The Prognostic Risk Study Of Acute Myocardial Infarction Based On The Theory Of Luck And Metabolomics

1 Objective1.1 To analyze the characteristics of five evolutive phases and six climatic factors in patients with acute myocardial infarction hospitalized death and re-occurrence of cardiovascular events after discharge;1.2 To explore specific metabolic markers in plasma of patients with recurrent cardiovascular events after discharge from acute myocardial infarction;1.3 To study the prognostic risk of acute myocardial infarction based on metabolomics and the theory of five evolutive phases and six climatic factors.2 Method2.1 We adopted the cross-sectional research method.Patients with AMI were grouped according to discharge outcome.The time of birth and time of onset of acute myocardial infarction were converted into five evolutive phases and six climatic factors.Then we analyzed the five evolutive phases and six climatic factors of hospitalized patients who died of acute myocardial infarction and those who did not die to explore the relationship between five evolutive phases and six climatic factors and the prognosis of acute myocardial infarction.2.2 We adopted the clinical case-control research method.Similarly,the year of birth and the time of onset of acute myocardial infarction patients were converted into five evolutive phases and six climatic factors.To explore the relationship between five evolutive phases and six climatic factors and the prognosis of acute myocardial infarction,we analyzed the five evolutive phases and six climatic factors of patients who did not have cardiovascular events after discharge,those who had cardiovascular events but did not die after discharge,and those who died of recurrent cardiovascular events after discharge.2.3 We used UPLC/MS metabolomics to analyze the plasma of patients with acute myocardial infarction.We then compared the plasma metabolites of patients with no cardiovascular events after discharge of acute myocardial infarction,patients with cardiovascular events after discharge of acute myocardial infarction,patients with cardiovascular events but not death after discharge of acute myocardial infarction,and patients with cardiovascular events and death after discharge of acute myocardial infarction,to look for metabolic markers of recurrent cardiovascular events after discharge from acute myocardial infarction.Finally,on the basis of the above research,we established a prognostic risk model of acute myocardial infarction based on the theory of five evolutive phases and six climatic factors and metabonomics by Logistic regression,to find metabolites and factors of five evolutive phases and six climatic factors related to prognostic risk of acute myocardial infarction.3 Result3.1 A total of 3286 inpatients with acute myocardial infarction were included in the cross-sectional study,including 3101 in the non-death group of acute myocardial infarction and185 in the death group of acute myocardial infarction.It was found that the mortality rate of inpatients born in the year of Shaoyang Xianghuo Sitian,Jueyin Fengmu in spring and Jueyin Fengmu Sitian and Shaoyang Xianghuo in spring was significantly higher than that of inpatients born in other years(P=0.021).3.2 A total of510patients with acute myocardial infarction were included in the clinical case-control study,including 410 patients without cardiovascular events after acute myocardial infarction and 100patients with cardiovascular events after acute myocardial infarction(70 patients with recurrent cardiovascular events after acute myocardial infarction but no deaths and 30 patients with recurrent cardiovascular events and deaths after acute myocardial infarction).After an average follow-up of18 months,it was found that patients with acute myocardial infarction born in the year of Shaoyang Xianghuo Sitian,Jueyin Fengmu in spring and Jueyin Fengmu Sitian and Shaoyang Xianghuo in spring were more prone to recurrence of cardiovascular events and death caused by recurrence of cardiovascular events(P=0.005).3.3 Using UPLC/MS metabonomics technology,48 differentiated metabolites which may be related to the prognosis of acute myocardial infarction were screened by multivariate statistical analysis,univariate statistical analysis,database comparison and standard comparison,including L-Histidine,2-Phenylglycine,D-Gluconic acid,Creatine,Guanidineacetic Acid,Uric acid,M-coumaric acid,L-Tyrosine,Malic Acid,3-Methyl-2-oxovaleric Acid,L-Phenylalanine,5-hydroxyindoleacetic acid,L-Kynurenine,L-Tryptophan,Indole-3-carboxaldehyde,LysoPC(17:0),LysoPC(18:0),Alpha-Linolenic acid,Gamma-Linolenic acid,L-Octanoylcarnitine,Allylestrenol,Isorhamnetin,L-3-phenyllactic acid,LysoPC(14:0),LysoPC(16:1),LysoPC(15:0),LysoPC(18:2),LysoPE(16:0),LysoPC(18:1),LysoPC(18:3),LysoPC(16:0),Alpha-CEHC,Linoleic