Characteristics Associated with Fatality in Patients with Acute Myocardial Infarction. Lamphoon Hospital
Keywords:
กล้ามเนื้อหัวใจตาย, โรคหลอดเลือดหัวใจ, พยากรณ์โรค, การตาย, ปัจจัยเสี่ยงAbstract
Background: Case fatality rate of acute myocardial infarction is high. Epidemiological data on the patients’ characteristics and risk factors of death are scarce. Objectives: To explain the characteristics of the patients diagnosed with acute myocardial infarction and to explore risk factors associated with case fatality. Design: Retrospective cohort study. Setting: Lamphoon Hospital. Methods: Patients diagnosed with acute myocardial infarction were searched from the hospital medical records dating between October 2002 and April 2005.There were 103 cases which were confirmed by WHO diagnostic criteria. Information retrieved form the medical records included demographic data, illnesses, signs and symptoms, clinical investigations. Treatments, complications and disease outcomes. Data were explained by descriptive statistics. Risk characteristics were analysed by chi-squared test and presented with risk ratio (RR) and 95% confidence intervals. Results: Subjects were 55.3% male, 44.7% female with an average age of 63.5 years. Diabetes were reported in 22.8%, hypertension 38.5%, high blood lipids 7.3%, coronary diseases 12.6% and smoking 48.5%. Chief complaints of chest pain were stated in 89.3%. Electrocardiogram showed ST elevation in 76.7% and non-ST elevation in 23.3%. Anterior wall infarction was reported in 56.3% and inferior wall 35.9%. Anti-coagulants therapy was given in 57.0%. Subjects had cardiac arrhythmia in 20.3%, congestive heart failure 24.0% and shock 36.7%. In-hospital fatality was reported in 21.6%. The characteristics which significantly increased the risk of death were older age, low blood pressure, tachycardia, anemia, renal insufficiency. High blood sugar, not treated with ASA and ACEI, conditions complicated with cardiac arrhythmia, congestive heart failure and shock. Conclusion: A part form risk factors which are already evident in medical literature, modifiable characteristics found in this study to increase case fatality were not being treated with ASA and ACEI, the treatment with which has been well documented to decrease death. Complications which also increased the risk of death included cardiac arrhythmia, congestive heart failure and shock, which must be prevented or corrected as soon as detected.
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