The Study of Vulnerable Patient for Coronary Heart Disease in Early Warning Index
|School||China Academy of Traditional Chinese Medicine|
|Course||Traditional Chinese Medicine|
|Keywords||Vulnerability of patients Logistic regression Acute myocardial infarction Prognosis Early warning indicators Acute cardiovascular events|
Coronary heart disease (CHD) is the most popular disease, and become one of the chief reason of death because of its high morbidity, high mutilation rate and high mortality in many developed countries. With the infectious disease controlled in China and improvement of people’s living, the morbidity and mortality of CHD increase year by year. How discover this vulnerable patient and how carry on valid earlier active intervention and prevent acute cardiovascular events, becomes the problem that need resolve urgently.The paper including two parts: summarize and clinic research.Summarize:This part summarizes the risk factors that influence the prognosis of CHD, includes traditional risk factors and new risk factors, introduce the concept of vulnerable patient and make a intimate description of how TCM describe risk factor for coronary artery disease.Clinic Research:Objective:Based on the gathering system of electronic medical record on coronary heart disease, taking on the risk factors as studying object, after 1-year visit, we carried on the study to the early-warning index sign of vulnerable patient, investigate that can predict the acute vascularcoronary event of sensitive factor, look for the risk factors which was in close relation to recrudescent ACS.Methods:The study record 441 patients from Xi Yuan hospital which diagnosis is CHD correctly,based on the gathering system of electronic medical record on CHD, and collect the information of ACS patients in real time or gather the clinical record of patients and do 1-year visit, and we regard sudden cardiac death (SCD), acute myocardial infarction (AMI), reconstructive vascular operation as acute cardiovascular event, and the patients who develop acute cardiovascular event is vulnerable patient. We adopt one way analysis and logistic stepwise regression analysis on hospitalized patient’s age, sex, past history of illness, personal history, accompanied illness, the laboratory test, ultrasonic cardiogram (UCG), ultrasonic artery, percutaneous coronary arteriongraphy, percutaneous coronary intervention (PCI), electrocardiography (ECG), dynamic electrocardiogram (DCG), traditional Chinese medicine (TCM) treatment based on syndrome differentiation, western medicine treatment and determine the index sign which can affect prognosis of CHD.Result:1．Result of clinical epidemiology:Age: The oldest age of patients is 96, and the youngest is 35, the mean age is 68．94±11．06．Sexuality: 287 cases are male, and 154 cases are female. Distribution of TCM pattern: 303 patients are diagnosed blood stasis, 204 patients qi deficiency, 191 patients phlegm, 89 patients yin deficiency, 38 patients qi stagnation, 28 patients yang deficiency, 21 patients blood deficiency, and 15 patients phlegm-heat. Results of accompanied illness: Among the cases, 277 patients have hypertensive disease, and 186 patients have old myocardial infarction (OMI) , and 120 patients have diabetes mellitus (DM), and 109 patients have pulmonary infection, and 96 patients have cardia insufficiency, and 78 patients have cardiac arrhythmia (CA).2．One way analysis on early warning index of vulnerable patient①Impact of treatment on prognosisIn consideration of the impact of AMI and congestive heart failure (CHF), we regard AMI and CHF as layer variable. To non-AMI patients, the acute cardiovascular event who have made use ofβ-blocker are less than who have not made use of it, and the acute cardiovascular event who have made use of dilthiazem are more than who have not made use of it. To AMI patients, the acute cardiovascular event who have made use of non-steroidal antiinflammatory drugs (NSAIDs) are more than who have not made use of them. To CHF patients, the acute cardiovascular event who have made use ofβ-blocker are less than who have not made use of it, and the acute cardiovascular event who have made use of dilthiazem,NSAIDs are more than who have not made use of it.②Impact of laboratory test and TCM pattern,sexuality,age on prognosisQuantitative data: The average level of patients who have developed acute cardiovascular event are lower than the patients who haven’t developed acute cardiovascular event in prothrombin time (PT),DCG SDNN level, and the average level of patients who have developed acute cardiovascular event are higher than the patients who haven’t developed acute cardiovascular event in glycosylated hemoglobin,average heart rate (P<0．05 or P<0．01) .Qualitative data: The patients who have stagnation of blood are more liable to develop acute cardiovascular event than the patients who don’t have stagnation of blood (P<0．05) ; the patients whose myocardium enzyme are abnormal are more liable to develop acute cardiovascular event than the patients whose myocardium enzyme are normal(P<0．05) .3．The result of logistic stepwise regression analysis on the early-warning index sign of vulnerable patientTo do logistic stepwise regression analysis on patient between follow-up acute cardiac event and sexuality, age, diagnosis, complication illness, western medicine and traditional Chinese medicine. Result shows that follow-up acute cardiovascular event have positive correlation with AMI, syncope, NSAIDs, and follow-up acute cardiovascular event have negative correlation withβ-blocker.Conclusion:1．Acute cardiovascular event localize to happen on old people; Male people are more liable to CHD than female people; Most of the pattern of CHD are blood stasis,often accompanied with phlegm, and most of deficiency in origin are qi deficiency, such that the pathogenesis are asthenia in origin and excess in superficiality; CHD onset seldom alone, so we can’t ignore the impact of hypertensive illness on CHD. 2．The patients who have stagnation of blood and whose myocardium enzyme are abnormal are more liable to develop acute cardiovascular event, and those are probable negative factors to the prognosis of CHD.3．The application ofβ-blocker can improve the prognosis of non-AMI patients and CHF patients, prevent acute cardiovascular event probably, but the application of dilthiazem, NSAIDs aggravate the prognosis of non-AMI patients, AMI patients and CHF patients probably; the diagnosis of AMI and syncope make the acute cardiovascular events increased probably.