Analysis Of Factors Related To Death During Hospitalization And Follow-up Of Initial Acute ST-elevation Myocardal Infarction

Objective: To analysis risk factors related to death of patients with initial acute ST-elevation myocardial infarction in hospital and follow-up period. In order to improve diagnosis and treatment of diseases,rescue measures and preventive medication.Making the adverse cardiovascular events to be predictability, we would make early intervention, in order to reduce the mortality of acute myocardial infarcti- on patients in the hospital.Methods:To collect patients(N=996) with initial acute ST segment elevation myocardial infarction admitted to the Cardiac intensive care unit of Tianjin Medical University second hospital department during2012 January to March 2015,We retrospectively analysis patients' basic clinical data,adjunctive investigations,coronary angiography and echocardiography results, complications and clinical drugs and other clinicai aspects in two groups,then taking multivariable Logistic regression methods to explore risk factors which are associated with the STEMI patients death.Results:(1) In our hospital,the total mortality of patients with initial STEMI is 4.82%(48/996), the male incidence rate of STEMI is higher than that in female(72.5%vs27.5%), but the hospital mortality in female patients is significantly higher than that in male(7.3%vs3.9%).The mortality rate of conservative treatment group was significantly higher than that of operation group.Rate for pump failure is 19.9%(199/996),which cardiogenic shock occurred rate was 3.8%(38/996) and cardiac function Killips II- III level occurrence rate was 16.2%(161/996),main death causes is pump failure by 52%(25/48) in patients with STEMI in hospital.(2) the survival group compared with the death group,the age of the death group was higher than that of the survival group about 12 years(75.11±11.11 vs 63.25±12.21,P<0.001);compared with the survival group,death patients HR and Killips3-4 grade,the proportion of anterior wall and extensive anterior wall myocardial infarction,the proportion increased number of leads,Cr,LADd,LVEDd was higher(P<0.05),and SBP,TG,RBC,Hct and LVEF were lower in death group patients(P<0.05),the death group underwent emergency PCI STEMI patients were significantly lower(54.2% vs74.2%, P<0.001),and postoperative infarction related artery distal blood flow of theTIMI3 level was lower(52.1%vs90.5%,P<0.001)and the proportion of patients in the death group with the sum STR more than 70% was significantly lower(29.2%vs56.0%,P<0.001),the usage rate of ACEI/ARB and beta blockers in death patients was lower,the death group of patients with heart failure(Killips II- III level),cardiac shock,three degrees AVB,atrial fibrillation,ventricular tachycardia/ventricular fibrillation incidence was significantly higher(P<0.001).(3) STEMI patients during hospitalization occurred death events of multiple logistic regression analysis showed that female,age,HGB,LVEF and cardiac function Killips3-4grade,complicated by ventricular rate/ventricular fibrillation and atrial fibrillation,concurrent third degree atrioventricular block are independent risk factors to predict the death in patients with STEMI(P<0.05).When age is more than or equal to 71.5years,the prediction of in-hospital mortality sensitivity was 80.3%,specificity was69.6%(AUC:0.773±0.003),HGB is less than or equal to 126.5g/L.The predicted inhospital death sensitivity was 80.4%,specificity was 56.1%(AUC:0.841±0.028);LVEF less than or equal to 44.5%,the prediction of in-hospital mortality sensitivity was 71.1%,specificity was 58.5%(AUC:0.667±0.045).(4) Multiple logistic regression analysis showed that age, heart rate,LVEF are independent risk factors to predict STEMI patients death events in 1 year(P<0.05),when the age is more than or equal to 70.5 years.The prediction follow-up death sensitivity was80.0%,the specificity was 76.1%(AUC:0.852±0.029).The heart rate is more than or equal to 90.5bpm.The predicted sensitivity of follow-up death was 36%,specificity was 85.9%(AUC:0.637±0.044);when the LVEF less than or equal to 48.5%.The prediction sensitivity of follow-up death was74.5%,the specificity was 66.7%(AUC:0.765± 0.036).The risk of death in patients with STEMI during 1 years was increased with age and heart rate, with the decrease of STEMI, and the risk of death in patients with LVEF.Conclusion:1.In STEMI patients, the incidence rate of myocardial infarction in male was higher than that of female, but the female mortality rate was higher than that of the male.2.STEMI patients who complicated with low SBP and(or)rapid HR,mean that they may have high risk to death in the hospital.and the main causes to death were heartfailure and cardiogenic shock.3.Interventional treatment is superior to conservative treatment,but the mortality rate of emergency PCI in STEMI patients was higher than that of PCI group, and the incidence of heart failure was lower than that of PCI group,4.Female,age,HGB,LVEF, Killips3-4 level,concurrent ventricular tachycardia /ventricular fibrillation, atrial fibrillation, complicated with ?°atrioventricular block are independent risk factors for STEMI patients predicting hospital mortality in patients with STEMI.5.Age, heart rate, and left ventricular ejection fraction are independent risk factors for predicting the occurrence of death in patients with STEMI during 1 years.