| Objective: To observe the control of risk factors, and compare the difference of major adverse cardiovascular events(MACE, include recurrent angina, non-fatal myocardial infarction, revascularization, Cardiac death) between two groups by specialized six months follow-up, and explore the risk factors associatied with the MACE.Background: Coronary heart disease(CHD) has become the most common and lethal disease with the developing of Global population aging, and half of cardiovascular deaths were attributed to acute coronary syndrome(ACS). In China, 0.7million individuals reportedly succumb to ACS annually, moreover the mortality rate is still increasing year by year. International multicenter register clinical studies GRACE showed that the mortality rat of ACS were 15%、25%、41% respectively in the frist year 、 third year and fourth year. With diagnosis and treatment methods’ s update, many ACS patients received timely and effective treatment. Therefore, the risk of death is greatly reduced. Percutaneous coronary intervention(PCI) as most minimally invasive procedures which can open the occlusion or stenosis coronary artery has become the main treatment of ACS currently. However, PCI can not prevent the process of coronary artery atherosclerosis. So MACE still appear frequently in short or long term after PCI. The efficacy of PCI decreased and the patient’s mortality increased due to the lack of second prevention of CHD. Previous studies showed that the risk factors of postoperative were controlled poorly and lifestyle did not be improved; however they could be controlled and improved well by strengthening secondary prevention of CHD. The research about health care workers participating in the follow-up to intervene the risk factors was rarely reported.Methods : A total of 512 ACS including ST-segment elevation myocardial infarction(STEMI),non-ST-segment elevation myocardial infarction(NSTEMI), and unstable angina(UA) consecutive patients who underwent PCI in the department of Cardiology, the First Affiliated Hospital of Henan University of Science and Technology from October 20, 2013 to October 20, 2014, whose average age were59.22±11.32 years old, were enrolled. According to the random number table, patients were randomly divided into intervention and control groups. After admission, all patients enrolled were collected comprehensive information including age, gender,weight, height, past medical history and so on. All patients were informed written points for attention after discharge and designed follow-up schedule. The intensive follow-up group accepted the extra follow-up time and contents by special professional physicians. All Patients were followed for 6 months. Collect the basic clinical data about admission and summary the rates of rehospitalization, the incidence of MACE and the costs associated with rehospitalization in six months; compare the control of risk factors between the two groups after six months and explore the risk factors associated with MACE.Results: Excepted the hypertension(P=0.041) and renal insufficiency(P=0.017),the baseline clinical were not statistically significant between the two groups. After six months, the risk factors existed between two groups were obviously improved,moreover the proportion of overweight, fat, smoking, blood pressure, triglyceride,cholesterol in the intervention group were better than the control(26% vs. 37.5%,2.9% vs. 3.9%, 18.8% vs. 28.6%, 1.44±0.75 mmol/l vs. 1.72±1.07 mmol/l, 3.74±1.01mmol/l vs. 4.28±1.01mmol/l, P<0.05), and the differences were statistically significant.The rates of rehospitalization, MACE and rehospitalization costs in intervention group were better than those in control group(11.1% vs. 12.5%,11.1% vs. 16.4%,10983±15662 RMB vs. 23187±28953 RMB). Univariate analysis found that post-brain thrombosis, the average heart rate in-hospital, Left ventricular end diastolic diameter,Percutaneous transluminal coronary angioplasty(PTCA), rescue PCI after thrombolysis are associated with MACE after PCI. Multivariate logistic regression analysis found that post-brain thrombosis(Odds Ratio=3.294, 95%Confidence interval: 1.345~8.064,P=0.009), PTCA(Odds Ratio = 7.095, 95%Confidence interval:1.464~42.680,P=0.016)are the independent predictors of MACE after PCI.Conclusions: Through the specialized follow-up from medical staff, the risk factors and lifestyle can be controlled and improved better. Thereby it maybe reduce the rate of MACE, rehospitalizations, hospital costs and improve the short-term prognosis in ACS patients after PCI. |
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