Correlation Of Traditional Chinese Medicine Syndrome Elements Of Acute Myocardial Infarction With Heart Function And Hospital Mortality And Observation Of Therapuetic Effect Of Chinese Medicine

This thesis was divided into two parts.1. Correlation of Traditional Chinese Medicine (TCM) Syndrome Elements of Acute Myocardial Infarction (AMI) with Heart Function and Hospital MortalityObjective:To investigate the distribution of TCM syndrome elements and their correlation with heart function and hospital mortality in patients with AMI in the five Grade III Class A hospitals.Methods:A total of 572 AMI patients admitted from 2002 to 2005 were studied. The general information, risk factors, past medical history, TCM syndrome types, heart function and therapeutic effectiveness were investigated. The data bank was established with ACCESS, the correlation between TCM syndrome elements and heart function, hospital mortality were analyzed with SPSS 13.0 analytic software.Results:Among the 572 AMI patients, there were 8 syndrome elements including qi deficiency, blood deficiency, yin deficiency, yang deficiency, qi stagnation, blood stasis, cold coagulation and phlegm turbidity. The syndrome element of qi deficiency (64.9%) is the most common element among patients of deficiency syndrome, while the syndrome element of blood stasis (88.3%) is the most common one in patients of excess syndrome. The syndrome element of qi deficiency, yang deficiency and yin deficiency were correlated significantly with heart function classification by the Logistical analysis (P<0.05, respectively), while there was no significant correlation between syndrome element of blood stasis or phlegm turbidity with heart functional classification (P>0.05). The patients differentiated as qi deficiency were mainly diagnosed as Killip's heart function of gradeⅠ(38.5%) and gradeⅡ(39.9%), while the patients differentiated as yang deficiency were mainly diagnosed as Killip's heart function of gradeⅢ(37.2%) and grade IV (27.9%). There existed significant difference between the qi deficiency and yang deficiency groups in Killip's heart function (Z=-5.583, P<0.01). There were no significant difference of hospital mortality between qi deficiency group and non-qi deficiency group, nor yin deficiency group and non-yin deficiency group (P>0.05), whereas the hospital mortality in yang deficiency group was much higher than that in non-yang deficiency group (P<0.001).Conclusion:The syndrome element of qi deficiency, yang deficiency and yin deficiency were correlated with heart function, and those patients with yang deficiency were much more severe than those with qi deficiency in poorer heart function. The hospital mortality in yang deficiency group was much higher than that in non-yang deficiency group.2. Prospective Cohort Study of AMI Treated with Chinese MedicineObjective:Adopting prospective cohort study to observe the clinical efficacy of TCM treatment for AMI.Methods:169 AMI patients admitted in Xiyuan Hospital from Jan 2007 to Mar 2009 treated with Chinese medicine more than one month were included into treatment group,165 AMI patients in China-Japanese Friendship Hospital and Anzhen Hospital who hadn't taken any Chinese medicine in the same period were included into control group. The corresponding clinical information was collected. The prognostic outcomes of each patient were observed, including main end-point (death, non-lethal myocardial infarction, revascularization), secondary end-point (cerebrovascular events, rehospitalization due to angina, heart failure and shock), TCM symptom scores and blood-stasis syndrome scores. Data bank was established with ACCESS. The baseline characteristics, TCM symptom scores, blood-stasis syndrome scores were analyzed by SPSS 13.0 analytic software. The methods of Kaplan-Meier and log-rank test were used to evaluate the prognosis. The Logistic regression analysis was used to calculate relative multi-factors. Results:The TCM symptom scores of 12-month follow-up in the treatment group were much lower than that in the control group (3.78±1.61 vs 4.29±1.78, P=0.008). The difference of symptom scores was mainly shown in the symptoms of chest pain, spontaneous perspiration and insomnia. The blood-stasis syndrome scores of 12-month follow-up in the treatment group were much lower than that in the control group (11.07±3.83 vs 13.73±5.25, P<0.01). Rehospitalization due to angina during the 6-month follow-up in the treatment group was lower than that in the control group (2.96% vs 7.88%, P<0.05), and Kaplan-Meier survival curve showed that event-free cum survival in 6-month follow-up rehospitalization due to angina in the treatment group was higher than that in the control group (Log Rank 4.700, P=0.030). Multi-factor analysis showed that Diabetes Mellitus and cardiac insufficiency were hazard factors of end-point, relative risk (RR) of end-point were increased to 1.927(95% CI= 1.004-3.697, P=0.049) and 1.775(95% CI=1.045-3.016, P=0.034) if the Killip's heart functional classification rose 1 grade. Whereas Chinese medicine, PCI and early use of ACEI were protective factors, RR were33.8%(95% CI=0.176-0.649, P=0.001), 27.1%(95% CI=0.143-0.513, P<0.001) and 45.1%(95% CI=0.230-0.884, P=0.020).Conclusion:Chinese medicine could reduce TCM symptom scores and blood-stasis syndrome scores, reduce the 6-month follow-up rehospitalization due to angina. Diabetes Mellitus and cardiac insufficiency were hazard factors of end-point in 6-month, whereas Chinese medicine, PCI and early use of ACEI were protective factors.