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【Objective】 Retrospective analysis of the Beijing Union Medical College Hospital from 2000 to 2004 continuous diagnosed coronary heart disease in hospitalized patients, understand their risk factors for recurrent cardiovascular events after the patient was discharged, blood biochemical parameters, heart echocardiographic indices, treatment status relationship, provide the basis for further strengthening the secondary prevention of coronary heart disease, improved patient outcomes. [Materials and Methods] an object of study: the Beijing Union Medical College Hospital medical record room computer query system, \A total of 2755 cases for continuous diagnosis of coronary heart disease in hospitalized patients, the use of computer generated random numbers, by number of multiples was selected (918 cases), then press screening inclusion criteria and exclusion criteria. Ultimately selected 634 cases. All data entry in patients with coronary heart disease database (ACCESS). 2: General information, risk factors, blood biochemical indicators (admission, prior to discharge, when followed up, to reach the terminal), ultrasound echocardiography indicators (during hospitalization), medication (during hospitalization and followed up) followed up and the outcome of the situation. 3 followed up method: take outpatient followed up, letters and visits, home visits and telephone follow-up. Patient referral which 156 cases (25.6%), the petition followed up 51 patients (8.4%), telephone follow-up, 312 cases (51.1%), home visits and 91 patients (14.8%). The relocation of the patients using the identity card number through the police station to find a new address or old address, indirectly, or by contacting the families to find patients. The follow-up include recurrent cardiovascular events, followed up the number of times each year, blood lipids measured results, medication (coronary heart disease secondary prevention drugs). Study endpoint defined: all-cause mortality, cardiovascular disease death, nonfatal myocardial infarction, congestive heart failure, unstable angina, need to PCI or CABG surgery, stroke. 5 Statistical Methods: Logistic single factor analysis of count data frequency, the two groups between the application of X ~ 2 test or Fishers exact test, measurement data are expressed as mean ± standard deviation and t test. Multiple regression analysis with logistic regression analysis of the impact of the prognosis. Application survival survival analysis (life table), and Cox regression analysis (or application quartile method for risk assessment). P <0.05 was statistically significant difference. [Results] 1, General Information: All included in the scope of the study in patients with coronary heart disease age 63.9 ± 10.1 years (30 to 79 years old), with a median age of 66 years old. 433 cases of male, age 62.4 ± 10.5 years; 177 cases of women, age 67.8 ± 7.7 years. The 60 to 80 age group, 33.6% of recurrent cardiovascular events was significantly higher than the 40 to 60-year-old and 40-year-old group (P = 0.011). 32.3% men and 23.7% women with recurrent cardiovascular events (P> 0.05). 1.1, coronary heart disease, type and complications of the hospital: into the group of coronary heart disease types, including unstable angina (1.3%), unstable angina or non-Q-wave myocardial infarction (45%) and ST segment elevation myocardial infarction ( 53.7%). Hospital diagnosis of coronary artery disease by coronary angiography, 461 cases (75.6%). 34.8% (54/155) of recurrent cardiovascular events in coronary lesions involving the three patients, 25.1% (70/278) of patients 1 and 2 coronary involvement recurrent cardiovascular events (P = 0.015). 9 cases of patients with left main disease, including six cases of recurrent cardiovascular events. Congestive heart failure during hospitalization in 20 cases, 13 cases of severe arrhythmia, cardiac arrest successful rescue of two cases. Complications during hospitalization of patients, 43% (15/35) followed up during recurrent cardiovascular events in patients with no complications, only 29% (167/575) to reach the end (P = 0.03). 