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Underwent emergency surgery and PCI in STEMI patients with cardiogenic shock, the clinical characteristics and prognosis

Author: DongSongWu
Tutor: YangXiangJun
School: Suzhou University
Course: Department of Cardiology
Keywords: Acute myocardial infarction Cardiogenic shock Prognosis Risk Factors
CLC: R542.22
Type: Master's thesis
Year: 2011
Downloads: 18
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Abstract


Objective: Through comparative analysis underwent PCI and partners and not with cardiogenic shock (CS) with acute ST-segment elevation myocardial infarction (STEMI), combined CS STEMI study the clinical characteristics and prognosis. Methods: A retrospective study Soviet Cardiology attached to a hospital from January 2007 to December 2009 underwent emergency PCI for acute STEMI patients 224 cases, 185 cases were male and 39 females, mean age 61.2 ± 12.8 years old. Whether the process according to hospital with cardiogenic shock into shock group (31 cases, 13.8%) and non-shock group (193 cases, 86.2%). Shock group through a comparative analysis of patients with non-shock group general information, coronary angiography (CAG) results, hospital information, etc., using the Binary Logistic Regression Analysis STEMI patients with shock factor. Patients were followed for survival studies, using Kaplan-Meier survival curves plotted Act, and the establishment of the Cox model analysis of long-term prognosis of patients with STEMI factors. Results: 1 shock group aged 67.0 ± 11.5 years, 67.7% of male ratio, non-shock group age of 60.3 ± 12.8 years, male proportion of 85%, compared the two groups, there is a statistically significant difference (p 0.007 and 0.023, respectively) . Seen from female myocardial infarction patients more susceptible to shock, it is worth attention. Two sets of onset of chest pain to admission time, anterior infarction, risk factors and previous cardiovascular history was no significant difference (p greater than 0.05). 2, two groups of patients angiography showed shock after revascularization TIMI 3 group stage proportional 74.2%, the proportion of multi-vessel coronary artery disease by 32.3%, non-shock group after revascularization TIMI 3-stage proportional 90.2%, multivessel coronary artery disease proportion of 16.6%, compared the two groups, there was a significant difference (p 0.018 and 0.038, respectively). The two groups in the infarct-related artery, basic TIMI 0-1 no significant difference (p greater than 0.05). 3, the shock group the proportion of patients with elevated fasting glucose 58.1%, LVEF0.35 ± 0.91 and 25.8% in-hospital mortality during hospitalization, non-shock group increased fasting blood glucose ratio 31.6%, LVEF0.43 ± 0.11 and hospital mortality was 2.6% , compared the two groups, there was a significant difference (p respectively 0.008,0.006 and lt; 0.001). The two groups in complications, CK-MB was no significant difference (p greater than 0.05). 4, two Logistic regression analysis showed: age, gender, the second day of admission, elevated fasting glucose, LVEF and multi-vessel coronary artery disease risk factors is CS. 5,224 patients, 211 cases of patients discharged alive after a mean follow-up time was discharged from 24.9 ± 10.8 months. Shock shock group and non-group 6 months survival rates were: 67.7%, 95.3%, p less than 0.001. 1-year survival rates were: 64.5%, 93.8%, p less than 0.001. Cox model regression analysis showed: shock, age, anterior myocardial infarction, revascularization after STEMI TIMI flow and survival time outside the hospital. 6, CS patients, inferior wall myocardial infarction in patients with LVEF 0.41 ± 0.91, in-hospital mortality of 6.7% and 1-year mortality after discharge, 13.3% non-inferior wall myocardial infarction in patients with LVEF 0.30 ± 0.82, and discharge from hospital mortality of 43.8% After one year mortality of 56.3%, a statistical difference between the two groups (p 0.04,0.023 and 0.013, respectively). But inferior wall myocardial infarction and non-inferior wall myocardial infarction in the general characteristics between the two groups, the contrast characteristics and hospital mortality was no significant difference (p greater than 0.05). Conclusion: 1, STEMI patients with CS combined clinical characteristics: age, women, fasting blood sugar, multivessel disease, poor TIMI flow after revascularization and low LVEF and so on. 2, STEMI risk factors for long-term survival outside the hospital are: shock, age, anterior myocardial infarction, TIMI flow after revascularization. 3, with the advances in medical technology, myocardial infarction prognosis of patients with shock better than before, and the inferior wall myocardial infarction with shock than non-inferior wall myocardial infarction with shock and long-term prognosis is good.

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CLC: > Medicine, health > Internal Medicine > Heart, blood vessels ( circulatory ) disease > Heart disease > Myocardial diseases > Myocardial infarction
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