| Background and Purpose Acute myocardial infarction(AMI)often has typical clinical symptoms,such as persistent Squeezing pain of praecordia or substernal with sweat profusely and other discomfort,while some myocardial infarction lacks of clear objective signs of myocardial infarction,clinical symptoms are atypical or there is no symptom at all,the evidence of myocardial necrosis is found when does relevant medical examination,which is called silent myocardial infarction(SMI).When SMI occurs,as the patients have no obvious discomfort,it is often unable to get timely diagnosis and treatment,and they are easy to appear cardiac insufficiency or even sudden death.The clinical characteristics,independent predictors and prognosis of SMI are studied in this paper to raise clinicians' understanding of SMI and arouse clinicians' attention to SMI.For high-risk patients with related risk factors,early screening,early prevention,early intervention and reduce the incidence of major adverse cardiovascular events(MACE).Objects and methods To select 240 elderly patients from January 2015 to January 2016 that were diagnosed with myocardial infarction by any two checks of routine electrocardiogram, echocardiography and single-photon emission computed tomography in the second affiliated Hospital of Zhengzhou University and confirmed by coronary angiography or cardiac enzymes.According to whether have the symptoms of typical anterior area discomfort or chest pain,the patients were divided into silent myocardial infarction group(SMI,n=60),male 22,female 38,age 60-82 years,mean 67±5.40 years old and symptomatic myocardial infarction group(TMI,n=180),males 110,females 70,aged60-80 years,mean 66±4.60 years old.The patient's history was carefully evaluated and the various clinical data needed by the study were improved.The clinical data of the two groups were compared and analyzed,the clinical characteristics and independent predictors of SMI were studied by using relevant statistical methods.At the same time,the incidence of major adverse cardiovascular events(MACE)in two years was compared between the two groups by telephone follow-up or inquire into the admission record.Results1 Comparison of clinical data between the two groups:The gender,cultural level,family history of coronary heart disease,diabetes mellitus,admission heart rate,fasting blood-glucose(FPG),high sensitivity troponin T(TNT),N terminal natriuretic peptide precursor(NT-pro BNP),infarct size and percutaneous coronary intervention(PCI)were compared between the two groups.The difference was statistically significant(P<0.05),but there was no significant difference in other data.2 Analysis of SMI risk factors : Multivariate Logistic regression analysis was performed with whether or not SMI occurs as dependent variable and gender,body mass index,smoking,family history of coronary heart disease,hypertension,diabetes mellitus,hyperlipidemia as independent variables.The results showed that diabetes mellitus and the family history of coronary heart disease were independent predictors of SMI,and the difference was statistically significant(P < 0.05).3 Comparison of the incidence of MACE between the two groups in two years:The incidence of MACE in SMI group was higher than that in TMI group,and the difference was statistically significant(P < 0.05).Conclusions(1)Compared with TMI group,SMI patients were more common in females, lower culture level,they were more common to have family history of coronary heart disease and diabetes mellitus,with relatively slow admission heart rate,FPG was relatively high,the lower level of TNT and NT-pro BNP,smaller infarct size,PCI treatment was relatively less.(2)The diabetes mellitus and family history of coronary heart disease were the independent predictors of SMI.(3)The patients of SMI were more likely to occur MACE than patients of TMI. |
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