| Objective:By analyzing the relevant clinical data,coronary lesions and intraoperative treatment of patients with heart failure with preserved ejection fraction after PCI with acute myocardial infarction,and following-up the major adverse cardio-cerebrovascular events of patients within 12 months,we investigate the risk factors and prognostic of patients with heart failure with preserved ejection fraction after PCI with acute myocardial infarction,explore its possible pathogenesis and provide assistance for better understanding and treatment of this disease.Methods:From January 2015 to June 2016,847 patients were continuous selected for whom diagnosed acute myocardial infarction in the first hospital of Jilin university.On the first day after the PCI,the echocardiography shows that the LVEF of whom is over than 50% after PCI.53 patients are excluded.By analyzing the clinical characteristics,BNP and results of laboratory and echocardiography,patients were divided into HF group and non-HF group.Obtained the clinical information from database and medical record query system of the first hospital of Jilin university.Follow-up the major adverse cardio-cerebrovascular events of patients within 12 months,summarized and established a database.Compared the relevant clinical data,results of laboratory,coronary lesions,intraoperative treatment and prognostic.Result:(1)Among patients with acute myocardial infarction with LVEF over than 50% after PCI,the HEpEF group is 222(27.96%)and non-HF group is 572(72.04%).The proportion of females in the HFpEF group wsa higher and the median survival time was older,the difference was statistically significant(P<0.01).The proportion of patients with hypertension and diabetes mellitus was higher than that of the non-HF group,the difference was statistically significant(P<0.01).(2)The serum pre-albumin and sodium levels in HFpEF group were lower than those in the non-HF group,BNP was higher in the HF group,the difference was statistically significant(P<0.01);Serum creatinine,potassium,triglyceride,low density lipoprotein,percentage of neutrophils,left atrial diameter,heart rate,systolic pressure and diastolic pressure had no significant difference between the two groups(P>0.05).(3)Comparing the coronary angiography data between the two groups,we can see that the multi-vessel disease and proximal coronary artery lesions in the HFpEF group are more common,and the time from onset to revascularization is longer.It had no significant difference between the two groups(P<0.05);The infarct-related artery(IRA)had no significant difference between the two groups(P>0.05).The application of tirofiban,temporary pacemakers,and thrombus suction had no significant difference between the two groups(P>0.05).(4)Logistic regression analysis showed that women,hypertension,multivessel disease,proximal coronary artery lesions,and the time from onset to revascularization were the independent risk factors of heart failure with preserved ejection fraction after PCI with acute myocardial infarction.By drawing the ROC curve,we can see area under the curve was 0.741(95% CI: 0.702-0.779,P< 0.01),theses factors have predictive value.(5)Follow-up these patients for 12 months.The primary endpoints of this study were MACCEs.We draw survival analysis curve and find the median survival time is 11.31(11.01,11.61)months in the HFpEF group and 11.65(11.52,11.78)months in the non-HF group.The median survival time in HFpEF group was shorter than that in non-HF group.(Log-Rank,P<0.05).Conclusion:1.Patients with acute myocardial infarction after PCI have a higher incidence of heart failure with preserved ejection fraction..Women,hypertension,diabetes,multi-vessel disease,proximal coronary artery lesions,and the time from onset to revascularization are risk factors.2.Follow-up the major adverse cardio-cerebrovascular events of patients within 12 months,patients with heart failure with preserved ejection fraction after PCI with acute myocardial infarction have higher incidence of MACCE and worse prognosis. |
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