| BackgroundAcute ST-segment elevation myocardial infarction(STEMI)is a serious clinical subtype of coronary heart disease.Its clinical manifestation,electrocardiogram changes and acute phase management are distinguished from other types of coronary heart disease and have significant specificity.The treatment of the disease should be due to local conditions and individuals.Although both at home and abroad have issued guidelines for the diagnosis and treatment of the disease,the short and long-term prognosis of the disease shows different status.Do the diagnosis and treatment of the disease adapt to local conditions and individuals,first of all,we should understand the situation of diagnosis and treatment in the region,so as to avoid loopholes and remedy.At present,little evidence-based medical data is available about STEMI in Nanyang district.Therefore,we conducted the study to assess trends in characteristics,treatment,and outcomes of STEMI in Nanyang in the past 15 years to find out the problems and provide decision-making basis for medical staff and the health department.ObjectiveTo assess the trends in clinical characteristics,management and outcomes for in-hospital patients with acute ST-segment elevation myocardial infarction(STEMI)of Nanyang Central Hospital from 2001 to 2016.MethodsRandomly selected acute myocardial infarction(AMI)patients who were admitted in Nanyang Central Hospital in 2001?2006?2011 and 2016.We analysised patients' clinical characteristics,management and outcomes of STEMI.ResultsWe sampled 758 AMI,of which 558 were STEMI.From 2001 to 2016,the onset age of men were 58.03 years old,57.6 years old,57.31 years old,and 59.97 years old,gradually declined in 2001-2011,and gradually increased in 2016(P<0.001).Women's age of onset were 62.82 years,63.6 years,64.23 years,and 64.19 years,generally increased gradually(P<0.001),and the incidence of male and female did not significantly changed over time(P = 0.79).The risk factors for cardiovascular disease such as hypertension,dyslipidemia and smoking substantially increased(P<0.05),at least two-thirds of patients who had two or more risk factors did not improvement(P = 0.21).The median onset time to addmission shortened from 24 h to 12h(P<0.001).Patients with Killip class or higher ?increased gradually(P =0.004).Patients transferred to the hospital gradually increased(P <0.001),and hospitalization days gradually reduced(P =0.009).The proportion of patients who did not receive reperfusion did not changed significantly,38.9% in 2001,16.7% in 2006,35.7% in 2011,38.4% in 2016(P=0.34),the rate of primary PCI application increased from 0% to 39.4%(P=0.02).Administration of aspirin within 24 h elevated from 79.2% to 96.9%(P<0.001),clopidogrel/ticagrelor from 0 to 96.9%(P<0.001),statins from 0 to 96.6%(P<0.001),?-blockers 52.1% to 72.4%(P=0.031),but the application of ACEI/ARB decreased 54.9% to 43.3%(P=0.002).During hospitalization,the rates of laboratory tests such as troponin,myocardial enzymes,electrocardiogram and echocardiography significantly changed(P <0.05).In 2001,2006,2011 and 2016,the in-hospital mortality were 8%,10.2%,9.2% and 7.1%(P=0.76),and the rates of death or treatment withdrawal because of terminal status were 2%,6.1%,7.3% and 8.1%(P=0.53),the above ratios were 10%,16.3%,16.5%,15.2%(P=0.76).Conclusion1?The quality of medical care for STEMI has improved from 2001 to 2016,while obvious gaps persist from the guideline.2?The in-hospital outcomes have not changed significantly from 2001 to 2016. |
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