1.2 risk factors: 90.4% of men and 89% of female patients there is at least one cardiovascular disease risk factors. Smoking history accounted for 60.3% (361/610), hypertensive patients accounted for 57.5% (351/610) the diabetes patients accounted for 24.1% (147/610), in patients with lipid disorders accounted for 22.5% (137/610). The t-test analysis, smoking, high blood pressure and diabetes occurred after discharge and did not occur in patients with cardiovascular events crowd there was a significant difference (P <0.05). Followed up when the heart rate greater than 80 beats / min 58.3% of patients had a cardiovascular event, whereas less than 80 beats / min only 24% of patients reaching the end point (P = 0.001). 2 hospital treatment: during hospitalization line PTCA or PCI, 338 patients (55.4%) patients. Line during hospitalization PTCA or PCI, 26.0% (88/338) of patients reach the finish line without line PTCA or PCI, patients, 46.8% (94/201) to reach the end (P = 0.042). Eight cases of processing blood vessels is not complete revascularization (TIMI blood flow 2) patients underwent PCI, 4 cases (50%) patients reach the end, the rest are revascularization. Placed coronary stent All applications arrived Caledon or clopidogrel to prevent stent restenosis. 96% of patients during the first hospitalization were aspirin, beta blockers or ACEI drugs, 73% of patients with statin lipid-lowering drugs. 3, followed up the situation: followed up for 1-73 months, the average follow-up time was 32.58 ± 20.04 months follow-up, 24 patients were lost to follow-up rate of 96.2%. Adhere followed up for 1 to 3 times a lipid data in patients with coronary heart disease and 36.7% of the total number of cases each year. Not the law followed up 35% of recurrent cardiovascular events in patients with coronary heart disease, and followed up for 1 to 3 patients per year 21% of recurrent cardiovascular events (P = 0.002). Insist on taking one year statins after discharge in patients with coronary heart disease accounted for 72.9% (with unmedicated patients with both recurrent cardiovascular events there is a statistically significant difference, P = 0.039), long-term adherence taking statins were 22.8 % (between patients with and without medication no significant statistical difference). Followed up during 60% of coronary heart disease patients insist on taking antiplatelet drugs, beta blockers and ACEI drugs, including coronary heart disease secondary prevention drugs. Coronary heart disease secondary prevention of drug taking crowd in the occurrence and non-occurrence of cardiovascular events in patients with a statistically significant difference (P = 0.000). Followed up during clinical events: follow-up of 610 cases of patients with coronary heart disease, 174 cases arrive cardiovascular and cerebrovascular events endpoint, 182 cases reaching the study endpoint. This study in patients with coronary heart disease followed up for cardiovascular events recurrence rate of 28.5%, 29.8% to reach the terminal event rate, including all-cause death (6.2%) (4.9%), cardiovascular disease death, nonfatal myocardial infarction (6.2%) , congestive heart failure (3.4%), unstable angina (12.1%), need PCI or CABG surgery (1%), stroke (0.82%). The 5 hospital cardiac ultrasound echocardiography indicators: left atrial diameter ≥ 39mm and <39mm reach the end of the follow-up period of patients (35.1%) and 26% (P = 0.023). Left ventricular end systolic diameter ≥ 40mm and 40mm patients were 42.6% and 27.6% to reach the end (P = 0.009). The left ventricular ejection fraction <50% and ≥ 50% of patients, respectively, 45.8% and 29.3% of recurrent cardiovascular events (P = 0.009) during follow-up. Blood biochemical parameters: The following blood biochemical parameters during hospitalization, cardiovascular events occurred during follow-up and patient population, a statistically significant difference: total cholesterol, HDL-C, non-HDL-C, ApoA1, ApoB lipoprotein, total cholesterol / HDL-C, LDL / HDL-C, ApoB/ApoA1, high-sensitivity C-reactive protein, uric acid, fasting blood glucose. Patient population prior to discharge blood biochemical indicators of cardiovascular events occurred during follow-up and did not occur with a significant statistical difference: total cholesterol, LDL-C, non-HDL-C, ApoB, total cholesterol / HDL-C, LDL / HDL-C, ApoB/ApoA1, uric acid and fasting blood sugar. Admission lipid parameters and followed up the difference in the occurrence and non-occurrence of cardiovascular events in populations of patients, with a statistically significant difference indicators include: total cholesterol, HDL-C, LDL-C, non-HDL-C, ApoA1 total cholesterol / HDL-C, LDL / HDL-C, ApoB/ApoA1 and fasting blood glucose. Followed up when compared with admission, LDL-C, LDL / HDL-C and fasting glucose values ??in the occurrence and non-occurrence of cardiovascular events in patients with decreased compared with the previous rise in HDL-C and ApoA1. Reach the end the patient's blood biochemical admission, HDL-C, ApoA1 over the previous fall, the remaining lipid indicators and fasting glucose increased. 