Analysis Of Risk Stratification And Short-term Outcome Of Acute ST Segment Elevation Myocardial Infarction In Tibetan Plateau

Objective: to investigate the clinical characteristics,risk stra-tification and risk factors related to in-hospital outcome of(STEMI)patients with acute ST segment elevation myocardial infarction in Tibet plateau,so as to further improve the short-term prognosis of STEMI patients and provide basis for the application of risk score of STEMI patients in this area.Method:1.Subjects: STEMI patients from the cardiovascular depar-tment of the people's Hospital of Tibet Autonomous Region from October 2013 to December 2018 were collected continuously in stri-ct accordance with the inclusion criteria and exclusion criteria.2.Data collection: detailed entry of all patients' personal information,clinical manifestations,previous history,blood routine,blood biochemistry,myocardial markers,ECG,color Doppler echocardiography,c-oronary angiography results,cardiovascular adverse events(malignant arrhythmia,cardiogenic shock,reinfarction,hospital death,mechanical complications),treatment measures(including revascularization,non blood circulation Reconstruction)and risk stratification scores.3.Risk stratification: clinical trials(TIMI,including 8 variables,w-ith a score of 0-3 for low risk,4-6 for medium risk,and ? 7 forhigh risk)score,global acute coronary syndrome registration(grace,including 6 variables,with a score of 49-125 for low risk,126-154 for medium risk,and ? 155 for high risk)score,Chinese myoca-rdial i-nfarction injection score were conducted for all patients Reg-istry study-ST segment elevation myocardial infarction(cami-stemi,7 variables,14 points in total)score.4.Statistical methods: all dat-a were analyzed by spss21.0 software.The measurement data meet the normal distribution and adopt t test;the measurement data do not meet the normal distribution and adopt rank sum test.Chi-squar e test or Fisher exact test were used for counting data.Binary logistic re-gression analysis was used to analyze the relationship betwee n the dependent variable and the independent variable.Spearman co-rrelation analysis was used to analyze the correlation between the t-wo continuous variables.Test level a= 0.05,P < 0.05 as the differ-ence was statistically significant.Results: 1.Comparative analysis of clinical characteristics of STEMI patients:(1)Social demographic distribution: the average age of onset of STEMI patients in Tibet Plateau was 56.012.3 yea-rs old,with 212 cases of Tibetan(70.7%)and 86 cases of Han nati-onality(28.7%).The average age of onset in Tibetan patients was59.0 ±11.6 years,and that in Han patients was 48.5 ±10.7 years old.The difference was statistically significant.In terms of age dist-ribution,the incidence of Tibetan patients in the elderly(50.5%)was more common than that in young people(12.7%)and middleaged people(36.8%),while that in middle-aged Han patients(51.2%)was more common than that in young people(36.0%)and old people(12.8%),and the difference was statistically significant.(2)Clinical manifestations: among the clinical manifestations of STEMI patients in Tibet plateau,there were 271(90.3%)cases with chest pain and 29(9.7%)cases without chest pain.The constituent ratio-s of clinical manifestations of Tibetan and Han STEMI patients we-re similar,in which chest pain(90.6% vs 89.5%)was the main cli-nical manifestation,and there was no significant difference in the incidence of each clinical manifestation.(3)risk factors: dyslipide mia(71.0%)was the most common risk factor among STEMI patie-nts in Tibet plateau,followed by smoking history(65.7%),hypertension history(50.0%)and hyperuricemia(41.3%).Tibetan and Han STEMI patients had a history of hypertension(55.2% vs 37.2%),hyperuricemia(36.8% vs 53.3%),high altitude polycythemia(6.6%vs 20.9%),and heart failure at admission(48.65% vs 26.7%).The incidence difference was statistically significant.(4)location of myo-cardial infarction: anterior wall infarction(including extensive anteri or wall,anterior septal wall,anterior wall)infarction(53.8% vs 46.5%)was common in Tibetan and Han STEMI patients,and the diff-erence was not statistically significant.2.Analysis of risk factors related to MACE: Male(OR=0.373,95%CI:0.153-0.910),peripheral oxygen saturation(OR=0.947,95%CI:0.904-0.993)and revascularizati on therapy(OR=0.619,95%CI:0.475-0.807)were protective factors fo-r MACE.Killip?-?(OR=1.326,95%CI:1.010-1.741)and hperuricemia(OR=1.810,95%CI:1.056-3.103)were independent risk factors for MACE,and the differences were statistically significant.3.Effect o-f hemoglobin level(Hb)on coronary artery disease: in male STEMI patients,different Hb levels affected the number of involved cor-onary arteries,namely single coronary artery(49.1% VS44.0% VS64.7%),double coronary artery(30.9% VS27.5% VS35.3),three coro-nary arteries(16.4% VS19.8% VS0.0%)and left anterior descendin-g coronary artery(63.6% VS71.4% VS58.5%),left circumflex coro-nary artery(36.4% VS27.4% VS23.3),and left anterior descending coronary artery(63.6% VS71.4% VS58.5%),and left circumflex co-ronary artery(36.4% VS27.4% VS23.3).Left trunk(0.0% VS3.3%VS0.0%)right coronary artery(58.2% VS48.4% VS29.4%)has no direct correlation.The difference was not statistically significant.3.The effect of different Hb levels on the number of involved co-ronary arteries,that is,single branch(50.0% VS62.5% VS100.0%),double branch(25.0% VS12.5% VS0.0%),three branches(25.5%VS12.5% VS0.0%)and the affected site,that is,the left anterior de-scending branch(91.7% VS62.5% VS0.0%),the left circumflex bra-nch(41.7% VS25.0% VS0.0%),the left circumflex branch(41.7%VS25.0% VS0.0%),and the affected site(91.7% VS62.5% VS0.0%).There is no direct correlation between the right coronary artery(41.7% VS25.0% VS100.0%)and the left trunk(0.0% VS12.5% V S0.0%).The difference was not statistically significant.4.Risk sco-re: there was no significant difference between TIMI score and GR-ACE score in the incidence of MACE events in early risk stratific-ation of STEMI patients.There was a correlation between CAMI-STEMI score and the incidence of adverse events(r = 0.939).Am-ong the three risk scores,the CAMI-STEMI score(OR = 1.175,95%,1.002-1.379,respectively)has a higher predictive value for the recent occurrence of MACE in patients with STEMI.Conclusion 1.In Tibetan plateau,the incidence of STEMI is more common in the elderly,while the incidence of STEMI in the Han nationality is mainly in the middle-aged.Chest pain was the main clinical manifestation of both groups of STEMI patients.2.Tibetan STEMI patients with hypertension are more common,and more likely to be complicated with heart failure,while Han STEMI patients with high altitude polycythemia and hyperuricemia are mor-e common.3.Male,higher peripheral oxygen saturation on admiss-ion and revascularization are protective factors for recent MACE inpatients with STEMI,while Killip ?-? and hyperuricemia are in dependent risk factors for MACE in patients with STEMI.4.The a-nterior wall of myocardial infarction(including extensive anterior w-all,anterior wall and anterior septal wall)was common in patients with STEMI at Tibetan plateau.Single vessel lesion and left anteri-or descending branch involvement were most common in coronary artery involvement,while different Hb levels were not directly relat-ed to the characteristics of coronary artery disease.5.For the med-ical institutions with the ability to implement PCI,the use of CA-MI score is of higher value in predicting the recent occurrence of MACE in patients with STEMI.