| Objective:To explore the effect of PCI Treatment on the occurrence of hospital death in patients with acute ST segment elevation myocardial infarction(AMI)aged 75 and over compared with simple drug conservative treatment,so as to provide a better treatment strategy for AMI patients aged 75 and over,and provide a clinical treatment basis for reducing the hospital death rate of such patientsMethod:From January 1,2015 to December 31,2018,1381 elderly STEMI patients were selected from the cardiovascular disease diagnosis and treatment center of the first hospital of Jilin University.The inpatient information of these patients was collected through the electronic medical record system.After the inclusion and exclusion criteria,928 eligible elderly STEMI patients were finally selected as the study objects,including 501 males(54%)and 427 females(46%).First of all,the patients were divided into two groups,According to different treatment methods,patients were divided into PCI group(376 cases)and simple drug conservative group(552 cases)to compare the general clinical data characteristics and the occurrence of death events in the hospital.Then,according to whether there was death in the hospital,patients were divided into death group(76 cases)and survival group(852 cases),to explore the influence of different treatment strategies on the prognosis of elderly STEMI patients in the hospital.Result:(1)Compared with the conservative treatment group,the heart rate of PCI group was lower,the time from onset to admission was shorter,the proportion of women in the younger PCI group was lower,the proportion of previous cerebral infarction and myocardial infarction was lower,the proportion of inferior myocardial infarction was higher,the killip grade of PCI group was lower than grade 2,and the proportion of ventricular arrhythmia was lower;The proportion of aspirin,Clopidogrel,statins,heparin,?-blocker and other related drugs used in PCI group was higher,and the proportion of hospital death was lower,the difference between the two groups was statistically significant(P<0.05)(2)The PCI treatment rate was 17.1% in the death group and 42.6% in the survival group,the difference between the two groups was statistically significant(P<0.05).Adjusted by logistic binary regression analysis,age,previous history of diabetes mellitus and heart failure,ventricular arrhythmia occurred in hospital,and the Killip grade ? ? had predictive value for the occurrence of in-hospital death in patients with acute ST segment elevation myocardial infarction aged 75 and over,PCI has a protective effect on avoiding hospital death in patients with acute ST segment elevation myocardial infarction over 75 years old(OR =2.433,95% CI 1.223-4.837,P=0.011)?(3)The age of patients was included in the ROC curve model.The statistical results showed that the age of patients had a predictive value for the occurrence of hospital death(P< 0.05).The area under the curve was AUC = 0.626,and the predictive cut-off value for the occurrence of hospital death was 80.5 years(cut off = 80.5)(4)Six factors,such as heart rate at admission,the location of myocardial infarction,Killip grade,History of taking aspirin,Clopidogrel and ACEI / ARB drugs,were included in logistic regression analysis.It was concluded that attack II grade?III was also of predictive value for in-hospital death of patients with acute ST segment elevation myocardial infarction over 75 years old treated by PCIConclusion:(1)Among all the research subjects,the proportion of patients who choose PCI treatment is lower.Compared with the conservative treatment group,the PCI treatment group has more men and younger age,and the proportion of previous history of cerebral infarction and myocardial infarction Low,heart rate on admission is low,the time from onset to admission is shorter,the proportion of inferior myocardial infarction is higher,Killip grade ? ? and the rate of ventricular arrhythmia is low;aspirin and Clopipine Gray,statins,heparin,?-blockers and other related drugs have a high proportion.The PCI treatment group has a low proportion of hospital deaths.PCI treatment can reduce hospital deaths in patients with acute ST-segment elevation myocardial infarction aged 75 years and older The incidence of the event plays a protective role in avoiding hospital deaths.(2)Age,previous history of diabetes and heart failure,and ventricular arrhythmia in hospital.Killip grade ? III has predictive value for the occurrence of in-hospital death in patients with acute ST segment elevation myocardial infarction over 75 years old.When the age of elderly patients is more than 80 years old,it is more likely to occur in-hospital death events(3)Killip grade?III is also a predictor of in-hospital death in patients with acute ST segment elevation myocardial infarction over 75 years old treated with PCI. |
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