อุบัติการณ์และปัจจัยเสี่ยงของการเสียชีวิตในผู้ป่วยกล้ามเนื้อหัวใจขาดเลือดเฉียบพลันชนิด STEMI ในโรงพยาบาลเจ้าพระยายมราช

Main Article Content

Noppawan Charoenyos, M.D.

Abstract

Objective: To study the incidence and risk factors of death in STEMI patients in Chaoprayayomraj Hospital.


Method: A retrospective study was done to assess incidence and risk factors of death in 144 STEMI patients in Chaoprayayomraj hospital from January 2009 to December 2010. All patients were divided into two groups due to history of receiving streptokinase drug. Patients in streptokinase group was divided into three subgroups depended on duration of chest pain to needle time. Data were collected from cardiovascular risk factors that included age, gender, BMI, smoking history, family history of premature cardiovascular disease, underlying disease and risk of death that included myocardium wall injury depended on number of leads in EKG showing ST-T abnormalities and complications included congestive heart failure, cardiogenic shock, cardiac arrhythmia, cardiac arrest and ischemic stroke. Data were expressed as mean ± S.D. Incidence and risk factors were determined by logistic analysis. Statistical analysis was performed using student’s t-test and comparison of percentage between groups was made with the chi-square test. Differences were considered statistically significant at p ≤ 0.05.


Results: The number of death was 23 patients. The factors that associated with death in STEMI patients were not received streptokinase drug, cardiac arrest and respiratory failure (p<0.001). And in the group of patients who had not been received with streptokinase drug had more cardiac arrest (p=0.023), lower body weight (p=0.028), more distal LAD occlusion (p=0.042) and more history of refer to higher hospital that had invasive coronary intervention (p =0.009) than the patients that had streptokinase drug group. The major factor cause patient without streptokinase drug was onset of chest pain more than 12 hours. The factors that associated with survival in STEMI patients were anterior wall or inferior wall myocardial infarction, proximal LAD occlusion, distal RCA occlusion, cardiogenic shock, cardiac arrhythmia and congestive heart failure.


Conclusion: This study confirmed that receiving streptokinase drug in STEMI decreased the death rate. Thus we must give Streptokinase drug in all STEMI patients if no contraindication especially in hospital that don’ t have invasive coronary intervention.

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Article Details

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นิพนธ์ต้นฉบับ
Author Biography

Noppawan Charoenyos, M.D., กลุ่มงานอายุรกรรม โรงพยาบาลเจ้าพระยายมราช จังหวัดสุพรรณบุรี

ว.ว. อายุรศาสตร์