Analysis Of Clinical Characteristics And Factors Affecting Short-term Prognosis In The Patients With AMI After Emergency PCI

ObjectiveTo analyze the clinical data of emergency PCI in acute myocardial infarction during hospital,and to analyze the clinical characteristics and the short-term prognosis of PCI,to find out the related risk factors of cardiac insufficiency and cardiac events.MethodsThe retrospective study was used.From Jan of 2000 to Dec 2007,emergency PCI was successfully performed in cardiology department of the second hospital of Tianjin medical university on 730 consecutive cases with AMI.According to age,cases were divided into adult group(＜50 years),pre-aged group(50-70 years)and aged group(＞70 years),the clinical characteristics and the short-term prognosis were compared among the three groups.According to whether cardiac insufficiency happened,cases were divided into two groups.And ccording to whether cardiac events happened,also cases were divided into two groups.The clinical risk factors were compared between the groups.Results1.The mean age of cases were 61.75±10.81years(29-87 years).The adult group were 111cases(15.21%),the pre-aged were 416 cases(56.98%) and the aged were 203 cases(27.71%).(1) The histories of smoking and drinking were lower in pre-aged and aged group as age increase;Females,hypertension,the histories of cardiac artery disease,prior MI,stroke and anaemia were higher(p＜0.05).(2) The typical chest pain as first symptom and anterior MI in adult group were higher than other groups(P＜0.05).(3) As age increase,pulse pressure,heart rates,WBC,HGB,blood K, GLU and BUN increased gradually;Blood Na and TG decreased gradually (P＜0.05).(4) As age increase,three vessels lesion,TIMI 0 grades before PCI and RCA as the IRA increased gradually;Single vessel lesion and LAD as the IRA deseased gradually(P＜0.05).(5) As age increase,the length of stents used in PCI increased gradually,the diameter decreased gradually(P＜0.05).(6) As age increase, the uses of diuretics and cardiotonic glycosides increased gradually(P＜0.05).(7) As age increase,LVEF and LVEDD increased gradually(P＜0.05).(8) As age increase,the happens of heart failure,pneumonia,alimentary tract hemorrhage and death increased(P＜0.05).2.Univariate analysis indicated that age,sex,diabetes,pneumonia,prior MI,TIMI 0 grades before PCI,more than one vessels lesion,heart rates,LVEF,pulse pressure, WBC,HGB,BUN,GLU,LDL-c,peak of CK,peak of CK-MB andΣSTI at admission were significantly associated with the in-hospital cardiac insufficiency.Multivariate logistic rerression analysis showed that age,heart rates,peak of CK-MB,GLU andΣSTI at admission were independent risk factors of cardiac insufficiency with AMI after PCI.3.Univariate analysis indicated that sex,age,heart rates,systolic blood pressure, diastolic blood pressure,pulse pressure,ΣSTI at admission,Hypertension,pneumonia, hyperlipemia,multi-wall MI,WBC,Fgb,Cr,GLU,peak of CK,peak of CK-MB, HGB,Na,Cl,more than one vessels lesion,LVEDD,symptom-to-balloon time,LAD as the IRA and no-reflow after PCI were significantly associated with the in-hospital cardiac events.Multivariate logistic rerression analysis showed that age,GLU at admission,Fgb,peak of CK-MB,more than one vessels lesion,LAD as the IRA,symptom-to-balloon time and no-reflow after PCI were independent risk factors of cardiac events with AMI after PCI.Conlusions1.Onset of the symptom of the AMI were atypical in the aged patients.And also these patients had high incidences of cardiac events and cardiac insufficiency in hospital.The reason may be related to more accompany diseases and more severe of coronary artery lesion,large pulse pressure,more white blood counts,stress hyperglycemia and so on.We should detect the aged coronary artery disease patients to prevent the occurrence of AMI;For AMI patients,we should intervene to prevent cardiac events and cardiac insufficiency to improve prognosis.2.Age,heart rates,peak of CK-MB,GLU andΣSTI at admission were independent risk factors of cardiac insufficiency with AMI after PCI. 3.Age,GLU at admission,Fgb,peak of CK-MB,more than one vessels lesion,LAD as the IRA,symptom-to-balloon time and no-reflow after PCI were independent risk factors of cardiac events with AMI after PCI.