Analysis Of Relationship Between Clinical Features And Death In275Acute St-elevation Myocardial Infarction Patients

Objective：To analyze clinical data of275acute st-elevation myocardial infarction(STEMI) hospitalized patients in retrospecte, discuss the correlationshiop betweenclinical features and death in STEMI hospitalized patients.Methods：Ranged from January2007to July2011, check275cases,who werediagnosed acute st-elevation myocardial infarction (STEMI), in cardiovasocular centerof the first affiliated hospital of Anhui medical university. To analyze gender, age, basicdisease, electrocardiogram results, the laboratory test results, coronary angiography,PCI and drug treatment, hospitalization days of all the patients in special statisticways.To discuss clinical features of the patients who were diagnosed STEMI,275cases of STEMI were divided into middle-aged group（age <60,n=150） and old group（age≥60,n=125）,make comparison about the characteristic performance of theclinical data between two groups. At the same time275cases of hospitalized patientswere divided into hospital STEMI survival group (n=250) and died group (n=25),undergo single factor analysis of the data between the two groups,try to find out whichone make effects on the risk of mortality in STEMI hospital patients.Attributingassociated risk factors(P <0.05) to many factors Logistic regression analysis, todiscusse related factors of mortality of STEMI hospital patients.Reasults: 1.Clinical material characteristics:275cases of patients with STEMI, youngest19yearsold,the biggest90years old; Male:227cases (82.5%),Female:48cases (17.5%),averageage:(64±13) years. Hypertension:140cases (50.9%) have diabetes:49cases (47.8%),atrial fibrillation:15cases (5.5%), smoking:117cases (42.5%); Drug treatment:113cases（41.1%）,accepted thrombolysis:3cases（1.1%）, recieved percutaneous coronaryinterention (PCI):159cases (57.8%), including emergent PCI51cases.Coronaryangiography single lesions in52patients (35.1%), two lesions56cases (35.2%), threeteams of lesions and45cases (28.3%), basically normal2cases(1.3%),myocardialbridge1cases(0.6%) among regular PCI.2.275cases of STEMI were divided into middle-aged group（n=150,53.7%） and oldgroup（n=125,46.3%）, according to the range of age; Making comparison of baselinedata betweem two groups:①gender composition.older group,male:97cases(77.0%)femal:29cases (23.0%); younger and middle-aged group,male:130cases (87.2%),female:19cases (12.8%), the ratio of females in older group was higher than inthe young and middle-aged group, gender difference was statisticallysignificant (P <0.05).②Index of hemoglobin （125.10±20.67）g.L-1,platelet count（183.32±66.99）×10^9L-1and triglycerides （1.38±0.81）mmol.L-1in old groupmore significantly decreased than in middle-aged group hemoglobin（137.08±19.64）g.L-1, platelet count（203.91±75.36）×10^9L-1and triglycerides（1.73±1.02）mmol.L-1(P <0.05);③In ECG,the number of young and middle-aged group（n=12,9.6%） who had right ventricular myocardial infarction was significantly morethan the older group （n=27,18.1%）(P <0.05).④In echocardiogram,the leftventricular ejection fractions (LVEF) of the young and middle-aged group(0.54±0.11)was significantly higher than that of the older group(0.49±0.12)(P <0.05).⑤In theincidence of risk factors:The number of the older group with hypertension(n=75,59.5%）,atrial fibrillation（n=11,8.7%）, respiratory tract infection（n=39,31%）, arrhythmia（n=74,58.7%）, heart failure（n=41,32.5%） was significantly more than that of the young and middle-aged group with hypertension(n=65,43.6%）, atrial fibrillation（n=4,2.7%）, respiratory tract infection（n=21,14.1%）, arrhythmia（n=69,46.3%）, heartfailure（n=26,17.6%）(P <0.05);⑥in the treatment: the number of the young andmiddle-aged group who accepted PCI（n=96,64.4%） meanwhile using Tirofiban（n=69,46.3%）was significantly more than the old group（n=31,24.6%）(P <0.05).3. Analysis of hospitalized patients with STEMI in single-factor statistic ways shows:analyze survival group (n=250,90.9%) and died group (n=25,259.1%) in275cases with STEMI, then,analyzing two groups in single-factor statistic ways, weconcluded:142cases survived (56.8%) and seven cases died (28.0%) in young andmiddle-aged group;108cases (43.2%) survived and18cases (72.0%)died in oldgroup.the ratio of mortality of old group was higher than young and middle-agedgroup (P <0.05).②the average systolic blood pressure (120.78±18.33)mmHg andaverage diastolic blood pressure (72.83±11.67) mmHg in survival group weresignificantly higher than in the died group in which the average systolic blood pressure(103.84±24.67) mmHg and mean diastolic blood pressure(59.92±16.01) mmHg,(P<0.05).③the average heart rate in the survival group (75.23±13.95) beats/minwas significantly slower than in the died group in which the average heart rate (84.36±23.60)beats/min (P <0.05).(4)the raitio of STEMI patients together with atrialfibrillation (n=10,4.0%), heart failure,(n=55,22.1%), cardiagenic shock (n=5,2.0%) insurvival group, was lower than that of STEMI patients together with atrial fibrillation(n=5,20%), heart failure,(n=12,48%), cardiagenic shock (n=6,24%) in the diedgroup(P <0.05).(5) the raitio of application of aspirin245cases (98.0%), clopidogrel in241cases (96.4%), tirofiban in97cases (38.8%), statins,235cases (94.4%), ACEI168cases (67.2%) was significantly higher in survival group than in the died group inwhich the raitio of application of aspirin in21cases(84.0%), clopidogrel in22cases(88.0%), three cases of tirofiban(12.0%), statins20cases (83.3%) of ACEI8cases (32.0%)) of patients,(P <0.05).⑥the raitio of smokers in survival group,111cases(44.4%) was significantly higher than those in died group,6cases (24.0%)(P <0.05).4. Analysis of STEMI hospitalized patients in multiple factors Logistic regression waysshowed that: in275cases of STEMI,according to analyzing the live group and the diedgroup in single-factor statistic ways, we made the conclusions STEMI mortality hascorrelationship with the age, heart rate,systolic blood pressure, diastolic blood pressure,cardiac shock, atrial fibrillation and ACEI. Further reaserch about the possibleassociated risk factors in more factors Logistic regression analysis showed that cardiacshock (OR=8.742,95%CI1.897～40.276,P=0.005) and atrial fibrillation (OR=3.886,95%CI1.034～14.604,P=0.045) were the independent risk factors about mortality ofSTEMI patients (P <0.05).Conclusion：1.The ratio of STEMI hospitalized patients together with hypertension,addiction tociggeretts is high, male patients of STEMI were significantly higher than femal.2.The ratio of STEMI hospitalized patients who accepted PCI is high, more than50%.Regular drugs treatment has became to be a basic treatment.3.The risk of STEMI mortality significantly increased with age, heartquickly beats, low systolic and diastolic blood pressure, arisen with cardiogenic shock,atrial fibrillation, heart failure4. Together with cardiogenic shock and/or atrial fibrillation was an independent dangerfactor for hospital mortality...