Retrospective Study Of Acute Myocardial Infarction During Hospitalization And Follow-up

We retrospective analyzed all the clinical data of1319consecutive patients fromour department with AMI during hospitalization and5-year follow-up betweenDecember2006and January2012.The aim of this study was to approach thein-hospital and5-year mortality in patients who suffered AMI and analyzeindependent predictors of death,so we could not only improve the treatment,emergency measures but also give advice to patients with AMI,and then we coulddecrease the in-hospital and long-term mortality in all patients with AMI.Results1.Retrospective analysis of the in-hospital clinical data from patients with AMI:(1)In the last5years,the in-hospital mortality rate of patients with AMI was7.4%inour hospital. The female patients were significant higher than the male patients inin-hospital mortality rate(13.2%vs5.7%,P=0.000).The standard medical therapygroup was significant higher than PCI group in in-hospital mortality rate(31.4%vs3.4%,P=0.000),the primary PCI was significant higher than delayed PCI group inin-hospital mortality(5.0%vs2.2%,P=0.008).The incidence rate of cardiogenicshock in patients with AMI was10.6%;The in-hospital mortality rate was47.1%inthose patients, especially in standard medical therapy group,the in-hospital mortalityrate was80.4%,while in primary and delayed PCI group,the in-hospital mortality ratedecreased to34.5%and17.6%.(2)The in-hospital mortality of patients with AMI were positive correlated with age,urea acid,blood urea nitrogen,creatinine,cystatin C,glucose,white blood cell,the peakconcentration of troponin,BNP,complicated with arrhythmia(III°AVB,sinus arrest,ventricular fibrillation,atrial fibrillation),cardiogenic shock,Killip3-4group,placement of IABP,medicine only;and were negative correlated with red blood cell,hemoglobin, hematocrit,receiving no drugs(ACEI/ARB,β-blocker,statins).In-hospitalmortality of patients with AMI underwent PCI were positive correlated withcreatinine and troponin after PCI and complicated with radiographic contrastnephropathy.(3)Logistic regression analysis showed that the high level of age,blood urea nitrogen,glucose,the peak concentration of troponin,BNP,complicated with arrhythmia(sinus arrest,ventricular fibrillation),cardiogenic shock,Killip3-4group,medicine only,placement of IABP,receiving no drugs(ACEI/ARB,statins) were associated withindependent risk factors of in-hospital mortality of patients with AMI;radiographiccontrast nephropathy was an independent risk factor of in-hospital mortality ofpatients with AMI underwent PCI.The sensitivity and specificity predictedin-hospital mortality were53.5%,84.7%when aged≥67.1y;the sensitivity andspecificity predicted in-hospital mortality were81.2%,60.0%when the level ofblood urea nitrogen≥7.2mmol/L;the sensitivity and specificity predicted in-hospitalmortality were68.1%,57.1%when the level of glucose≥8.1mmol/L;the sensitivityand specificity predicted in-hospital mortality were52.6%,65.2%when the peakconcentration of troponin≥6.98ng/ml;the sensitivity and specificity predictedin-hospital mortality were80.3%,64.4%when the level of BNP≥691pg/ml.2.Retrospective analysis of the follow clinical data from patients with AMI:(1)Retrospective analysis of death in long-term:①I n the last5years,the5-year total and follow-up mortality rate of patients withAMI were18.2%,8.0%in our hospital.The female patients were significant higherthan the male patients in in-hospital and follow-up mortality rate(27.9%vs15.0%,P=0.000),(10.9%vs7.2%,P=0.106).There were significant difference in totaland follow-up mortality rate between standard medical therapy group and PCIgroup(61.9%vs10.4%,P=0.000),(31.1%vs5.6%,P=0.000).The total and follow-upmortality rate in primary PCI group were10.6%,4.2%;the total and follow-upmortality rate in delayed PCI group were10.1%,6.8%.The total mortality rate was59.7%in patients with AMI presenting with cardiogenic shock,especially in standardmedical therapy group,it could reach89.6%,but it decreased to40.8%,40.7%inprimary and delayed PCI group;primary PCI group had a significant lower follow-upmortality rate than standard medical therapy group and delayed PCI group(3.3%vs28.6%23.8%,P=0.000).