| Objective:By collecting and analyzing the demographic data,clinical characteristics and prognosis of patients of acute myocardial infarction combined with type 2 diabetes or not,this study aims to sum up the distribution of TCM Syndrome in patients of type 2 diabetes combined with acute myocardial infarction,and to analyze the clinical characteristic of patients with AMI.The 4-year prognosis of AMI patients were compared to explore the effect of type 2 diabetes on the prognosis of patients with acute myocardial infarction.Method:According to certain inclusion criteria and exclusion criteria,patients who were hospitalized from January 1,2012 to December 31,2013 for acute myocardial infarction in Dongfang hospital,Dongzhimen hospital and Beijing Chinese Medicine Hospital,department of Cardiology and/or CCU are divided into diabetes group(group D)and non diabetic group(group N)at admission.The baseline data,general condition,physical and chemical examination results,clinical data and the severity of coronary artery lesion in two groups are collected.Two groups of patients are collected for tongue images,pulse condition,TCM diagnosis and differentiation of TCM syndrome.Patients in group D and group N have been followed up for 4 years.Then use T test,logistic regression analysis,Cox survival model and other statistical methods to analyze the characteristics of the two groups,the distribution of TCM syndrome and the prognosis,and to evaluate the effect of type 2 diabetes on the condition and prognosis of patients with acute myocardial infarction.Results:1?Analysis of baseline data:of the 420 patients,311 are male(74.0%)and 109 women(26.0%);the minimum age is 29,the maximum age is 95,and the average age is 64.29.There are 380 STEMI patients and 40 patients with NSTEMI.Patients with acute myocardial infarction combined with diabetes have a greater proportion of hypertension,hyperlipidemia,as well as the history of myocardial infarction(P<0.05).There is no significant difference in blood pressure,heart rate and other vital signs between the two groups.2?The characteristics of type2 diabetes combined with acute myocardial infarction:After the onset of myocardial infarction,patients in group N has the higher level of myocardial enzyme and myocardial damage marker.Patients in group D are more likely to have heart failure than those in group N(36.65%vs26.25%).50.31%of diabetic patients show atypical symptoms of myocardial infarction,far more than that of non-diabetic patients(31.27%).59.29%of patients in group D have pathological changes in 3 main coronary arteries,which is significantly more than its counterpart(40.83%).A total of 333 patients received interventional treatment,and patients in group N received 1.84 stents on average while 2.18 stents in group D.3?Distribution of TCM syndromes:blood stasis syndrome has the highest frequency among AMI patients,accounting for 93.17%(group D)and 89.96%(group N),respectively.The most common TCM syndrome factors of diabetic patients with acute myocardial infarction are blood stasis syndrome,Qi deficiency syndrome,and yin deficiency syndrome.Meanwhile,AMI patients without DM are highly related to blood stasis syndrome,Qi deficiency syndrome and phlegm syndrome.4?4 years of prognosis comparison:378 patients were discharged from hospital for 4 years follow-up.In group D,the number of MACE events was 31,accounting for 41.33%.There were 17 patients(23.23%)with recurrent angina,6(8.00%)with myocardial infarction and 12(16.00%)with revascularization,5 of those died of cardiovascular events,7 died for other causes and the total death rate is 16.00%.86 of them were lost to follow-up.In group N,the number of MACE events was 28,accounting for 27.72%.There were 15 patients(14.85%)with recurrent angina,5(4.95%)with myocardial infarction and 16(15.84%)with revascularization,3 of those died of cardiovascular events,7 died for other causes and the total death rate is 9.90%.158 were lost to follow-up.Cox survival model analysis shows that the risk of long-term death in patients with diabetes is 1.412 times higher than that of non-diabetic patients.Conclusions:1?The main syndromes of acute myocardial infarction were blood stasis syndrome.Qi deficiency syndrome and phlegm turbidity syndrome,and the syndrome factors of high correlation with diabetes were Yin deficiency syndrome,that is,patients of acute myocardial infarction with type 2 diabetes are more likely to present blood stasis syndrome,Qi deficiency syndrome,yin deficiency syndrome and phlegm syndrome.2?Patients of acute myocardial infarction with type 2 diabetes are more likely to have complications such as hypertension,hyperlipidemia,old myocardial infarction and old cerebral infarction.The course of coronary heart disease in patients of group D is longer than group N,and the heart function is worse at admission.3?Patients with diabetes combined with acute myocardial infarction tend to have more severe coronary lesions,bigger proportion of 3-branch-lesion and more likely to have atypical symptoms;they also tend to receive more stents than those without diabetes.Diabetes does not increase the ratio of non ST-segment elevation myocardial infarction.4?The risk of recurrent angina,recurrent myocardial infarction,revascularization,cardiac death,and other cardiovascular events(MACE)in patients with acute myocardial infarction with type 2 diabetes in 4 years is higher than that in non-diabetic acute myocardial infarction patients.Diabetes can increase the risk of death in patients with acute myocardial infarction. |
PDF Full Text Request