Study On TCM Syndrome Differentiation Distribution And Related Factors Of Patients With Acute Coronary Syndrome Based On GRACE Score

Objective:1.Focusing on the central position of TCM syndrome in the research of "Combination of Disease and Syndrome" in Chinese medicine,to explore the distribution of TCM syndrome differentiation in patients with ACS,and to analyze the related factors combined with clinical indicators.2.To explore the correlation between the risk assessment of ACS prognosis represented by GRACE score and traditional cardiovascular risk factors,objective clinical indicators and TCM syndrome differentiation,and to find the factors that closely affect the risk degree of ACS,so as to prompt the potential correlation between the TCM syndromes and ACS risk assessment.Methods:A total of 271 ACS patients hospitalized in cardiology department of the affiliated hospital of Nanjing University of Chinese Medicine from May 2020 to February 2021 were selected.The routine clinical data,prognostic risk assessment,severity of coronary artery obstruction,TCM syndrome differentiation and other information were collected,and the case report forms were filled in.The collected data were statistically analyzed.Results:1.The traditional classification of ACS is related to blood lipid(LDL-C and TC)and its history,inflammatory index(hs-CRP,platelet/lymphocyte percentage,neutrophil/lymphocyte percentage,etc.),Fib and cardiac function(P<0.001),and has a general relationship with hypertension history,BMI,HR,etc.(P<0.05),and is not significantly related to specific smoking quantity,smoking cessation or not,diabetes history,HDL,cystatin-C,etc.(P>0.05)2.The distribution characteristics of TCM syndromes of ACS patients:single pathogenesis factors:Qi deficiency syndrome(66.9%)>Yin deficiency syndrome(58.7%)>Phlegm turbidity syndrome(48.0%)>Blood stasis syndrome(39.8%)>Qi stagnation syndrome(24.9%)>Yang deficiency syndrome(8.2%)>Cold coagulation syndrome(0.7%);compound syndrome types:Deficiency syndrome of Qi and Yin(32.0%)>Phlegm turbidity syndrome(24.9%)>Qi deficiency and blood stasis syndrome(15.6%)>Qi stagnation and blood stasis syndrome(13.8%)>Yin deficiency syndrome of heart and kidney(7.4%)>Heart blood stasis syndrome(3.7%)>Yang deficiency syndrome of heart and kidney(2.6%).3.GRACE score is significantly correlated with age,blood pressure,BMI,cardiac function,glycosylated hemoglobin,inflammatory index,fibrinogen,D-dimer,Cystatin-C and the degree of coronary artery obstruction(P<0.01);smoking history,hypertension,diabetes mellitus,hyperlipidemia and other related degrees are general correlated with GRACE score(P<0.05).Smoking and glycosylated hemoglobin are mainly associated with the risk of death(P<0.01),dyslipidemia history and LDL-C are mainly associated with the risk of death/myocardial infarction(P<0.05).4.BMI,LVEF,segmental wall dyskinesia,percentage of neutrophils/lymphocytes,Fib,Cys-C are the independent risk factors of in-hospital and 6-month death or death/myocardial infarction.Smoking mainly affects the risk of death,and LDL-C mainly affects the risk of myocardial infarction;BMI,LVEF,Fib and Cys-C are the independent influencing factors of the risk of 1-year mortality/myocardial infarction combined risk and 3-year mortality risk.Among them,abnormal ventricular wall motion and Fib are the most important influencing factors of in-hospital and 6-month risk,while cardiac and renal function(LVEF,Cys-C)can predict the long-term risk.5.Qi stagnation,Blood stasis,Qi deficiency and Yang deficiency can be used as the basis to distinguish GRACE risk level,in which Qi stagnation and Qi deficiency indicate low risk,Yang deficiency indicate high risk,and Blood stasis indicate higher risk.There is a close relationship between complex syndrome and BMI,smoking history,WBC,creatinine and uric acid(P<0.05).The severity of coronary artery obstruction of Qi deficiency and Blood stasis syndrome is relatively higher(P<0.05).The risk of death in hospital,6-month and 1-year death/myocardial infarction and 3-year death are the highest in Yang deficiency syndrome of heart and kidney,which suggests that some of the syndromes are important for the evaluation of coronary artery obstruction and the risk of prognosis when treating ACS patients.Conclusion:1.The independent prognostic factors of GRACE score in ACS patients include BMI,LVEF,segmental wall dyskinesia,percentage of neutrophils/lymphocytes,Fib,Cys-C;BMI,LVEF,Fib and Cys-C are independent risk factors of 1-year mortality/myocardial infarction and 3-year mortality.2.GRACE risk assessment in patients with acute coronary syndrome is related to TCM syndrome differentiation,Yang deficiency and Blood stasis syndrome of ACS patients indicate high risk,Qi stagnation and Qi deficiency syndrome indicate low risk.Yang deficiency of heart and kidney is an important syndrome to predict the risk of death in hospital,6-month and 3-year mortality.We can take this opportunity to improve the identification of potential high-risk population in the early stage of ACS.3.The distribution of TCM syndromes in patients with acute coronary syndrome is related to some clinical factors,which suggests that TCM syndrome differentiation has potential objective basis.