Analysis Influential Factors On Short-term And Long-term Prognosis Reperfusion Treatment In Patients With Acute ST-segment Elevation Myocardial Infarction

Objective: To investigate the main influencing factors on short-term and long-term prognosis in acute myocardial infarction patients, we analyze short-term and long-term clinical outcomes after different reperfusion treatments in acute ST-segment elevation myocardial infarction patients.Methods: 354 patients with ST-segment elevation myocardial infarct- tion from January 2005 to January 2007 in our hospital were enrolled and their clinical dates were analyzed retrospectively. Patients were divided into two groups, intravenous thrombolysis group with 154 cases and direct PCI group with 200 cases, according to the treatment they received. The intravenous thrombolysis group was treated with rt-PA within 12 hours after disease onset, while direct PCI group was treated by PCI within 12 hours. Clinical data of the general characteristics, a number of hospital-related factors (infarction-related artery open rate, incidence rate of myocardial re-infarction, peak concentration of CK-MB, left ventricular end-diastolic diameter, left ventricular ejection fraction, white blood cell counts and glomerular filtration rate, the major cardiac events, severe bleeding and length of hospital stay) and 2-year follow-up prognosis were compared between two groups. Using multivariate analysis method, we analyze the risk factors on short-term and long-term prognosis in acute myocardial infarction patients.Results: There were no significant differences of age, combined diseases, incidence of admission to the implementation of treatment, loca- tion of myocardial infarction, as well as glomerular filtration rate and white blood cell count, peak concentration of CK-MB, the left ventricular end- diastolic diameter, serious bleeding events during hospitalization between two groups. The mortality of thrombolysis group is slightly higher than PCI group, but the difference was no statistical significance. The recanalization rate and left ventricular ejection fraction of PCI group were significantly higher than those of thrombolysis group (P <0.05). Compared with thrombolysis group, PCI group had lower re-infarction rate and incidence rate of heart failure during hospitalization, and the average length of hospital stay also shorter (P <0.05). The 2-year follow-up showed that cardiovascular events and end-point events of PCI group were obviously less than thrombolytic therapy group. PCI treatment can improve the heart function much better than thrombolytic therapy. The fatality rate of acute anterior myocardial infarction was higher, and the leading death cause was malignant arrhythmias and pump failure. Multivariate analysis showed that age, increasing white blood cell counts and lowering glomerular filtration rate in patients were all the risk factors of early death.Conclusion: Compared with intravenous thrombolysis, direct PCI had higher recanalization rate, lower re-infarction rate and lower rate of incidence of heart failure. Direct PCI treatment could improve cardiac function, reduce symptoms, shorten the length of hospital stay, lower long-term illness rate, improve the long-term prognosis and so on. Age, elevated white blood cell counts and reduced glomerular filtration rate were the risk factors of early death in acute myocardial infarction patients, which should be taken more attention.