The Retrospective Study Of Integrated Traditional And Western Medicine For Acute Myocardial Infarction

ObjectiveThis study reviewed the medical records of coronary heart disease patients with acute myocardial infarction of First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, analyzed the distribution of their treatment, medicine usage, distribution of TCM symptoms, Chinese medicine usage, etc, and compared the prognosis of patients with different treatment (conservative,Thrombolysis,acute PCI, Qingre Recipe, non-Qingre Recipe), so as to provide reference for forward-looking aeute myocardial infarction Traditional Chinese and Western Medieine of the Clinical Pathway Programe.MethodsThrough the retrospective study approach, this study selected the patients whose the first diagnosis as "acute myocardial infaretion" of Guangzhou University of Traditional Chinese Medicine, First Affiliated Hospital of Jan 1,2008～Dec.31,2010, and in accordance with the different treatment divided into the conservative group, thrombolysis group and acute PCI group, according to Chinese medicine decoction with or without use of Qingre recipe, further divided into the conservative groups of Qingre and non-Qingre, thrombolytic groups of Qingre and non-Qingre, acute PCI groups of Qingre and non-Qingre, and compare the prognosis. The main evaluation indicators:the incidence of adverse events during hospitalization (recurrent angina, recurrent MI, acute heart failure, cardiogenic shock, ventricular tachycardia/ventricular fibrillation, death), and the incidence of recurrent angina, recurrent MI, rehospitalization, again PCI, death within 6 months after discharge.ResultsThe cases of 339 patients were collected,205 cases of the conservative group, accounting for 60.5%, thrombolysis 61 cases, accounting for 18.0%,73 cases of acute PCI group, accounting for 21.5%. One conservative group of 104 cases of Qingre Recipe, a conservative group of 70 cases of non-Qingre Recipe;One thrombolysis group of 26 cases of Qingre Recipe, a thrombolysis group of 25 cases of non-Qingre Recipe; One acute PCI group of 63 cases of Qingre Recipe, a acute PCI group of 7 cases of non-Qingre Recipe; In the distribution of TCM symptoms,Shi symptoms are more than Xu symptoms, blood stasis, heat toxin and sputum cloud syndrome evidence in the main in Shi symptoms, according to the order of frequency:blood stasis syndrome (86.1%), heat toxin syndrome (64.9%), sputum cloud syndrome (43.1%). Qi Xu, Yin Xu and Yang Xu syndrome evidence in the main in Xu symptoms, according to the order of frequency:Qi Xu Syndrome (24.8%), Yin Xu Syndrome (18.0%) and Yang Xu Syndrome (4.1%). Medicine use:ACEI or ARB, aspirin, clopidogrel, heparin or low molecular weight heparin, beta blockers, lipid-lowering statin drugs, nitrate utilization close to 100%; Traditional Chinese medicine use: activating blood goods such as Danshen injection is the most used injections, others such as Shengmai and Shenfu injection. Cistanche catharsis oral liquid and edestan soft capsule are the most used oral medicine, others such as Danshen capsules. In the decoction of Chinese medicine, Qingre Huoxue Recipe is the most used, followed by Wendan Recipe,Shengmaisan,Baoyuan,Shenfu Recipe etc. Adverse events during hospitalization and discharge outcome comparison:conservative group vs thrombolysis group vs acute PCI Group:the incidence of postinfarction angina, heart failure, cardiogenic shock, death and discharge Killip3,4 grade,, thrombolysis and acute PCI group are significantly lower than those of the conservative group (P<0.05 or P<0.01); The incidence of postinfarction angina, acute PCI group were significantly decreased compared with thrombolysis group (P<0.05); The incidence of recurrent MI and VT/VF, acute PCI group had decreased compared with thrombolysis and conservative group, but the difference was not significant. Qingre group vs non-Qingre group:either the conservative group, acute PCI group or thrombolysis group, The incidence of postinfarction angina, recurrent MI, heart failure, cardiogenic shock, VT/VF, death, discharge Killip3,4 grade, the Qingre group was lower than those of non-Qingre, but the differences were not significant. Adverse events during the six months follow-up comparison:conservative group vs thrombolysis group vs acute PCI Group:the incidence of recurrent angina, re-admission, PCI, acute PCI group was significantly lower than the conservative group (P<0.05 or P <0.01), thrombolytic group was lower than conservative group, but the difference was not significant; the incidence of recurrent angina, the acute PCI group was significantly decreased compared with thrombolysis group (P <0.05). The incidence of recurrent MI and death, the acute PCI group had decreased compared with the thrombolysis group and the conservative group, but the difference was not significant; Qingre group vs non- Qingre group:the incidence of recurrent angina, the conservative Qingre group was significantly lower than the conservative non- Qingre group, the difference was significant (P<0.01), for thrombolysis and acute PCI patients, the Qingre group was lower than non- Qingre group in the incidence of recurrent angina either, but differences were not significant. Whether conservative, acute PCI or thrombolytic group, the Qingre group had decreased compared with the non-Qingre group in the incidence of recurrent MI, rehospitalization, PCI, death, but the differences were not significant.ConclusionConservative treatment still accounted for the largest proportion in all AMI patients, acute PCI has exceeded thrombolysis to be the primary means of emergency reperfusion in our hospital. The distribution of TCM symptoms of AMI patients showed that Shi syndromes and heat syndrome were more than Xu syndromes and cold syndrome. Heat toxin syndrome accounted for 64.9%, suggesting that heat-toxin is also the main pathogenesis of AMI and shoud not be ignored. Western medicine strictly follow the guidelines. Chinese medicine treatment including activating blood, clean heat, clean phlegm, Yiqi, Ziyin, Wenyang etc. Reperfusion therapy was superior to conservative treatment to improve prognosis of AMI patients, and using Qingre treatment in dialectical way can significantly decline the incidence of angina in patients of conservative group and may improve the prognosis,which remind us that Qingre recipe shoud be a Chinese AMI treatment guideline and shoud be written into clinical pathway.