Clinical Characteristics And Outcomes Of Non-ST-segment Elevation Myocardial Infarction:cohort Study

Objectives: A single-center large sample non-ST-elevation myocardial infarction(NSTEMI)cohort was established to explore the clinical characteristics and the influencing factors of outcomes,and to evaluate the effect of interventional therapy strategies in patients with different risk stratification of NSTEMI.Methods: A total of 1357 patients who were definitely diagnosed NSTEMI in Tianjin Chest Hospital from January 2017 to December 2017 were enrolled.A large single-center NSTEMI cohort was established and basic clinical data,laboratory tests,treatment data were collected.During the 1-year follow-up,the primary endpoint was all-cause death,and the secondary endpoint was major adverse cardiac events(MACEs).Kaplan-meier survival curve was used to analyze the cumulative incidence of events,and Cox regression was used to analyze the influencing factors of MACEs,so as to explore the clinical characteristics of NSTEMI patients and independent predictors of MACEs occurrence.Patients were divided into subgroups according to GRACE score and time from admission to interventional treatment.Cox interaction regression and subgroup analysis were used to discuss the relationship between the timing of different interventional treatments,GRACE risk stratification and clinical outcomes,and to evaluate the effect of early interventional treatment strategies for patients with different risk stratification of NSTEMI.Results:1.Clinical characteristics of NSTEMI cohort A total of 1357 patients were enrolled in the NSTEMI cohort,with age of 65(57,73)years old.There were 917 cases(67.58%)of patients with hypertension,994 cases(73.25%)with hyperlipidemia,and 790 cases(58.22%)of smokers.The proportion of patients with high,medium and low risk of GRACE score is similar,<108 group have 413 cases(30.43%),109-140 group have 506 cases(37.29%),and >140 group have 438 cases(32.28%).There were 770 patients(56.74%)performed percutaneous coronary intervention(PCI),coronary angiography showed three-vessel lesions in 623 patients(45.91%),464 patients(34.19%)with ?1 vascular occlusion disease,and 165 patients(12.16%)with combined or simple left main(LM)lesions.There were 1244(98.4%)patients treated with dual antiplatelet therapy within 24 hours of hospitalization,and 1243(98.3%)patients treated with anticoagulants.The hospital stay was 6(5,8)days.2.Analysis of influencing factors of clinical outcomes in NSTEMI cohort The follow-up time was 1 year,and the primary end point was 57 cases(4.51%);secondary end point was 209 cases(16.53%),there were 57 cases(4.51%)with all-cause death,29 cases(2.29%)with non-fatal AMI,58 cases(4.59%)with target lesion revascularization,78 cases(6.17%)with heart failure,and 6 cases(0.47%)with stroke.(1)Univariate Cox regression analysis: The following 16 indicators were found to be statistically significant: age,diabetes,Killip III-IV,GRACE score 109-140,GRACE score >140,number of stents,uric acid,Lp(a),hypersensitive troponin T(Hs-cTnT),LV,?1 vascular occlusion,three-vessel lesions,and combined or simple LM lesions are risk factors for MACEs;male,smoking,Killip I-II,PCI are protect factors of the MACEs.(2)Multivariate Cox regression analysis: A total of 5 clinical variables were independent predictors of MACEs: age [hazard ratio(HR)= 1.035,95% confidence interval(CI)1.013-1.058,p=0.002] GRACE score>140(HR=3.482,95%CI 1.765-6.870,p<0.0001),admission to intervention time >72 hours(HR=4.989,95%CI 2.249-11.081,p<0.0001),Hs-cTnT(HR=1.153,95%CI 1.042-1.267,p=0.0066)and ?1 vascular occlusion(HR=1.542,95%CI 1.038-2.273,p=0.0301)are independent risk factors for MACEs.(3)Interaction term Cox regression analysis and subgroup analysis: GRACE score >140 and admission to intervention time <24 hours(p=0.0004),24-72 hours(p=0.0143);GRACE score 109-140 points and admission to intervention time <24 hours(p=0.0370),24-72 hours(p=0.0471)have an interactive effect on the impact of MACE events. Subgroup analysis found that: for high-risk NSTEMI patients with a GRACE score of >140,interventional treatment within 24 hours is a protective factor for MACEs(HR=0.166,95% CI 0.052-0.532,p=0.0025);for low-risk NSTEMI patients with GRACE score ?108,admission to intervention time >72 hours was an independent protective factor for MACE events(HR=0.201,95% CI 0.045-0.897,p=0.0355).Conclusion:1.This study found that the NSTEMI cohort features: more men than women,more previous hypertension and hyperlipidemia,The number of high,medium and low risk patients was similar.More than half of the patients were treated with PCI,and many parents have three-vessel lesions.2.The 1 year mortality rate of single-center NSTEMI patients is 4.51%,lower than the 6.44% of the domestic CAMI study,also lower than the 18.7% of the US statistics in 2005 and 12.40% of the French TAO study.The incidence of 1 year MACE events is also lower: 16.53%,which is lower than 16.76% of the statistics of domestic research.3.Age,GRACE score >140,admission to interventional treatment after 72 hours,Hs-cTnT,?1 vascular occlusion are independent risk factors for MACEs within 1 year,helping clinicians identify high-risk factors early and choose the best diagnosis and treatment strategy.4.For high-risk NSTEMI patients with a GRACE score >140,interventional therapy within 24 hours can effectively reduce the risk of MACE events within 1 year;for patients with low-risk NSTEMI with a GRACE score of ?108,interventional therapy 3 days after admission was associated with reduced MACEs within 1 year.