| Objective To analyze the trends of clinical characteristics,diagnosis and treatment patterns and hospitalization outcomes,distribution characteristics in different populations and in-hospital death and its risk factors of 4726 patients with acute myocardial infarction undergoing emergency PCI(Percutaneous Coronary Intervention,PCI)in General Hospital of Ningxia Medical University from 2010 to 2019.Methods Through medical record retrieval,the medical records of all patients with acute myocardial infarction undergoing emergency PCI(including general clinical datas,cardiovascular risk factors,complications,results of coronary angiography,PCI procedures,adverse events and hospitalization outcomes,etc.)were collected for retrospective analysis.First of all,taking 2 years as a time period,all patients were divided into 5 groups from far to near,namely:2010-2011 group,2012-2013 group,2014-2015 group,2016-2017 group and2018-2019 group,to analyze the trends of the demographic data,clinical characteristics and in-hospital MACCE(Major Adverse Cardiac and Cerebrovascular,MACCE)over time;Then,the patients were divided into three groups according to their age: < 60 years old group,60-75 years old group and > 75 years old group,to analyze the gender differences in general clinical data,surgical conditions and hospital outcomes in different age groups.Finally,the patients were divided into death group and survival group according to the in-hospital outcomes to explore the nosocomial mortality rate and risk factors related to death.Results 1.Demographic data,clinical characteristics,in-hospital MACCE events and mortality of patients with acute myocardial infarction undergoing emergency PCI :a total of4726 patients with acute myocardial infarction undergoing emergency PCI were included in this study,with a mean age of 59.9±11.7 years.There were 3802 males(80.4%)with an average age of 58.28±11.62 years old and 924 females(19.6%)with an average age of66.56±9.55 years old,and the male to female ratio was 4.1:1.Among them,including 87%(4113)of STEMI(ST-segment elevation myocardial infarction,STEMI)patients and 13%(613)of NSTEMI(Non-ST-segment Elevation Myocardial Infarction,NSTEMI)patients.The mean rate of increase in patients was 1.98% over the 10-year period.The most common cardiovascular risk factors were smoking(67.4%),hypertension(50.6%),dyslipidemia(34%)and type 2 diabetes(26%),among which smoking,dyslipidemia and type 2 diabetes showed a decreasing trend(all trend P < 0.05),while hypertension was increasing(trend P < 0.05).The most common hospital complications were heart failure(17.6%)and pulmonary infection(17.4%),both of which showed a decreasing trend(P < 0.001).The pre-hospital treatment time of patients was gradually prolonged(trend P < 0.001),and the door to balloon time was shortened year by year(trend P < 0.001).The rates of concurrent treatment of partial or all non-infarct arteries during PCI varied in stages,the peak value was 16.1% from 2014 to2015.The incidence of MACCE and all-cause mortality in hospital were 10.7% and 2.6%respectively,and there was no time change(trend P > 0.05).2.Analysis of population and disease characteristics in different age groups:women accounted for 57.5% of patients aged60-75,while men accounted for 54.8% of patients under age of 60.Compared with patients aged 60-75 and < 60,patients aged over 75 were more likely to suffer from heart failure(28.1% vs 21.5% vs 12.3%,P < 0.001),pulmonary infection(26.8% vs 20.9% vs 12.3%,P <0.001),cardiogenic shock(9.7% vs 5.6% vs 3.1%,P=0.009),multiple organ failure(2.2% vs1.7% vs 0.8%,P< 0.001)and cardiac arrest(3.9% vs 1.7% vs 1.1%,P< 0.001),.And the in-hospital mortality was also high(5.5% vs 3.4% vs 1.16%,P< 0.001).In addition to smoking(22.5% vs 78.30%,P < 0.001),myocardial infarction history(8.9% vs 9.2%,P=0.735)and PCI history(5.2% vs 5.7%,P=0.543),female patients were complicated with hypertension(67% vs 46.6%)P=0.026),dyslipidemia(37.1% vs 33.2%,P=0.024),stroke history(11.5% vs 7.4%,P< 0.001)and chronic renal failure history(2.4% vs 1.4%,P< 0.001)were all higher than male patients.In addition,the symptoms to door time of female patients was longer than male patients(8.86±9.31 h vs 7.5±7.29 h h,P< 0.001),and the in-hospital mortality rate was higher(4.2% vs 2.2%,P< 0.001).3.Analysis of risk factors for in-hospital death: Multivariate regression analysis showed that age(OR = 2.77,95% CI: 1.16 ～ 6.73,P<0.001),heart rate(OR = 1.01,95% CI: 1.01 ～ 1.02,P=0.004),cardiogenic shock(OR=7.06,95% CI : 3.11 ～ 16.01,P< 0.001),pulmonary infection(OR=2.61,95% CI: 1.18 ～ 5.81,P=0.018),ventricular tachycardia(OR=6.82,95% CI: 2.85 ～ 16.29,P< 0.001)and the disease begins with loss of consciousness or syncope(OR = 4.64,95% CI: 4.53 ～ 4.66,P< 0.001)were independent risk factors for in-hospital death of patients.Conclusion 1.The average age of patients with acute myocardial infarction undergoing emergency PCI was about 60 years old,and males were 4.1 times as likely as females.Women are older and more complications than men.Patients over 75 years old was prone to suffer from severe complications such as heart failure,pulmonary infection,cardiogenic shock and multiple organ failure.2.The most common cardiovascular risk factors were smoking,hypertension,dyslipidemia and type 2 diabetes.Smoking,dyslipidemia and type 2diabetes were on the decline while hypertension was on the rise.3.The incidence of total MACCE and all-cause mortality did not decrease in the hospital,but the incidence of heart failure decreased significantly.And MACCE increases with age.The fatality rate of female patients was higher than that of male patients,which is related to the older age of female patients,the delayed treatment and more complications.4.Age,admission heart rate,cardiogenic shock,pulmonary infection,ventricular tachycardia and lossing of consciousness or fainting as the first symptoms were independent risk factors for nosocomial death. |
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