| Objective: To analyze the clinical characteristics of patients with acute ST-segment elevation myocardial infarction(STEMI)and to investigate the factors that influence the28-day mortality rate of patients.Research method: Patients with acute STEMI who admitted in the emergency department of the Hospital from January 2017 to September 2017 were selected for the study,and clinical data were collected from the patients,and 28-days follow-up was performed by telephone or by reviewing medical records,and they were divided into two groups according to their outcomes after 28 days of presentation,with 21 cases in the death group and 68 cases in the survival group,and risk factors were screened by univariate inter-group comparisons.The variables with group comparision were included in the multifactorial logistic regression analysis to find out independent risk factors associated with the 28-days mortality of patients,and the predictive value of these risk factors was assessed by ROC analysis.Results: 170 patients with acute STEMI admitted to the emergency department were included in this study,of whom 46(27.0%)were female,with a mean age of(64.3±13.2)years,147(86.5%)were in the survival group,and 23(13.5%)were in the death group.There was no statistically significant difference between the two groups in terms of gender,body mass index,combined underlying diseases,and smoking and drinking history(P > 0.05).There were no statistically significant differences in age(years)(62.6 ± 13.2 vs.69.2 ±11.9,P=0.025),D-dimer level(μg)[440.0(250.0,980.0)vs.600.0(500.0,1400.0),left ventricular ejection fraction(%)[55.0(48.0,60.0)vs.49.0(42.0,53.0),P= 0.001] and24-hour GRACE score at admission(score)[120.0(113.0,132.0)vs 151.0(129.0,167.0),P=0.001] and whether direct PCI was performed [100(68.0%)vs 10(43.5%),P=0.04 ]were statistically significantly different,however,there was no statistically significant difference in whether patients underwent PCI in <90 minutes [64(43.5%)vs.5(21.7%),P=0.056](P>0.05).After multifactorial analysis,the patient’s GRACE score within 24 hours of admission(OR=1.027,95% CI 1.010-1.045;P=0.001)was an independent risk factor for their28-day morbidity and mortality,and the patient’s left ventricular ejection fraction(OR=0.933,95% CI 0.881-0.988;P=0.018)was a significant predictor.The ROC curve for the predictive value of 28-day mortality in STEMI patients showed that the cut-off value of GRACE score for predicting 28-day mortality in STEMI patients was 140.2,with an AUC of 0.758 [95% CI(0.639,0.878)],sensitivity of 69.60% and specificity of 83.00%;the cut-off value of LVEF for predicting 28-day mortality in STEMI patients was 51.5%,with a specificity of 83.00%.The cut-off value of LVEF for predicting death at 28 days in STEMI patients was 51.5%,with an AUC of 0.723 [95%CI(0.608,0.838)],sensitivity of 73.9%,and specificity of 69.4%.Conclusion:The difference of age,D-dimer level,LVEF,GRACE score within 24 hours of admission,and left ventricular ejection fraction level were statistically significantly in different prognostic groups of patients with acute STEMI.GRACE score and LVEF were independent correlates of predicting 28-days mortality in patients with STEMI and had outstanding predictive value for patient prognostic assessment. |
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