A Survey Of Current Practice For Acute ST-segment-elevated Myocardial Infarction And An Analysis Of Metaphase Prognosis Factors: Findings From The Multi-central Research

A Survey of Current Practice for Acute ST - segment -elevated Myocardial Infarction and an Analysisof Metaphase Prognosis Factors: Findings from theMulti - central ResearchAbstract PurposeDescribe the characteristics and status quo of pacients suffered from ASTE-MI ( Acute ST - segment - elevated Myocardial Infarction) , filter prognosis factors of patients suffered from STEMI, compare different tactical curative effects, offer evidence - based medicine "s basis while physician make a diagnosis and give treatment to ASTEMI.Methods1. Clinic data: choose successively patients suffered from ASTEMI initially in 15 third - class hospitals in 9 cities from February 2005 - October 2005 , and have a follow — up when the disease comes on after 30 days, 100 dats, and 180 days, then get complete 556 data.2. Observational guideline;Include the patients' characters of base line, clinical interference measure and end point events. The people whose measurement data accord with normal distribution are shown as average standard deviation , and with imnormal distribution are described as median and quartile range;enumeration count data is described as constitute ratio. Compare if the characters of base line has the statistical discrepancy of the patients in different groups, measurement data is checked up as the whole groupa test, enumeration count data is checked up as X~2 test . Take the follow up of the MI symptom 'soutbreak as a jumping - off, and death as a stair end - point, and death combined with the important cardiac events as a sub end - point .3. Result of follow up;Use x test check up to compare the survival rate and non - affair rate of the patients in different groups, when p^O. 05, there are statistical discrepancies among the 3 groups rate. Use Log - rank test check up in depth to compare the survival time in different groups'tactic. When p^O. 05, there are tatistical discrepancies between the two groups.4. Prognosis analysis-. Use Cox proportional hazards recreation model to have single factor and multi - factor analysis. Compose recreation format.Result1. Statistical fescription of observational guideline;Compare the characters of base line of patients in differert groups with interference measure. The guideline with statistical discrepancies is from the disease come - up to treatment. Other factors have no statistical discrepancies in different groups.2. Result of follow up;There is tatistical discrepancy between survival rate and non - affair rate after a follow — up in different groups when the disease comes on after 30 days, 100 dats, and 180 days. Use Log — rank check up in depth to compare the survival time with non — affair time in the 3 groups' pa-cients.3. Prognosis analysis;3. 1 For a pair of 23 factors, analyse Cox single factor of the two end -points. There are 15 variable which significant level is <0. 15, including age, sex, the number of dangerous factors of coronary disease, smoking index, time from the disease come - on to reperfusion treatment, rhythm of the heart, Killip classification, the product of ST - segment - elevated range and leads' number, CK peak value, CK - MB peak value, position of the MI, the strategy of reperfusion , clinical medicine additional therapies ( with anti - blood platelet and ACEI medicine and with anti - blood platelet medicine, ACEI and Chinese medicine ) and the second prevent ( anti - blood platelet medicine, ACEI/ARB medicine, (Bblocker).? 5 ?3.2 Take death as terminal affair. Prognosticate the factors flitered. There are 4 prognostic factors entering Cox recreation model. Senility, Killip classification increase;abroad anterior wall myocardial infraction increase death risk. The relative hazardous degree RR(95% CI) are 1. 045 ( 0. 013 ,1. 078 ) , 1. 566 (1.131,2. 167) and 3. 243(1. 611,6. 529) ,while the second prevent can decrease death risk. The RR(95%CI) is 0.974(0.965,0.983).3. 3 Take death combined important cardiac events as terminal affair. Prognosticate the factors flitered. There are 5 prognostic factors entering Cox recreation model. The number of dangerous factors of coronary heart disease and a-broad anterior wall myocardial infraction increase the the risk of sub end poind. TheRR(95%CI) are 2. 101(1. 225,3. 608) , 1.538(1.119,2.114) and 2. 828(1.705,4.690). However, direct PIC and long-term the second prevent can decrease the risk of sub end point. The RR(95% CI) are 0. 523 (0. 276,0. 989) and 0.989(0. 986,0.992).Conclusionl.The male patients are more than female patients. But as age goes, the tendency weakens graduately. Many people who had coronary heart disease are the most for factors and Killip classification. The most are MI position without anterior wall and interventricular septum.2. Among differernt reperfusion strategys for death end - point, PCI is better than medical treatment. For sub end point, PCI is better than medical treatment and thrombolytic therapy .3. The research of the clinical treatment and neasure of ASTEMI is close to overseas reports. There will be much room on early developing, ACEI machine and the use of pblocker.4. Senility, Killip classification increase and abroad anterior wall myocardial infraction increase th risk of the prime end point of the patients suffered from ASTEMI. But the second prevention can make it decrease.5. Senility, sex, the number of dangerous factors of coronary heart disease and patients suffered from abroad anterior Mi's sub end point's risk increase.However primary Percutaneous coronary intervention, satable and long - term the second prevention can low the risk of the sub end point.