| Objective:Acute ST-segment elevation myocardial infarction(STEMI)is the dramatic reduction or interruption of blood supply to the diseased coronary arteries,resulting in severe and prolonged ischemic necrosis of the corresponding myocardial cells.Most of the basic etiology is due to the sudden rupture of coronary atherosclerotic plaque,bleeding,resulting in the formation of the corresponding lumen thrombus and then blocking the blood vessels caused by myocardial cell dysfunction,a small number of coronary artery spasm.At present,the majority of acute myocardial infarction is STEMI,which has a rapid change of condition,many complications,and a high risk of death.Many studies has shown that it is not only the main cause of death in industrialized populations,but also an important cause of death in developing countries.In recent years,many STEMI patients can not be effectively diagnosed early and delayed treatment,this increases the number of deaths from diseases significantly.The emergency room is the first place for most patients with STEMI.For patients with early myocardial infarction,if they choose appropriate assessment methods,they can find critical patients in time and conduct proper and reasonable treatment,which is of great significance for improving the survival of patients.With the growth of modern economy and the improvement of people's life conditions,the high purine diet is popular with people.Uric acid is the final compound of purine metabolism,and the existence of asymptomatic "hyperuricemia" is gradually threatening human health.Uric acid,as an inflammatory index,is closely related to many pathological and physiological processes such as oxidation,antioxidation,atherosclerosis,endothelial dysfunction,and thrombosis.At present,a large number of studies in China and abroad have shown that uric acid is associated with hypertension,cerebral infarction,acute or chronic renal failure and other diseases,and many studies have also confirmed that uric acid is associated with short-term and long-term prognosis of acute myocardial infarction.However,the correlation of the serum uric acid combined with Killip classification on the prognosis of STEMI is very little,and the view is different.At present,the specific mechanism of the prognosis of blood uric acid and Killip classification and acute myocardial infarction is not yet clear.The purpose of this study was to investigate the value of blood uric acid and Killip classification of patients for predicting the risk of STEMI in-hospital mortality,and provide evidence for the early choice of a reasonable diagnosis and treatment plan.Methods:This study collected 277 consecutive STEMI patients who were first diagnosed at the emergency department of the Affiliated Hospital of Chengde Medical College from December 2014 to May 2016 and were unable to undergo emergency PCI and thrombolytic therapy.The serum uric acid levels were recorded at admission.The levels for men greater than 420ug/ml(7mg/dL),women greater than 360ug/ml(6mg/dL)can be defined as hyperuricemia.According to blood uric acid levels were divided into two groups: hyperuricemia group,uric acid normal group.Heart failure caused by acute myocardial infarction is classified into Killip class I and Killip classes II-IV according to the Killip classification method.The clinical data about the patients in hospital were collected,including gender,age,past history,clinical manifestations,and important laboratory test results.The primary end point of the study was the occurrence of all-cause deaths and cardiogenic deaths during hospitalization.Independent risk factors for death in hospital with Killip classes II-IV patients were analyzed using multivariate Logistic regression analysis;Comparisons about the mortality in Killip classes II hyperuricemia and Killip class II-IIV hyperuricemia were performed using the Chi-square test of the four-table row and the tabulated data.P<0.05 was statistically considered significant.Results:Among the 277 patients enrolled in the study,59 cases were hyperuricemia and 218 cases were normal uric acid.There were 187 patients in Killip class I and 90 patients in Killip classes II-IV.The incidence of hyperuricemia in the Killip classes II-IV patients(n=30,33.3%)was higher than that in the Killip class I patients(n=29,15.5%).The P values of the age and gender were greater than 0.05,and the data were comparable.1 Compared with normal uric acid group,the UA,Cr and BUN values were significantly higher in hyperuricemia group than in normal uric acid group on admission.The results were respectively(453.2±48.8ummol/lvs.285.8±65.5ummol/l),(97.7±45.7ummol/lvs.70±16.8ummol/l),(7.2±3.5mmmol/l vs.5.8±2.0mmmol/l),the P values were all less than 0.01.2 Compared with patients with normal uric acid in Killip classes II-IV,the UA,Cr,and BUN values were also significantly higher in patients with highacid uric acid in Killip class II-IV on admission,and the results were respectively(458.6±53.0ummol/lvs.269.4±73.3ummol/l),(113.7±57.1 ummol/l vs.77.1±19.9umol/l),(8.4±4.3mmol/l vs.6.0±2.0mmol/l),the P values were less than 0.01,and the results were statistically significant,too.3 Comparison of hospital Mortality in STEMI Patients There was no statistical difference in mortality at discharge(P=0.093(13.6% vs 6.0%)between hyperuricemia group and normal uric acid group.There was a statistically significant difference in mortality between the Killip classes II-IV hyperuricemia patients and the Killip classes II-IV normal uric acid [P=0.044(26.7% vs.8.3%)].4 Factors affecting Killip classes II-IV death in STEMI patients were analyzed by multivariate Logistic regression analysis.Statistical analysis was performed to compare the risk factors such as general baseline data and major laboratory findings.The history of hypertension,systolic blood pressure,smoking history and WBC,Cr,BUN and UA were selected as independent variables.Multivariate logistic regression analysis was performed to determine if mortality in hospital was a dependent variable in Killip classes II-IV in STEMI patients.The results showed that after adjustment for other risk factors,uric acid was only associated with in-hospital mortality independently,[P=0.012,(OR=0.992,95% confidence interval 0.985 to 0.998))],for history of hypertension,systolic blood pressure at admission,smoking history and WBC,Cr,BUN,There was no independent association between hospital deaths in Killip classes II-IV patients(P values were 0.409,0.959,0.777,0.508,0.987,0.555,respectively.All were greater than 0.05,not statistically significant).5 The plasma uric acid levels of death and survivors in Killip classes IIIVpatients were 406.3±134.6mmol/Land 320.2±103.7 mmol/L,respectively,and the P value was 0.015.The results were far less than 0.05,indicating a statistically significant difference.6 Hyperuricemia patients in Killip class II died in 1 case(5.3%),hyperuricemia patients in Killip class III-IV died in 7 cases(36.8%).Using the Chi-square test of the four-table row × list data,the P value was equal to 0.018,less than 0.05,there were statistically significant differences.Conclusion:1 Hyperuricemia can increase the risk of death of Killip classes II-IV in STEMI patients in hospital.The level of serum uric acid and Killip classification can reflect the severity of STEMI patients to a certain extent,and can be used as a reference for clinical prognosis evaluation.2 Blood uric acid level is an independent predictor of in-hospital mortality in Killip classesII-IV for STEMI patients and is a simple and quick indicator for early screening critical patients. |
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