7 prognostic multivariate regression analysis: 7.1, by t test or chi-square test, P values ??<0.05 parameter logistic multiple regression analysis, independent predictive value of the following parameters on recurrent cardiovascular events: age, BMI, number of cigarettes smoked per day, history of diabetes followed up heart rate, total cholesterol, HDL-C, total cholesterol / HDL-C LDL-C/HDL-C ratio., ApoB/A1, lipoprotein a, high-sensitivity C- reactive protein, uric acid, troponin I, left atrial diameter, left ventricular end-systolic diameter, left ventricular ejection fraction. OR values> 1 indicator: HDL-C, troponin Ⅰ, left ventricular systolic diameter, left ventricular ejection fraction. 7.2, application COX regression of coronary heart disease-related factors on the risk-free rate. After adjustment of age, BMI, occupation, smoking history, heart rate and other relevant factors, the daily smoking> 40 20 40 <20 group of patients with recurrent cardiovascular events risk are non-smoking patients group 3.00 times, 1.88 times and 1.23 times. The body mass index of 28 to 35,24 to 28 patients the risk of recurrent cardiovascular events in 24 group below 2.39 times and 1.27 times respectively. Heart rate when the heart rate and follow-up of acute phase shows with recurrent cardiovascular events were significantly correlated, followed up heart rate than the acute phase of the heart rate better prognostic indicators. Left ventricular ejection fraction <40%, 40% and 50%, from 50% to 60% of the group of patients with recurrent cardiovascular events risk are more than 60% of the group's 1.98 times, 1.82 times and 1.34 times. High-density lipoprotein cholesterol and recurrent cardiovascular events was negatively correlated ≤ 35mg/dl, 36 ~ 40mg/dl risk of recurrent cardiovascular events of 41 to 45mg/dl patients group are 45mg/dl group 2.01 times , 1.83-fold and 1.30-fold. With the increase in the level of LDL-C (LDL-C <100mg/dl group rose to> 160mg/dl group), the absolute risk of recurrent cardiovascular events increased 2.22-fold (95% confidence interval: 1.3 to 3.7, P values ??<0.05). Apolipoprotein B / apolipoprotein A1> 1.04,0.84 ~ 1.04,0.69 to 0.84 patient group, the risk of recurrent cardiovascular events are group 0.69 below 2.41 times, 1.61 times and 1.59 times. 7.3, survival analysis results show: 1 year to 6 years of cumulative event-free survival rates were 85.3%, 79.8%, 75.9%, 73.8%, 73.1% and 72.3%, the risk of cardiovascular events rate is 15.8% , 6.61%, 5.02%, 2.87%, 0.91% and 1.15%, respectively. [Conclusion] For patients with coronary heart disease, recurrent cardiovascular events is a high probability event. Of coronary heart disease in patients with long-term, regular clinical follow-up can reduce the incidence of cardiovascular events. However, only a small number of patients receiving long-term, regular follow-up time. 2, advanced age, obesity, smoking, history of diabetes, fast heart rate when followed up poor prognosis; total cholesterol LDL-C/HDL-C ratio., Total cholesterol / HDL-C, ApoB/A1 lipoprotein a, high-sensitivity C-reaction protein, uric acid, troponin I, left ventricular end-systolic diameter and cardiovascular events was independent positive correlation; HDL-C, left ventricular ejection fraction and cardiovascular events were independent negative correlation. 3, 1 year after discharge of patients hospitalized with coronary heart disease risk of recurrent cardiovascular events was significantly higher than that of other time periods, with the passage of time, the risk of cardiovascular events is decreasing year by year. 4, for the secondary prevention of coronary heart disease, a large hospital and can not meet the needs of the community, the development of other prevention mode (such as the Community Prevention) is an urgent task.
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