The Analysis Of The Clinical Characteristics And Treatments Of The In-hospital Patients Of ST Elevated Myocardial Infarction Complicated With Heart Failure

Objective: To investigate the incidence,clinical characteristics,in-hospital treatments and short-term prognosis that in-hospital patients of ST elevated myocardial infarction newly complicated with heart failure.To provide clinical evidence for physician makes effective treatment.Methods: From May 2015 to October 2015, 696 in-hospital patients were continuous selected for whom diagnosed ST elevated myocardial infarction in the first Bethune hospital of Jilin university. Obtained the clinical information from database and medical record query system of the first Bethune hospital of Jilin university. The basic clinical characteristics,therapy plans and short-term prognosis were analyzed according to the occurrence of heart failure(HF) at admission were divided into HF group and non-HF group.Results:(1) Among 696 STEMI patients,288 patients(41.1%) were complicated with HF and 408 patients(58.6%) were without HF. The average age of HF group was older and the proportion of women was higher than non-HF group,P<0.05. HF group of patients with chronic renal insufficiency, diabetes history were more than that of non-HF group,P<0.05. With prolonging to 12 hours then on admission that can increasing the incidence of HF, The blood pressure, glomerular filtration rate in HF group were lower than non-HF group,P<0.05. The heart rates and fasting glucose in HF group were higher than non-HF group,P<0.05. The proportion of the extensive anterior myocardial infarction in HF group was higher than non-HF group,P<0.05.(2) Among 696 STEMI patients,547 patients(78.5%) were examined by coronary angiography,485 patients(69.7%) were underwent percutaneous coronary intervention(PCI).STEMI patients in HF group were examined by coronary angiography and underwent percutaneous coronary intervention that were 74.3% and 52.4%.STEMI patients in non-HF group were examined by coronary angiography and underwent percutaneous coronary intervention that were 81.6% and 60.3%.Compared with the non-HF group,triple-vessel lesions and left main coronary artery stenosis were more in HF group,P<0.05.aspirin, clopidogrel or ticagrelor and statins were used enough in the STEMI patitents,but beta blocker,ACEI/ARB and spironolactone were used less.At the same time triple-drug combined therapy(beta blocker,ACEI/ARB and spironolactone),double-drug combined therapy(beta blocker and spironolactone; ACEI/ARB and spironolactone) were used more in HF group,P<0.05.(3) The patients of the HF group complicated with ventricular arrhythmias, atrial fibrillation, cardiac shock, mechanical complications were more than non-HF group, P<0.05. Compared with the non-HF group,length of stay was longer and in-hospital mortality was higher in the HF group,P<0.05.(4) The multistate modle describes variables predictive of the development HF, anterior myocardial infarction(OR=3.462) and cardiogenic shock(OR=3.130) as the strongest predictors.Conculsion:(1) ST elevated myocardial infarction patients complicated with HF was common.Age,sex,diabetes mellitus,anterior myocardial infarction, ventricular arrhythmia, cardiac shock as associated with the risk of developing HF in the multivariate analyses.(2) The coronary artery lesion was more serious in STEMI patients can induced to complicate with HF and more. There much to do to improve the recommend therapy apply on the clinical practice.(3) Compared with the patients without HF;the baseline was lower,the therapy was more insufficient;the short-term prognosis was worse in the STEMI complicated with HF..