②T hefollow-up mortality of patients with AMI were positive correlated with thelevel of age,urea acid,blood urea nitrogen,creatinine,cystatin C,BNP,LVEDd,complicated with Killip3-4group,medicine only;and were negative correlated withthe level of red blood cell,hemoglobin,hematocrit,EF and receiving drugs(β-blocker,statins).Otherwise, follow-up mortality of patients with AMI underwent PCI were positive correlated with the level of creatinine,troponin after PCI,and were negativecorrelated with the level of hemoglobin after PCI,the inner diameter of stent.Cox regression analysis showed that the high level of age,blood urea nitrogen,creatinine,hemoglobin and BNP, complicated with Killip3-4group,medicine only,receiving no drugs(β-blocker,statins) were associated with independent risk factorsof follow-up mortality of patients with AMI.The sensitivity and specificity predictedfollow-up mortality were76.6%,63.4%when aged≥76y;the sensitivity andspecificity predicted follow-up mortality were84.5%,53.9%when blood ureanitrogen≥7.2mmol/L;the sensitivity and specificity predicted follow-up mortalitywere80.9%,51.6%when creatinine≥96umol/L;the sensitivity and specificitypredicted follow-up mortality were69.6%,62.3%when hemoglobin≤129g/L;thesensitivity and specificity predicted follow-up mortality were83.5%,59.5%whenBNP≥691pg/ml.(2)Cardiac function of patients with AMI in follow-up was positively correlated withSTEMI,EF at admission,receiving drugs(ACEI/ARB,β-blocker)in the following;andwere negatively correlated with the level of troponin,the peak concentration oftroponin,BNP,LVESd,LVEDd,complicated with cardiogenic shock, Killip3-4groupin hospital.(3)Reperfusion therapy of patients with AMI in follow-up was positively correlatedwith the level of low density lipoprotein,red blood cell,hemoglobin,hematokrit atadmission,Gensini score,the severity of coronary artery stenosis,extent of coronaryartery stenosis; and were negatively correlated with the level of age,creatinine,cystatin C,BNP,complicated with cardiogenic shock,Killip3-4group.ConclusionThe standard medical therapy group are significant higher than the PCI group intotal,in-hospital and follow-up mortality rate.The primary PCI group is higher thanthe delayed PCI group in in-hospital mortality rate,but is lower in follow-upmortality rate.The leading cause of death is cardiogenic shock.PCI can decreasein-hospital and follow-up mortality rate of patients with AMI presenting withcardiogenic shock.It shows treating infarction related artery quickly can decrease thein-hospital and follow-up mortality rate of patient with AMI presenting withcardiogenic shock.The patients who receive medicine only are significant higher in total,in-hospital and follow-up mortality rate than the patients underwent PCI.Itshows that PCI is the best treatment for patients with AMI.The female patients are significant higher in total,in-hospital and follow-upmortality rate than the male.The female always have an older age,severe coronarystenosis,more complications and multiple organ failure,it shows that the female treatlate.So,we should do more to raise public awareness,especially in female of AMI tocontrol the risk factors,diagnose earlier,treat earlier.The independent risk factors of patients with AMI in in-hospital and follow-updeath include:the high level of age,blood urea nitrogen,BNP,Killip3-4group,medicine only,receiving no statins;the independent risk factors of in-hospital deathinclude:the high level of glucose,the peak concentration of troponin,complicatedwith arrhythmia(sinus arrest,ventricular fibrillation),cardiogenic shock,placement ofIABP,receiving no ACEI/ARB;the independent risk factors of follow-up deathinclude:the level of creatinine,hemoglobin,receiving no β-blocker.We should payattention to predictors of death such as age,blood urea nitrogen and BNP.Cystatin Cis significant positive correlated with urea acid,blood urea nitrogen,creatinine,BNPand age,it as also a good risk predictor.So,we detect cystatin C for more patients withAMI in clinical.