Effect Of Early Plasma Renin Level On Long-term Prognosis Of Patients With Acute Myocardial Infarction After Optimized Treatment

Objective:Objective to study the influence of early plasma renin level on long-term prognosis in patients with acute myocardial infarction(AMI)after optimized treatment.Method:According to the inclusion criteria and exclusion criteria,this study enrolled patients who were hospitalized in the Department of Cardiology,Affiliated Hospital of Chengde Medical College from October 2018 to October 2019.They were diagnosed with AMI and underwent percutaneous coronary intervention(PCI)within 12 hours after the onset of the disease,and the postoperative culprit vascular blood flow classification(THF)was evaluated There were 58 patients with TIMI grade 3 and secondary prevention of coronary heart disease after operation.General clinical data and examination results were recorded,including gender、age、history of hypertension、history of diabetes、history of smoking、vital signs、admission blood routine、liver function、renal function and blood lipid.After PCI treatment,the number of coronary artery lesions(culprit vessels)and the degree of coronary artery lesions(the degree of coronary artery lesions using Gensini scoring system)were recorded.Venous blood was drawn to measure the plasma renin concentration after 6 hours of lying on the back of the patient(the blood drawing time was strictly controlled within 24 hours of onset).Left ventricular end diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)were measured within one week after admission.All patients were followed up for 1 year,renin angiotensin-aldosterone-system(RAAS)inhibitors were adjusted to the maximum tolerated dose within 6 months after discharge,At the same time,LVEDD and LVEF were measured again one year after discharge.6-minute walk test(6MWT)and major adverse cardiovascular events(MACE)were recorded MACE,MACE includes recurrent myocardial infarction、recurrent angina pectoris、heart failure、malignant arrhythmia、death,etc.According to the median plasma renin concentration,patients were divided into high renin group(n=29)and low renin group(n=29).According to the median Gensini score,the patients were divided into high Gensini score group(n=29)and low Gensini score group(n=29).The LVEDD、LVEF、6MWT and mace were compared between the two groups one year later.The differences of LVEDD and LVEF between patients in hospital and 1 year after discharge were compared.Binary logistic regression analysis was used to determine whether early plasma renin was the influencing factor of 1-year prognosis in patients with AMI after optimized treatment,excluding other factors(non renin factors).Result:1.Renin group1.1 According to the median,they were divided into high renin group[33.94(24.17,53.28)] and low renin group [8.46(4.54,14.27)],in age、gende、smoking history、diabetes、hypertension、heart rate、systolic blood pressure、diastolic pressure、WBC、RBC、PLT、HGB、HCT、RDW-CV、RDW、c Tn T、BNP、TP、ALB、ALT、AST、CRE、BUN、UA、TCH、TG、LDL-C、HDL-C、APO-A1、APO-B、LVEDD、LVEF,there was no significant difference between the high renin group and the low renin group(P > 0.05).1.2 there were no significant differences between the high renin group and the low renin group in coronary artery single vessel disease、 multi vessel disease and Gensini score(P > 0.05).1.3 there were no significant differences in LVEDD、LVEF、6MWT and MACE between the high renin group and the low renin group after 1-year follow-up(all P > 0.05).1.4 Binary logistic regression analysis showed that without adjusting for other factors(model 1),early plasma renin was not an influencing factor of1-year prognosis in patients with AMI after optimized treatment;after adjusting for age、history of hypertension、history of diabetes and smoking(model 2),early plasma renin was not an influencing factor of 1-year prognosis in patients with AMI after optimized treatment;TCH、TG and h were adjusted on the basis of model 2 Early plasma renin was not an influencing factor of 1-year prognosis in patients with AMI after optimized treatment of DL-C and LDL-C(model 3);on the basis of model 3,early plasma renin was not an influencing factor of 1-year prognosis in patients with AMI after optimized treatment of TP、ALT、CRE、UA、WBC and PLT(model4).1.5 There was no significant difference between LVEDD during hospitalization and one year after discharge(P > 0.05),and LVEF was significantly higher than that during hospitalization(P < 0.001).2.Gensini score grouping2.1 According to the median,they were divided into high Gensini group[80.00(68.00112.50)] and low Gensini group [40.00(32.50,48.00)].There were no significant differences in age、gender、diabetes、hypertension、LVEDD、LVEF、systolic blood pressure、diastolic blood pressure、renin and other baseline data between high Gensini group and low Gensini group(all P > 0.05).2.2 One year after discharge,there were no significant differences in LVEDD、LVEF、6MWT and MACE between high Gensini group and low Gensini group(P > 0.05).Conclusion:1.The early plasma renin level has no effect on 1-year prognosis in patients with acute myocardial infarction after optimized treatment.2.The cardiac function of patients with acute myocardial infarction can be improved after 1 year of optimal treatment.