Analysis Of 10-year Diagnosis And Treatment Of Emergency STEMI Chest Pain Patients In Wafangdian City

ObjectiveTo explore the diagnosis and treatment status of STEMI patients in Wafangdian City,and analyze the impact of intervention time on the prognosis of patients,so as to clarify the medical level of high-risk patients with chest pain in Wafangdian City,and provide reference for the development of Wafangdian chest pain center in the future.MethodAccording to the hospital electronic information system,there were 8468emergency chest pain patients in Wafangdian county hospital from January 2008 to January 2018,including 7855 patients with ACS chest pain.In this study,2119 patients with acute ST segment elevation myocardial infarction were selected as the research object and analyzed retrospectively.The general information（gender,age,hypertension,diabetes,hyperlipidemia,history of stroke and smoking）and diagnosis and treatment status（diagnosis,treatment and drug use）of all subjects were collected.The gateball time and referral of patients were recorded.The incidence of complications and mortality in different years were observed and calculated.The prognosis in this study included the incidence of cardiovascular events,mortality,cardiac function indexes,serum c Tn I,CK-MB,NT pro BNP,D-D levels and cardiac function.Result（1）General data:2119 patients with acute ST segment elevation myocardial infarction in Wafangdian City from 2008 to 2018 were selected,including 166 in 2008,233 in 2009,133 in 2010,113 in 2011,115 in 2012,136 in 2013,168 in 2014,104 in2015,250 in 2016,319 in 2017 and 382 in 2018.1392（65.69%）were male.There were727 female patients（34.31%）,1079 hypertension patients（50.92%）,628 diabetes patients（29.64%）,526 hyperlipidemia patients（24.82%）,138 stroke patients（6.51%）,741 smoking patients（34.97%）.There was no statistical difference in age,gender,history and smoking history of the patients in the first five years（2008-2012）and the later 5 years（2013-2018）.（2）Goal time（95.02±43.76 min）for patients in the following 5 years group was lower than that（81.67±24.57min）in the previous 5 years,and the difference was statistically significant（P<0.05）.The referral rate of patients（5.96%）in the following 5years was significantly lower than that of the previous 5 years（14.47%）,and the difference was statistically significant（P<0.05）.The mortality rate of the patients in the following five years was significantly lower than that of the previous 5 years（7.76%）,and the difference was statistically significant（P<0.05）.There was no significant difference in Killip level,left ventricular ejection fraction and incidence of ventricular aneurysm in the first 5 years group and the later 5 years group（P>0.05）.（3）The surgical treatment rate（65.93%）of the patients in the following five years was significantly higher than that of the previous 5 years（46.19%）,while the conservative treatment rate（34.07%）was significantly lower than that of the previous 5years（53.81%）,and the difference was statistically significant（P<0.05）.Proportion of ca²⁺antagonists drug use,vascular converting enzyme inhibitors,andβreceptor blockers（66.45%,67.18%,90.21%）was significantly higher than that of the first five years（50.53%,55.66%,68.55%）,and the difference was statistically significant（P<0.05）.（4）Logistic regression analysis showed that gateball time,surgical treatment was performed within 24 hours and Ca²⁺antagonist treatment factors are risk factors affecting the prognosis of the disease,and the differences were statistically significant（P<0.05）.The results showed that there was significant difference in the overall survival rate between the two groups.The overall survival rate within 24-h surgical treatment group was better than that after 24-h surgical treatment group（?²=4.385,P=0.036）.In the conservative treatment,The overall survival rate in the Ca²⁺antagonists,vascular converting enzyme inhibitors,andβcalcium channel blockers used group were better than that in the non drug treatment group（?²=3.857,P=0.041）.Conclusion（1）In 2008-2018,the incidence rate of STEMI in Wafangdian City emergency ACS chest pain increased.The proportion of patients with chronic diseases,hypertension and diabetes was higher,and the proportion of smoking history was higher.（2）The use rate of Ca²⁺antagonists,angiotensin-converting enzyme inhibitors,βreceptor blockers in patients with acute ST segment elevation myocardial infarction from 2013 to 2018 increased significantly,and the mortality of patients decreased.Compared with the previous five years,due to the establishment of chest pain center in the latter five years,the number of patients using interventional surgery increased,and the popularity of interventional surgery and patients’acceptance of surgery were higher.Therefore,the mortality of patients in the latter five years of the hospital decreased significantly.（3）In the next five years,the referral rate of emergency patients with ST segment elevation myocardial infarction in Wafangdian City was significantly reduced,and the average gateball time of patients was significantly shortened,which can achieve certain emergency effect and fully respond to the policy of serious illness not leaving the county.（4）Gateball time,surgical treatment was performed within 24 hours and Ca²⁺antagonist treatment are the risk factors affecting the prognosis of the disease.The treatment of patients with emergency chest pain in Wafangdian hospital can promote early emergency intervention,shorten the time of referral delay,improve the prognosis of patients and increase the overall survival rate of patients.