| BackgroundWith the change of the dietary structure, the population ageing, the increasing of hyperlipidemia, hypertension, diabetes and smoking, the incidence and morbidity of coronary heart disease (CHD) are increasing year by year in our country. It is well known that CHD has become the world’s number one cause of death and disability in21st century. As severest type of CHD, acut ST-segment elevation myocardial infarction (STEMI) are attracting more attention. Epidemiological and clinical studies of STEMI flourished greatly.STEMI results from the interruption of blood supply to the myocardium, causing the myocardium to be damaged. The vulnerable plaque rupture, and the following thrombosis are the main pathological mechanism factors of STEMI. The early and effective myocardial reperfusion is the best therapy for reducing the area of myocardial necrosis, saving the dying myocardial cells and improving heart function and clinical outcome. Percutaneous coronary intervention (PCI), providing the most safe and effective treatment for patients with acute myocardial infarction, has been applied widely. Open the infarct-related artery as soon as possible and revcover the reperfusion to the dying myocardium is the best theraputic stactics for STEMI. There are a large number of studies have proven that reperfusion after the AMI attack could save the dying myocardial cells, preserve cardiac function and improve prognosis. PCI has become a routine medical therapy method in the experienced heart centers. However, risk factors that affect the prognosis of the STEMI patients remain poor.Objective1To assess the clinical characteristics of age-related acute ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention.2To investigate and analyze whether female is a significant independent predictor of in-hospital clinical outcomes in patients with acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention.3To explore the cause of cardiac death in patients with acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. In order to identify high-risk patients, and provide a basic guidance of treatment in patients with acute ST-elevation myocardial infarction treated with primary percutaneous coronary intervention.Methods1Study populationAll STEMI patients accepted primary percutaneous coronary intervention who were admitted to department of vasculocardiology, Wuhan General Hospital, Guangzhou Military Command between July2009and July2012were enroled in my study. The statistical results were filled in the Excel table.307patients with STEMI were enrolled including245males and62females, with the mean age being62.3±12.3.2Research MethodsA detailed review of the medical record was made and clinical variables including baseline characteristics, Coronary angiography results, and the incidence of adverse events during hospitalization were analyzed. Baselinec characteristics include age, gender, cigarette smoking, history of hypertension and diabetes mellitus and Killip classification of cardiac function. Patient’s adverse outcomes were defined as cardiogenic shock, congestive heart failure, malignant arrhythmia and cardicgenic death.3Statistical AnalysisThe SPSS statistical package for Windows version13.0was used for the statistical analysis. Continuous variables were expressed as mean value±standard deviation (mean±SD), and the comparison between groups was made using2independent-samples t or t’test; Categorical variables were by number (%), the chi-square test was used to compared categorical variables; Logistic regression was used to multiplicity analysis. A P value<0.05was considered statistically significant.Results1Part one of study1.1Grouping307patients with STEMI admitted From July2009to July2012, accepted PCI were retrospectively Analysis.307patients were divided into three groups according to age:non-elderly group (<65years old). Low-elderly group (65-75years old), and high-elderly group (≥75years old). Bageline parameters (age, gender, history of hypertension diabetes and smoking, myocardial infarction site, heart rate, blood pressure, Killip classification), serum biochemical index and angiographic characteristics of3groups were collected. Clinical follow-up end point was adverse cardiac event including cardiac death, cardiac shock, malignant arrhythmia, acute heart failure.1.2Risk factors analysisThere were no significant differences in the history of diabetes, Anterior wall myocardial infarction, hospital stay, prehospital delay time, Heart rate, blood pressure among three groups (P>0.05). Compared with non-elderly group, the low-elderly or high-elderly group have less femal patients and less history of hypertension (P<0.05). The history of smoking and cardic function Killip classification≥Ⅱ were higher in high-elderly group than other groups (P<0.05).There were no significant differences in the white blood cell count, glycosylated hemoglobin, high density lipoprotein cholesterol (HDL-C) level, lipoprotein (a), lipoprotein (a), creatine kinase muscle-brain fraction (CK-MB), troponin T (TnT), super sensitive c-reactive protein (hs-CRP) among three groups (P>0.05). Hemoglobin, total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) level were higher in non-elderly group than other groups (P<0.05). in the low-elderly group or high-elderly group than in non-elderly group. Serum creatinine level was higher in the low-elderly group or high-elderly group than in non-elderly group (P<0.05), and it was higher in the high-elderly group than in low-elderly group(P<0.05).There were no significant differences in the incidence of no reflow and the number of implanting stents among three groups (P>0.05). Compared