Correlation Between The Onset Time And Ventricular Remodeling In Acute ST-segment Elevation Myocardialinfarction

Objective: This article isaiming at investigating the relationship between the first aid time window of acute ST segment elevation myocardial infarction(STEMI)and ventricular remodeling(VR)after reperfusion therapy from the whole time window of onset and providing first aid basis for clinical guidance.Methods:From January 2017 to June 2019,a total of 253 STEMI patientswho underwent primary percutaneous coronary intervention and were hospitalized in Chengdu second people’s Hospital were selected.According to the truth that whether the growth rate of left ventricular end-diastolic volume was greater than or equal to 20% at 3 months after operation,the patients were divided into two groups.:VR group(n = 87)and non-VR group(n =166).We collectedthe clinical information of each group accurately:(1)The General data: sex,age,smoking history,drinking history,body mass index(BMI),past history(including history of hypertension,hyperlipidemia,diabetes,hyperuricemia,and peripheral arteriosclerosis),medical history(including β receptor blocker,angiotensin converting enzyme inhibitor(ACEI)/ angiotensin II receptor blocker(ARB),Lipid-lowering drugs,calcium channel blockers(CCB)),first medical contact,Severity of coronary lesion,infarction-related vascular(IRA),the dysfunction of ventricular wall.(2)Serum biochemical indexes: Creatinine(CREA),Blood urea nitrogen(BUN),Total bilirubin(TBIL);(3)the first aid time window:Door to balloon(D2B),First medical contact to balloon(FMC-to-B),Symptom onset to first medical contact(SO-to-FMC),Symptom onset to balloon(STB);(4)Echocardiographic index:Left ventricular end diastolic dimension(LVEDd),Left ventricular end-systolic dimension(LVESd),Interventricular septal end-diastolic thinkness(IVSD),Left ventricular posterior wall end-diastolic thinkness(LVPWD),Left ventricular end-diastolic volume,(LVEDV),Left ventricular end-systolic volume(LVESV),Left ventricular end-diastolic volume index(LVEDVi),Left ventricular end-systolic volume index(LVESVi),Left ventricular mass index(LVMI),Left ventricular end-diastolic volume growth rate(△ LVEDV),Left ventricular ejection fraction(LVEF).First of all,we compare the general clinical data,serum biochemical index,and the first aid time window of the two groups of patients respectively,and then the relationship between exposure factor SO-to-FMC>120 min and left ventricular remodeling was obtained by four-lattice statistical analysis.At the same time,We got further analysis on the correlation between the indexes of ventricular remodeling and first aid time window in the group,and finally the unconditional logistic regression analysis was performed to obtain risk factors for ventricular remodeling.Results:(1)The comparison between the VR group and non-VR group: 1)There was no significant difference in baseline data between the two groups(P>0.05)apart from history of hyperuricemia,gender and first medical contact(including outpatient,during hospitalization or emergency),which was comparable;2)Comparison of emergency time window and LVEF between the two groups: SO-to-FMC time and STB time in VR group were higher than those in non-VR group,while LVEF was lower than in non-VR group(P <0.05).There was no significant difference in FMC-to-B time and D2 B time between the two groups(P>0.05).3)Comparison of SO-to-FMC time in the two groups: SO-to-FMC time> 120 min was assigned to the exposed group,SO-to-FMC time≤120 min was assigned to the non-exposed group.Statistical analysis showed that SO-to-FMC time> 120 min was a risk factor for left ventricular remodeling in STEMI patients,and the difference was statistically significant(P<0.001).(2)Spearson correlation analysis between first aid time window and left ventricular remodeling index in the group showed that SO-to-FMC time(rs=0.21,P< 0.05),STB time(rs=0.23,P < 0.001))were positively correlated with LVEDd;SO-to-FMC time(rs=0.37,P <0.001),STB time(rs=0.36,P < 0.001))were positively correlated with LVESd;SO-to-FMC time(rs=0.30,P < 0.001),STB time(rs=0.31,P < 0.001))were positively correlated with LVEDV;SO-to-FMC time(rs=0.37,P < 0.001),STB time(rs=0.36,P < 0.001))were positively correlated with LVESV;SO-to-FMC time(rs=0.38,P < 0.001),STB time(rs=0.38,P < 0.001))were positively correlated with LVESVi;SO-to-FMC time(rs=0.33,P < 0.001),STB time(rs=0.35,P < 0.001))were positively correlated with LVEDVi;SO-to-FMC time(rs=0.40,P <0.001),STB time(rs=0.39,P < 0.001)were positively correlated with△LVEDV;SO-to-FMC time(rs=-0.27,P < 0.001),STB time(rs=-0.28,P < 0.001)were negatively correlated with IVSD;STB time(rs=-0.22,P < 0.001)was negatively correlated with LVPWD,but there was no significant correlation between SO-to-FMC time and LVPWD(P> 0.05);STB time and SO-to-FMC time were negatively correlated with LVMI(P> 0.05).Similarly,there was no significant correlation between D2 B time,FMC-to-B time and left ventricular remodeling index(P> 0.05);The logistic regression showed that the SO-to-FMC time(OR = 1.001,95% CI:1.001,1.002),SO-to-FMC time >120min(OR=2.82,95%CI : 1.42,5.61)and STB time(co-linearity with the SO-to-FMC time was positive and the variance expansion factor was more than 200)were independent risk factors of ventricular remodeling in patients with STEMI,but there was no independent correlation among the history of hyperuricemia,gender,and the first medical contact with the left ventricular remodeling index(P> 0.05).Conclusion: In this study,SO-to-FMC time and STB time were the independent risk factors of ventricular remodeling after acute ST-segment elevation myocardial infarction,and it was positively correlated with the ventricular remodeling index(LVESd,LVESV,LVEDV,LVEDV△ LVEDV)after myocardial infarction;SO-to-FMC time > 120 min was a risk factor for ventricular remodeling in STEMI patients.Controlling it within 2 hours may reduce the incidence of ventricular remodeling and cardiovascular adverse events in the later stage,which posed a clinical thinking to us.