Clinical Analysis Of The 1010 Patients With Acute Myocardial Infarction In Chongqing

0bjective: Acute myocardial infarction (AMI) is a serious type of coronary heart disease, which characterized by a high mortality and disability rate, more complications and a number of prognostic factors. The clinical characteristics and therapeutic measures of AMI are constantly evolving but also regional differences in China. There have been some large-scale surveys of AMI conducted in Beijing, Shanghai, Zhejiang, Shandong and other places. In the study, we documented knowledge about the clinical characteristics, management and risk factors for in-hospital mortality of the patients with AMI in Chongqing to guide and improve the local prevention,treatment and prognosis of AMI and to provide future reference for prospective study.Methods: 1010 case histories of hospitalized patients with AMI in Chongqing were surveyed. All the patients'baseline data, medical history, diagnosis, treatment and drug use characteristics were collected to be analyzed.Result:Reperfusion treatment: Among these patients, 32.2% underwent percutaneous coronary intervention (PCI), and 9.0% received primary PCI, 12.1% underwent thrombolytic therapy. The rate of earlier Reperfusion was 21.1%.Drug use: The rates of Various medication employed in the 1010 patients were: unfractionated heparin(UFH)/ low- molecular - weight - heparin (LMWH) 86.6%, nitrates 76.7%, satins 80.8%, aspirin 90.1%, aspirin plus clopidogrel 74.7%,angiotensin-converting enzyme inhibitors (ACEI)/angiotensin-receptor blocker(ARB) 74.2%,β-receptor blocker 55.1%. There were no statistically significant changes year by year in the rates of drug use. But it was significantly increased in 2007 compared with 2002.Risk factors for 30-day hospital mortality: The overall 30-day hospital mortality is 18.9%.There is a higher hospital mortality in patients with higher Killip class, faster heart rate, higher level of total cholesterol (TC), triglyceride (TG), low-density lipoprotein -Cholesterol (LDL-C), white blood cells (WBC), creatinine (CR), uric acid (UA), body mass index (BMI), fasting plasma glucose and postprandial blood glucose. However, patients with higher level of high density lipoprotein-cholesterol (HDL-C) and higher use of UFH/LMWH, satins, nitrates, aspirin,β-receptor blocker,ACEI/ARB had a lower hospital mortality. Multivariate analysis showed that CR, postprandial blood glucose, Killip class, fasting plasma glucose, heart rate, age, BMI, LDL-C were independent risk factors for 30-day hospital mortality in patients with AMI. But HDL-C, PCI, use of ACEI/ARB were independent protective factors for patients with AMI.Conclusion: Our data suggest that:1. There is a low rate of early reperfusion for AMI in Chongqing.2. There is still existed gap between guidelines and clinical practice in the AMI drug therapy in Chongqing area.3. 30-day hospital mortality is higher than requirements.4. CR, postprandial blood glucose, Killip class, fasting plasma glucose, heart rate, age, BMI, LDL-C, HDL-C, PCI, use of ACEI/ARB were independent predictor of 30-day hospital mortality in patients with AMI in Chongqing.