acid,LysoPE(18:1),D-(+)-Galactose,P-hydroxyphenylacetic acid,4-hydroxyphenylpyruvic acid,(r)-3-hydroxybutyric acid,Ortho-hydroxyphenylacetic acid,Phenylalanylphenylalanine,LysoPE(18:0),Oxoglutaric acid,Cytidine,Dehydroepiandrosterone sulfate,Androsterone sulfate,Sulfolithocholylglycine,L-glutamine and Uridine diphosphate glucose.Further pathway enrichment indicates that the recurrence of cardiovascular events after discharge of acute myocardial infarction is related to biological processes such as phenylalanine metabolism.Finally,based on the above findings,a prognostic risk model of acute myocardial infarction was established by binary stepwise logistic regression(the accuracy rate of predicting cardiovascular events after acute myocardial infarction was 94.9%).Ten independent risk factors(including(r)-3-hydroxybutyric acid,Alpha-Linolenic acid,L-3-phenyllactic acid,Linoleic acid,LysoPC(16:0),LysoPC(18:1),Oxoglutaric acid,Phenylalanylphenylalanine,Uric acid and birth year of Jueyin Fengmu Sitian,Shaoyang Xianghuo in Spring or Shaoyang Xianghuo Sitian,Jueyin Fengmu in Spring)related to prognosis of acute myocardial infarction were further screened out from the above metabolites and factors of five evolutive phases and six climatic factors,which were not related to age,sex and ST segment elevation.Among them,(r)-3-hydroxybutyric acid,Alpha-Linolenic acid,L-3-phenyllactic acid,LysoPC(18:1),Oxoglutaric acid,Uric acid and birth year of Jueyin Fengmu Sitian,Shaoyang Xiang huo in Spring or Shaoyang Xianghuo Sitian,Jueyin Fengmu in Spring were risk factors for recurrent cardiovascular events after acute myocardial infarction,while Linoleic acid,LysoPC(16:0)and Phenylalanylphenylalanine were protective factors for prognosis of acute myocardial infarction.4 Conclusion4.1 Acute myocardial infarction patients born in the spring years of Shaoyang Xianghuo Sitian and Jueyin Fengmu are more likely to die in hospital,recurrence of cardiovascular events after discharge,and recurrence of cardiovascular events leading to death.4.2 L-Histidine,2-Phenylglycine,D-Gluconic acid,Creatine,Guanidineacetic Acid,Uric acid,M-coumaric acid,L-Tyrosine,Malic Acid,3-Methyl-2-oxovaleric Acid,L-Phenylalanine,5-hydroxyindoleacetic acid,L-Kynurenine,L-Tryptophan,Indole-3-carboxaldehyde,LysoPC(17:0),LysoPC.(18:0),Alpha-Linolenic acid,Gamma-Linolenic acid,L-Octanoylcarnitine,Allylestrenol,Isorhamnetin,L-3-phenyllactic acid,LysoPC(14:0),LysoPC(16:1),LysoPC(15:0),LysoPC(18:2),LysoPE(16:0),LysoPC(18:1),LysoPC(18:3),LysoPC(16:0),Alpha-CEHC,Linoleic acid,LysoPE(18:1),D-(+)-Galactose,P-hydroxyphenylacetic acid,4-hydroxyphenylpyruvic acid,(r)-3-hydroxybutyric acid,Ortho-hydroxyphenylacetic acid,Phenylalanylphenylalanine,LysoPE(18:0),Oxoglutaric acid,Cytidine,Dehydroepiandrosterone sulfate,Androsterone sulfate,Sulfolithocholylglycine,L-glutamine and Uridine diphosphate glucose are related to the prognosis of acute myocardial infarction.Recurrent cardiovascular events after discharge from acute myocardial infarction are related to biological processes such as phenylalanine metabolism.4.3 (R)-3-hydroxybutyric acid,Alpha-Linolenic acid,L-3-phenyllactic acid,Linoleic acid,LysoPC(16:0),LysoPC(18:1),Oxoglutaric acid,Phenylalanylphenylalanine,Uric acid and birth year of Jueyin Fengniu Sitian,Shaoyang Xianghuo in Spring or Shaoyang Xianghuo Sitian,Jueyin Fengmu in Spring are independent risk factors for the prognosis of acute myocardial infarction unrelated to age,sex and ST segment elevation.Among them,(r)-3-hydroxybutyric acid,Alpha-Linolenic acid,L-3-phenyllactic acid,LysoPC(18:1),Oxoglutaric acid,Uric acid and birth year of Jueyin Fengmu Sitian,Shaoyang Xianghuo in Spring or Shaoyang Xianghuo Sitian,Jueyin Fengmu in Spring were risk factors for recurrent cardiovascula r events after acute myocardial infarction,while Linoleic acid,LysoPC(16:0)and Phenylalanylphenylalanine were protective factors for prognosis of acute myocardial infarction.4.4 We established a prognostic risk model of acute myocardial infarction based on the theory of five evolutive phases and six climatic factors combined with metabonomics,and screened out the factors of five evolutive phases and six climatic factors and biomarkers related to the prognostic risk of acute myocardial infarction.It is helpful for clinicians to understand the risk stratification of acute myocardial infarction and take effective intervention measures in time.It will benefit many patients with acute myocardial infarction.It provides an effective reference for the application of the theory of five evolutive phases and six climatic factors in the prediction of clinical diseases,and also provides a reliable scientific basis for the inheritance and development of the theory of five evolutive phases and six climatic factors.