22.8%,p<0.005). Compared with the cases without rupture, patients with cardiac rupture were significantly older (67±11 year vs. 62±13 year, p<0.05) in addition to more female involved (64% vs. 21%,P<0.005). Moreover, patiens with cardiac rupture were more liable to develop inferior STEMI with poor cardiac function, all kinds of atrial arrhythmia (93%vs.73%,p<0.05), and symptoms of nausea and vomiting (32% vs. 17%,P<0.05;18% vs. 3% , P<0.005) accomplished AMI(32% vs. 17%,P<0.05;18% vs. 3% , P<0.005). Furthermore, these patients were characterized by high proportion of thrombolysis (32% vs. 15%,P<0.05), and low use of ACEI and beta blocker(36% vs. 65% for ACEI,P<0.005;39% vs. 62% for beta blocker,P<0.05). There had no significant difference in primary PCI, bigeminy, trigeminy and quadruple-antithrombotic between patients with or without cardiac rupture.Conclusion: Cases with cardiac rupture after AMI are not uncommon (6.7%), most of which are free wall rupture with extremely high mortality (100%). Rupture always occurred 3 to 7 days after infarction. Older women and patients with STEMI exhibited higher incidence. Symptoms including nausea, vomiting, inappropriate thrombolysis, may increase the risk of cardiac rupture. Conversely, early use of ACEI and beta blocker may reduce the risk. Enhanced antithrombotic therapy does not related to the risk of cardiac rupture.