Cohotr Study Of Traditional Chinese Medicine In238Patients With Myocardial Infarction

OBJECTIVES1．To abserve traditional Chinese medicine(TCM) in patients with myocardialinfarction treatment, and analyze specific strength analysis of TCM.2.To acquire major events in patients with myocardial infarction(MI), andstudy its relationship with traditional Chinese medicine.METHODSApply a cohort study design.Make "Hospital of TCM in patients with MI cohort study questionnaire".Through the hospital medical record information management system, select238cases of MI patients who were treated in Affiliated Hospital of ShandongUniversity of Traditional Chinese Medicine from January1,2008to December31,2012, record clinical features, Syndrome differentiation of TCM, TCMtreatment and the occurrence of events, based on medical records, the Chinesemedicine treatment and the occurrence of the primary endpoint follow-upafter discharge.Establish the hospital of TCM in patients with MI cohort study database,logging data, using Epidata software to analyse specific strength and itsapplication in TCM in exposed group and non-exposure group. Analyse therelationship of primary endpoint events and traditional Chinese medicinewith Logistic regression.RESULTS1.Chinese medicine treatment During hospitalization period: exposure group (the application of traditional Chinese medicine injection≥7days)172cases (72.27%), including weak exposed group (the application oftraditional Chinese medicine injection <14days)44cases (18.49%) andstrong exposed group (the application of traditional Chinese medicineinjection≥14days)128cases (53.78%). During follow-up period: exposuregroup (Application of oral medicine≥28days)117cases (71.78%), includingweak exposed group (oral Chinese medicine≥28days and <3months)40cases(24.54%), medium exposed group (oral Chinese medicine≥3months and>6months)15cases (9.20%)and strong exposed group (oral Chinese medicine≥6months) in62cases (38.04%).2.Primary endpoint events The number of patients who suffered from Primaryendpoint events during hospitalization (including cardiovascular death, nonfatal myocardial infarction and non fatal stroke) were46, accounting for19.33%, of which19patients (11.05%)were from the exposure group and27(40.91%)were from non exposed group (without the use of TCM injections orapplication time <7days). The endpoint event incidence of two groups hadsignificant Statistics difference (P <0.01),The RR value is0.2701, namelythe exposed group’s primary endpoint events incidence was only about27.01%of the non exposed group. The endpoint event incidence of weak exposed groupand strong exposed group (25.00%vs6.25%) had significant Statisticaldifference (P <0.05). The primary endpoint events during follow-up was45,accounting for27.61%, of which the exposure group was27(23.08%) andnon-exposed group was18(39.13%). The endpoint event incidence of two groupshad Statistical difference (P<0.05). The RR value is0.5898, namely theexposed group’s primary endpoint events incidence was only about58.98%of the non exposed group. The weak exposed group, medium exposure group andstrong exposed group’s endpoint events incidence were37.50%,26.67%, and12.90%, there was a Statistical difference between three groups(P<0.05).3.Logistic regression analysis Logistic regression analysis of single factor showed that, endpoint events during hospitalization was related toage, clinical stage，Killip cardiac functional grading, NYHA grading,arrhythmia, old myocardial infarction, application of ACEI, the applicationof traditional Chinese medicine injections, however, according tomultivariate analysis, no variables went into the Logistic regression model.Single factor analysis also showed that the follow-up outcome was connectedwith gender, arrhythmia, application of ACEI and application of oraltraditional Chinese medicine. The application of oral traditional Chinesemedicine, gender and concomitant arrhythmias went into the Logisticregression model. The gender and concomitant arrhythmias were (41.84±26.21)independent risk factors on primary endpoint events: The risk in women is2.588times of the male (95%CI=1.328-5.045, P=0.005), the risk associatedwith arrhythmia occurrence end event is3.566times no arrhythmia subjects(95%CI=1.749-7.273, P=0.000). The application of oral traditional Chinesemedicine were protective factors for primary endpoint events duringfollow-up, the risk of primary endpoint events to those who apply oraltraditional Chinese medicine was only39.6%of non-users(95%CI=0.199-0.792,P=0.009).CONCLUSIONS1.Chinese medicine is widely used in the treatment of myocardial infarction,traditional Chinese medicine is mainly used in TCMI inpatients during thetreatment, and proprietary Chinese medicines and herbal decoction is mailyused after they are discharged.2.Hospitalization endpoint is connected with age, clinical stage, Killipcardiac functional grading, NYHA grading, arrhythmia, old myocardialinfarction, application of ACEI,and the application of traditional Chinesemedicine; follow-up outcome is connected with gender, arrhythmia, hypertension, application of ACEI and application of Chinese medicine. Theapplication of TCM is one of protective factors for outcome in patients withMI.