Diagnosis And Treatment Of Acute Coronary Syndrome Establishment And Application Epidata Database

Objective:To establish an acute coronary syndrome EpiData database and to provide a better platform for clinical research, his study aims to evaluate the local small sample in yunnan province of the gender differences in clinical practice, guide the clinical prevention and treatment.Methods; Design a framework of acute coronary syndrome database first; and on the basis of it, through establishing the questionnaire files, data files, and CHK files, as well as data importing and exporting, etc. aims to establish a database with EpiData3.1as the background. Having incorporated continuously the patients with acute coronary events admitted in The First Affiliated Hospital of Kunming Medical University of Yunnan Province in emergency or referral from March to November of2012, a total of420patients with acute coronary syndrome were registered to study. We compared the male patients with acute coronary syndrome with those female ones from the perspectives of clinical statistics,different methods of treatment and hospital transition.The results:1.Buildiing a database of acute coronary syndrom with a storage, data input and output, statistical analysis,, retrieval functions.2. A total of420cases of patients’information was recorded in the database, Including84women and336men,The average age of patients was59.43±59.43years (ranging from26to76), women accounted for20%in420patients with acute coronary syndrome. Average age of female patients is higher than men (64.03±8.72vs58.27±10.09,P<0.001) and the number of ACS is far less than male patients (84vs336, P=0.029). The rate of high blood pressure (73.5%vs53.3%, P<0.001), diabetes (46.1%vs32.7%, P<0.001) and hypercholesterolemia (41.6%vs33.1%, P=0.007), atrial fibrillation (10.1%vs5.4%, P=0.006), congestive heart failure (15.4%vs7.0%P<0.001), renal damage (15.1%vs7.2%, P<0.001), the chance of cerebrovascular accident (14.3%vs9.5%, P=0.02) which the women fall ill is higher. 3. The clinical characteristics of patients with different types of ACS, and an average age difference (P=0.116) of patients is not huge; the proportion of Female patients with NSTEMI and the UAP is higher than STEMI group (P<0.001). The proportion of patients with NSTEMI and UAP in ischemic heart disease, diabetes, previous myocardial infarction, always reperfusion therapy, heart failure,renal function is higher than the proportion of STEMI patients (P<0.05), NSTEMI, UAP patients with high blood pressure is higher than the proportion of patients with STEMI group (P<0.007), the proportion of UAP, STEMI patients who smoked is higher than NSTEMI patients (P<0.001), while the patients of NSTEMI, UAP, STEMI with hypercholesterolemia’s proportion is not obvious difference (P=0.39), and STEMI and NSTEMI, UAP patients’s average BMI is not very different (P=0.57). In different gender ACS patients, male patients after age40,with the age growing, the proportion of ACS is in decreasing, while women is on the other hand.4. During hospitalization, the rate of the NSTEMI, UAP patients using asprin and low molecular heparin is higher than that in patients with STEMI group (P<0.001). The use of clopidogrel, GpIIb/IIIa antagonists of the proportion in patients with STEMI is much higher than NSTEMI, UAP patients (≦0.001), while the three groups in the use of statins’s difference is not huge (P=0.25).Hospital patients, the useing of aspirin and clopidogrel in patients with STEMI is higher than the proportion of NSTEMI, UAP patients (P<0.05), patients with UAP with ACEI/ARB is higher than the proportion of STEMI and NSTEMI patients (P<0.001), while STEMI and NSTEMI, UAP patients using beta blockers, statins, and warfarin as a percentage of difference (P>0.05).5.In different gender of the ACS patients, male patients after age50, along with the age growth, in420cases of patients with ACS decreased in proportion, but far higher than female patients; And female patients,50years old before is few in420cases of patients of ACS, a gradual increase in the proportion of ACS occurred after the age of50.6. The rate of smoking in the male patients is higher than the female patients (P<0.001);the proportion of male patients with STEMI is higher than that of female patients (P<0.001), while the proportion of patients with NSTEMI and UAP in male patients is lower than that of women (P<0.001); the proportion which the female patients combine with hypertension, diabetes, hypercholesterolemia, atrial fibrillation, congestive heart failure, renal damage, cerebrovascular accident is higher than that of male patients (P<0.05); the range of female patients with elevated systolic blood pressure is higher than male patients (154±33vs141±30, P<0.001); while the proportion which the male patients have a history of myocardial infarction, peripheral blood vessels, kidney damage, heart rate changes, and coronary artery lesions are not different comparing with women.(P>0.05)7.Although st-elevation myocardial infarction (STEMI) is othen found in male patients (36.8%vs22., P<0.001), but NSTEMI (40.0%vs48.2%, P<0.001) and UAP (23.5%vs29.6%, P<0.001) ratio were higher in female patients. Renal impairment, changes in heart rate and number of coronary artery lesions showed no obvious difference (P>0.05). Smoking is more common in male subjects (32.4%vs4.9%, P<0.001).8.In ACS patients with multiple risk factors in analysis, age (every10years more), cardiac function, Killip class III/IV, STEMI raise, female Odds the wire values were greater than1, belongs to the dangerous factors, systolic blood pressure (every10MMHG more), PCI in hospitalization, and statin using, Odds thewire values are less than1, and belongs to protection factors. In addition to the female (P=0.47) there was no significant statistical difference, the rest were statistically significant (<0.05).Conclusion:1. Built with storage, query, statistical analysis, data input and output, retrieval functions such as acute coronary syndrome (acs) database.2.Smoking, hypertension, diabetes and hypercholesterolemia are important risk factors for the ACS patients.3. ACS patients during hospitalization and after discharge, the using of drugs such asaspirin, clopidogrel has statistical significance (P<0.05).4.In different gender of the ACS patients, male patients after age50, along with the age growth, in420cases of patients with ACS decreased in proportion, but far higher than female patients; And female patients,50years old before is few in420cases of patients of ACS, a gradual increase in the proportion of ACS occurred after the age of50.5.Patients with STEMI is commonin men, Patients with NSTEMI and UAP are more seen in women.6. Among the ACS patients, the proportion of men in terms of incidence of a disease and smoking were much higher than that of women, with statistical significance (P<0.05), but the proportion of female patients with ACS complications was higher than that of men, with statistical significance (P<0.001).7.Male and female patients with ACS, the number of coronary artery involvement have no statistical difference (P>0.05).8.ACS patients died in many risk factors to analysis, the age (every10years more), cardiac function, Killip class Ⅲ/Ⅳ, STEMI raise and female older belongs to the ACS risk factors, with statistical significance (P<0.05).