Analysis Of Distribution And Risk Factors Of Different Subtypes Of Acute Coronary Syndrome

Objective : To investigate the subtype composition and trends of patients with acute coronary syndrome(ACS)and the differences in risk factors between ACS subtypes.Methods : 748 patients with first-accurate diagnosis of ACS diagnostic criteria for percutaneous coronary intervention in the emergency department of our hospital from January 2015 to December 2017 were selected.Randomized selection of288 patients with normal coronary angiography and exclusion of coronary heart disease in the same period as a control group.Collecting demographics,medical history,clinical,laboratory tests,and coronary angiography data.According to the type of ACS,they were divided into three subtype groups: acute ST-segment elevation myocardial infarction group(n=325),non-ST-segment elevation myocardial infarction group(n=233)and Stable angina pectoris group(n=200).The SPSS 22.0 statistical software was used to retrospectively analyze the composition ratio and yearly changes of ACS subtypes.The clinical data of each group were compared and analyzed,multivariate logistic regression was used to analyze the risk factors of ACS subtypes.Results:(1)The composition ratio of STEMI in patients with ACS in our hospital showed a downward trend,and the composition ratio of UAP and NSTEMI showed an upward trend.The gender composition of different subtypes of ACS was male,but the composition ratio of male patients showed a downward trend year by year,and the composition ratio of female patients showed an increasing trend year by year.The average age of males in different subtypes of ACS was higher than that of females.UAP was the highest in the 45~59 age group,and NSTEMI and STEMI were the highest in the 59 ~ 79 age group.Different subtypes of ACS show obvious seasonal variation,STEMI is high in winter and spring,and UA and NSTEMI are high in summer and autumn.(2)Univariate analysis of risk factors for ACS subtypes showed that the levelsof NT-ProBNP,Hs-CRP,and LDL-C in the three subtypes of ACS were higher than those in the non-ACS group(P<0.05);NSTEMI the levels of FBG,FIB and D-dimer in the STEMI group were higher than those in the non-ACS group,and the LVEF and HDL-C levels were lower than those in the non-ACS group(P<0.05).The proportion of patients with UAP combined with hypertension was higher than that of non-ACS group,the difference was statistically significant(P<0.05).(3)Multivariate logistic regression analysis showed that the independent risk factors of UAP were NT-ProBNP(OR=2.680,95%CI: 1.601~7.942)and Hs-CRP(OR=2.131,95% CI: 1.034~4.218)(all P<0.05);the independent risk factors for NSTEMI were NT-ProBNP(OR=10.290,95%CI:2.559~91.115),LVEF(OR=1.121,95%CI: 1.045~1.203),FIB(OR=2.976,95%CI:0.953~1.929)(all P<0.05);the independent risk factors for STEMI were D-dimer(OR=2.680,95%CI: 1.601~7.942),LVEF(OR=2.964,95%CI: 0.821~0.967),LDL-C(OR=9.542,95%CI: 2.267~80.514)(all P<0.05).(4)Correlation analysis between ACS subtype Gensini score and risk factors showed that the Gensini score of UAP group was positively correlated with NT-ProBNP and Hs-CRP levels(r=0.548,0.413,P<0.05);Gensini score of NSTEMI group and NT-ProBNP,FIB The levels were positively correlated(r=0.482,0.277,all P<0.05).The Gensini score of STEMI group was positively correlated with D-dimer,NT-ProBNP and LDL-C(r=0.456,0.429,0.364,all P<0.05),and negatively correlated with LVEF level(r=-0.502,P<0.05).Conclusion:There have been differences in gender,age and seasonal distribution of ACS subtype diseases in our hospital in the past 3 years.There are significant differences in the risk factors of ACS subtypes.Different risk factors have different effects on the degree of ACS subtype coronary artery disease.It is important to clarify the difference in the risk assessment and clinical treatment of ACS subtype.