with the non-elderly group and the low-elderly group, the incidence of three vessel lesions or left main coronary artery disease was higher in the high-elderly group (P<0.05). Successful reperfusion was lower in the high-elderly group than in the low-elderly and non-elderly group (P<0.05).Cardiac death occurred in27patients. There were no significant difference in the cardiac shock among three groups (P>0.05). The incidence of cardiac death increased with the increase of age (P<0.05). Incidence of malignant arrhythmia was higher in the low-elderly group and high-elderly group than in non-elderly group (P<0.05). Incidence of acute heart failure and combined cardiovascular events were higher in the high-elderly group than in the low-elderly or non-elderly group (P<0.05).2Part two of study2.1GroupingThis was a retrospective cohort study.307patients suffered from first STEMI accepted primary percutaneous coronary intervention therapy were admitted during July2009to July2012. End points were death and a composite of cardiac events during in-hospital stay. The relation between sex difference and the above end points was testified.2.2Risk factors analysisThis study involved307patients, the proportion of female was20.2%. There were no significant difference in the incidence of anterior wall myocardial infarction, hospital stay, heart rate and systolic blood pressure and diastolic pressure between the two groups (P>0.05). The average age, prehospital delay time, the history of hypertension and diabetes, and the incidence of cardic Killip classification≥Ⅱ were higher in female group than in male group (P<0.05). The histories of smoking was less in female group than in male group (P<0.05). There were no significant difference in the glycated hemoglobin, TC, lipoprotein (a), LDL-C, CK-MB, TnT, hs-CRP level between the two groups (P>0.05). White blood cell count, hemoglobin, serum creatinine and TG level were lower in female group than in male group (P<0.05). HDL-C level was higher in female group than in male group (P<0.05).There were no significant difference in three vessel or left main coronary artery disease, no reflow, successful reperfusion, and number of implanting stents (P>0.05).There were no significant differences in the incidenee of cardiac death and malignant arrhythmia. The incidence of cardiac shock, heart failure and ombined cardiovascular events were higher in female group (P<0.05).3Part three of study3.1GroupingThis was a retrospective cohort study.307patients with first STEMI attack accepted with primary percutaneous coronary intervention therapy were admitted during July2009to July2012. The patients were grouped as cardiogenic death group and surrvival group. The factors which contribute to the survival rate within hospital stay were analyzed with Logistic regression.3.2Risk factors analysisUnivariate analysis indicated that history of diabetes, anterior wall myocardial infarction, cardic Killip classification≥Ⅱ, age, prehospital delay time, heart rate, systolic blood pressure, diastolic pressure, white blood cell count, serum creatinine, TC, TG, HDL-C, LDL-C, hs-CRP, three vessel or left main coronary artery disease, successful reperfusion, number of stent, the incidence of cardiac shock and malignant arrhythmia were significantly associated with the in-hospital mortality.Multivariate logistic regression analysis suggests that lower HDL-C, high hs-CRP, and serum creatinine level, age, anterior wall myocardial infarction, Killip classification≥Ⅱ, cardicgenic shock are the indepent risk factors for in-hospital motality.Conclusions1Compared with non-elderly group, the proportion of female and the history of hypertension were higher in the low-elderly or high-elderly group. The history of smoking was higher in non-elderly group than other groups. The incidence of Killip classification≥Ⅱ was higher in high-elderly group than other groups. Hemoglobin, TC, TG, LDL-C level were higher in non-elderly group than other groups. Serum creatinine level was higher in the low-elderly group or high-elderly group than in non-elderly group, and it was higher in the high-elderly group than in low-elderly group.Three lesions or left main coronary artery disease was higher in the high-elderly group than in the non-elderly group or low-elderly group. Successful reperfusion was higher in the high-elderly group than in the low-elderly or non-elderly group. The incidenee of cardiac death was increased with the increase of age. Rate of malignant arrhythmia was higher in the low-elderly group or high-elderly group than in non-elderly group. Rate of acute heart failure and combined cardiovascular events were higher in the high-elderly group than in the low-elderly or non-elderly group.2The average age, prehospital delay time, the histories of hypertension and diabetes, and the incidence of Killip classification≥Ⅱ were higher in female group than in male group. The history of smoking was less in female group than in male group.White blood cell count, hemoglobin, serum creatinine and TG were less in female group than in male group. HDL-C was higher in female group than in male group.There were no statistical differences in the incidenee of cardiac death and malignant arrhythmia. The incidences of cardiac shock, heart failure and ombined cardiovascular events were higher in female group than in male group. 3Multivariate logistic regression analysis suggests that lower HDL-C, high hs-CRP, and serum creatinine level, age, anterior wall myocardial infarction, Killip classification≥Ⅱ, cardicgenic shock are the indepent risk factors for in-hospital motality. |
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