Retrospective Analysis And Follow-up Study Of Acute Myocardial Infarction

Obgective:To investigate the variation trend of clinical characteristics,mortality and influencing factors of acute myocardial infarction(AMI)patients.And summarize the experience in the diagnosis and treatment of AMI,to provide real clinical data for improving the diagnosis and treatment of AMI and reducing the short-term and long-term mortality of AMI patients.Methods:A total of 4868 patients who hospitalized for AMI in our hospital from January 1,2007 to December 31,2018 were reviewed,and 3526 patients were followed up.The annual percentage change(APC)method was used to analyze the variation trend of the constitute ratio and the in-hospital mortality of ST segment elevation myocardial infarction(STEMI)and non STEMI(NSTEMI).At the same time,statistical approach as correlation,regression,survival were used to analyze the influence and predictive factors of in-hospital and longterm mortality of AMI patients.Results:1、Retrospective analysis of AMI(1)During the 12 years,the number of AMI cases increased,the proportion of STEMI decreased from 84.3% to 54.8%,the proportion of NSTEMI increased from 15.7% to 45.2%,and the hospitalization ratio of STEMI and NSTEMI decreased from 5.4:1 to 1.2:1.Advanced age,female,hypertension,diabetes,dyslipidemia,previous PCI/CABG treatment,multiple coronary arteries and left main artery disease were independent risk factors for NSTEMI.The mean age of onset of AMI decreased,and the proportion of patients with type 2 diabetes increased(from 21.0% to 30.1%).The overall in-hospital mortality rate of AMI was 5.4%,and the annual in-hospital mortality rate decreased from 7.0% to 4.3%.The mortality rate of patients without PCI during hospitalization was significantly higher than that of patients with primary PCI and elective PCI(28.9% vs 3.7% vs 1.6%,P < 0.001).The proportion of patients without PCI decreased from19.2% to 6.0%,and that of STEMI patients without PCI decreased from 13.0% to 5.3%,the proportion of NSTEMI patients who did not receive PCI decreased from 52.8% to 6.8%.The mortality rate of AMI patients during hospitalization was higher in females than in males(9.3% vs 4.2%,P < 0.001).Cardiogenic shock was the primary cause of death during hospitalization(37.8% and 31.4% of male and female deaths respectively),the secondary cause of death in males was mechanical complications(24.4%),and the secondary cause of death in females was multiple organ failure(29.5%).During the 12-years,the use of statins increased from 84.3% to 98.5%,while the use of ACEI/ARB and β blockers(approximately 54.5% and 61.5%)did not change significantly.Further analysis showed no difference in the use of ACEI/ARB in anterior wall myocardial infarction and non anterior wall myocardial infarction.(2)Advanced age,grade III-IV cardiac function,cardiogenic shock,sinus arrest,ventricular fibrillation,urea,white blood cell,blood glucose,high Gensini score,and no PCI treatment were the independent risk factors for AMI death in-hospital,while primary or elective PCI,use of statins,and ACEI/ARB drugs were protective factors for death during hospitalization.Predictors of in-hospital death include: Age ≥73.6 years(sensitivity 65.5%,specificity 73.3%),urea≥7.1mmol/L(sensitivity 63.2%,specificity 75.7%),white blood cell ≥12.47×109/L(sensitivity 44.6%,specificity 84.1%),Gensini score ≥67(sensitivity 63.4%,Specificity 69.3%),blood glucose > 7.1(sensitivity 69.7%,specificity 52.6%).2、Analysis of follow-up data of AMI patients(1)The 1-year,3-year,5-year,10-year and total mortality rates of AMI patients were 3.3%,9.3%,12.2%,14.1% and 14.6%,respectively.The 1-year,3-year,5-year,10-year and total mortality of female patients were higher than that of male patients(5.0% vs 2.9%,14.4% vs 7.9%,18.8% vs 10.4%,21.3% vs 12.2%,21.5% vs 12.7%,P < 0.05).There were no significant differences in 1-year,3-year,5-year,and 10-year mortality between STEMI and NSTEMI patients(3.3% vs 3.5%,9.2% vs 9.4%,11.8% vs 12.9%,13.9% vs 14.6%,14.8% vs 14.4%,P > 0.05).The 1-year,3-year,5-year,10-year and total mortality rates of patients who did not receive PCI were significantly higher than those of patients with PCI(12.3% vs 2.6%,31.9% vs 7.4%,41.3% vs 9.75,44.6% vs 11.5%,45.3% vs 12.0%,P < 0.05).(2)The independent risk factors for long-term mortality in patients with AMI were advanced age,diabetes,smoking,elevation of urea,creatinine,lipoprotein A and troponin,while primary or elective PCI,use of statins,β-blockers and elevation of hematocrit were protective factors.Conclusions1、In the past 12 years,the number of AMI patients in our hospital continued to increase,among which the proportion of NSTEMI increased significantly.The increase in the elderly population,in the prevalence of basic diseases such as hypertension,diabetes and dyslipidemia,and the popularization of secondary prevention drugs for coronary heart disease are thought to be the causes.Therefore,clinicians need to raise awareness of NSTEMI and improve the diagnosis and treatment of NSTEMI.2、In the past 12 years,AMI in-hospital mortality was significantly reduced,especially for NSTEMI,but not for STEMI.The reason was that there were more female STEMI patients who did not receive PCI from 2014 to 2017 and the mortality increased significantly.It indicate that active opening of infarct-related vessels in the early stage of AMI can significantly reduce the early mortality of AMI patients.Therefore,it is necessary to strengthen the public’s understanding of chest pain and its treatment,especially for elderly and female patients,when chest pain attacks should be timely treatment,reduce prehospital delay and improve the rate of early diagnosis and early treatment.3、PCI(whether primary PCI or elective PCI)can improve the early and long-term prognosis of AMI patients,and primary PCI is superior to elective PCI.In addition to PCI,the prognostic factors of AMI include the use of statins,β-blockers,ACEI/ARB drugs,diabetes mellitus,smoking and other factors.There was no change in the use of beta-blockers or ACEI/ ARBs over the 12-year period.This suggests that clinicians,on the one hand,should continue to learn to provide the best treatment for patients;On the other hand,we should attach importance to the education of patients and emphasize the importance of smoking cessation and medication compliance.