| Objective:To explore and analyze the treatment characteristics of elderly patients with acute ST segment elevation myocardial infarction(STEMI)who received emergency percutaneous coronary intervention(PCI).The time window distribution of Door-to-balltime(DTB)was analyzed,and the factors affecting the delay of DTB were analyzed;and the prognostic factors affecting the elderly patients with STEMI after emergency PCI were observed.Methods:(1)Taking the Cardiology Department of Chengdu Third People’s Hospital as the research hospital,this study selected 110 elderly patients(≥75 years old)with acute STEMI from January 1,2018 to January 1,2021 as the research object,the selected patients all received emergency PCI treatment,the clinical data of the patients were sorted out,and their treatment characteristics were retrospectively analyzed.(2)Combined with the consensus of Chinese experts in the construction of chest pain centers,according to the DTB delay situation,they were divided into:DTB delayed group(DTB≥90 min)52 cases;DTB non-delayed group(DTB<90 min)58 cases,the patient data were sorted out and analyzed retrospectively.The delay status of DTB and its influencing factors.(3)Further by querying the medical record system,etc.,the elderly patients with acute STEMI after PCI were divided into groups according to whether cardiovascular adverse events occurred,and they were divided into the occurrence group and the non-occurrence group,and the prognostic factors of the patients were analyzed.Results:(1)According to the inclusion and exclusion criteria,among the 110 patients included in this group,there were 56 males,accounting for 50.91%,and 54 females,accounting for 49.09%.The average DTB time of patients was(160.78±241.21)min.Statistics of past medical history showed that smoking history was 25.45%(28/110);angina pectoris 5.45%(6/110),coronary heart disease 11.82%(13/110),myocardial infarction 3.64%(4/110),dyslipidemia 7.27%(8/110),hyperuricemia 2.73%(3/110)),8.18%(9/110)of cerebral infarction,3.64%(4/110)of abnormal renal function,2.73%(3/110)of gastrointestinal bleeding/peptic ulcer,and 3.64%(4/110)of previous PCI.Infarction-related artery(IRA)in this group of patients,right coronary artery(RCA)31.76%(47/148),left circumflex artery(LCX)22.30%(33/148),left anterior descending artery(LAD)45.27%(67/148);number of lesions:three-vessel disease 5.45%(6/110),two-vessel disease 28.18%(31/110),single-vessel disease 61.82%(68/110),normal 4.55%(5/110).The infarct site of the patients:multi-site infarction 26.36%(29/110),inferior wall infarction 22.73%(25/110),anterior wall infarction 50.91%(56/110).Killip rating:55.45%(61/110)for level 1,25.45%(28/110)for level 2,6.36%(7/110)for level 3,and 12.73%(14/110)for level 4.In the place of residence,67.27%(74/110)of urban patients and 32.73%(36/110)of rural patients;medical insurance of patients,of which 12.72%(14/110)paid at their own expense,20.90%(23/110)of new rural cooperative medical system,medical insurance 66.37%(73/110);patients with night onset were 29.09%(32/110).(2)The average time for DTB in patients with acute STEMI in this study was 160.78 minutes after arriving at the hospital;the time for patients to stay in the emergency room was 113.57 minutes,and the average time for patients to leave the emergency room to balloon dilation was 47.21 minutes.See Table 3 for further detailed segmentation.From the analysis of the time of admission to the hospital,91 patients(82.73%)completed the ECG for the first time within 10 minutes,19 patients(17.27%)completed the ECG for the first time within 10 minutes,and 43 patients(39.09%)made the emergency PCI treatment decision within 10 minutes.%),52 cases(47.27%)in the DTB delayed group(DTB≥90 min)in this study;58(52.73%)in the DTB non-delayed group(DTB<90 min),the time distribution of each period is non-normal distribution,after Shapiro-WilK test,(P<0.05).(3)Univariate analysis showed that residence(rural area),angina pectoris,coronary heart disease,cerebral infarction and out of hospital transfer were important factors affecting DTB time delay(P<0.05);There was no correlation between other indexes and DTB delay(P>0.05).(4)Logistic multi factor regression model,the dependent variable was determined by whether DTB was delayed.The results showed that residence(rural area),angina pectoris,coronary heart disease,cerebral infarction and out of hospital transfer were independent risk factors for DTB delay(P<0.05).(5)The incidence of adverse cardiac events in 110 patients during hospitalization was 11.82%(13/110),1 patient(0.91%)with cardiac death had reinfarction,3 patients(2.73%),and 3 patients with post-infarction angina pectoris cases(2.73%),6 cases(5.45%)of atrial fibrillation/flutter.(6)The results showed that there was no statistical difference in smoking history,gender,angina pectoris,myocardial infarction,hyperuricemia,abnormal renal function,gastrointestinal bleeding/peptic ulcer and other medical history data between the two groups(P>0.05);There were significant differences in the indicators of coronary heart disease,dyslipidemia,cerebral infarction,age,and multiple infarction between the two groups(P<0.05).(7)The LVEF in the occurrence group was lower than that in the non-occurrence group,and the difference was statistically significant(P<0.05).(8)Comparing the emergency PCI treatment conditions of the two groups of patients,the proportion of postoperative no-reflow and the delay time of DTB in the occurrence group were higher than those in the non-occurrence group,and the difference was statistically significant(P<0.05);(9)IRA in the two groups RCA and LCX,and there was no statistical difference(P>0.05);while the incidence group accounted for 55.56%of IRA and LAD,and the multivessel disease accounted for 50.00%,which were significantly higher than those of the non-occurrence group.Branch disease accounted for 17.83%,and the difference was statistically significant(P<0.05).(10)There was no significant difference in HDL-c,LDL-c,TC,TG,UA,BUN,PLT and other indicators between the patients with adverse cardiac events during hospitalization and those in the non-occurring group(P>0.05).(11)After emergency PCI in patients with acute STEMI,the independent risk factors affecting the prognosis of patients mainly included DTB delay time,IRA anterior descending artery,multivessel disease,and advanced age(P<0.05).Conclusions:(1)This study shows that the main characteristics of elderly patients with STEMI include:higher age,combined with multiple underlying diseases,multivessel disease,long history of smoking,and multi-site infarction.Most of the patients are urban residents.,have medical insurance.(2)The delay time of DTB in our hospital is mainly in the two stages of the emergency room-balloon expansion time and the time of the patient’s stay in the emergency room.There is still huge room for improvement.(3)After analysis,the main risk factors affecting the delay time of DTB in elderly STEMI patients are residence(rural areas)and transfer from other hospitals.(4)The risk factors affecting the prognosis of the elderly patients who underwent emergency PCI after the onset of acute STEMI included postoperative no-reflow,DTB delay time,IRA anterior descending artery,multivessel disease,and advanced age(≥80y). |
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