The Analysis Of The Influence Factors Of Left Ventricular Systolic Dysfunction Developed In Patients With Acute Myocardial Infarction With Left Main Coronary Artery Disease

ObjectiveThe purpose of this study was to explore the related factors and short-term prognosis of left ventricular systolic dysfunction in acute myocardial infarction(AMI)patients with left main coronary artery(LMCA)disease by comparing the clinical data,laboratory examination,imaging data and prognosis of AMI patients with LMCA disease.MethodsContinuous data collection was performed between January 1,2017 and December 31,2020 on AMI patients confirming the presence of LMCA disease and receiving PCI remedy who were asked for help in the Department of Cardiology of the Quanzhou First Hospital Affiliated to Fujian Medical University.Patients(118male patients,20 female patients)were divided into groups according to their LVEF within 48 h after access into rEF group(LVEF < 40%),mrEF group(LVEF40%～49%)and pEF group(LVEF 50% or higher).The clinical information,clinical data,laboratory examination,imaging data and prognosis were extracted.The measurement data between the three groups were analyzed by ANOVA,post-hoc analysis or Kruskal-Wallis H test,and the enumeration data were tested by χ2 test or Fisher’s exact test.The last,using multivariate Logistic regression to analyze the risk factors related to the event of left ventricular systolic dysfunction in AMI patients with LMCA disease.IBM SPSS 23.0 software was used for all statistical analysis,and P <0.05 was considered statistically significant.ResultsThere were 138 inpatients were included in this study,including 41 cases(29.7%)in the rEF group,36 cases(26.1%)in the mrEF group,and 61 cases(44.2%)in the pEF group.1.Comparison of clinical features among the three groupsCompared with the mrEF group,the patients in the rEF group had lower SBP at admission(P<0.05).Compared with the pEF group,the patients in the rEF group had higher heart rate at admission,lower systolic blood pressure at admission,lower proportion of hypertension,and higher proportion of anterior myocardial infarction and STEMI(P<0.05).The proportion of STEMI in mrEF group was higher than that in pEF group(P<0.05).2.Comparison of laboratory data among the three groupsCompared with the mrEF group,the patients in the rEF group had lower glomerular filtration rate,higher CRP and higher BNP(P<0.05).Compared with the pEF group,the patients in the rEF group had higher WBC count,higher neutrophil count,higher neutrophil percentage,higher NLR,and higher CRP,lower albumin,higher fasting blood glucose,higher uric acid,higher creatinine,lower e GFR,higher c Tn I and higher BNP(P<0.05).Compared with pEF group,the patients in the mrEF group had higher WBC count,higher neutrophil count,higher neutrophil percentage,higher NLR,higher CRP,higher fasting blood glucose,higher uric acid,higher creatinine,lower glomerular filtration rate,higher c Tn I and BNP(P<0.05).3.Comparison of imaging data among the three groupsCompared with the mrEF group,the left ventricular end-systolic diameter was larger in the rEF group(P<0.05).Compared with the pEF group,the patients in the rEF group had larger left atrial anteroposterior diameter,left ventricular end-systolic diameter and left ventricular end-diastolic diameter,and worse LMCA disease(P<0.05).Compared with the pEF group,the patients in the mrEF group had a larger LVDs and a larger LVDd(P<0.05).4.Comparison of Short-term prognosis among the three groupsCompared with the mrEF group,the patients in the rEF group had a higher proportion of cardiogenic shock and a higher Killip grade(P<0.05).Compared with the pEF group,the patients in the rEF group had more hospital stay days,a higher proportion of cardiogenic shock,a higher proportion of death within 30 days,a higher Killip grade,and a higher proportion of nosocomial ventricular tachycardias/ventricular fibrillation(P<0.05).The patients in the mrEF group had a higher rate of cardiogenic shock,a higher rate of death within 30 days,and a higher Killip rating than those in the pEF group(P<0.05).Conclusion1.The left ventricular systolic dysfunction in AMI patients with LMCA disease was mostly manifested as faster heart rate,lower SBP,had the history of hypertension,had the anterior myocardial infarction,ST segment elevation,higher WBC count,higher neutrophils count,higher neutrophils percentage,higher NLR,higher CRP,lower albumin,higher fasting blood glucose,higher uric acid,higher creatinine,lower glomerular filtration rate,higher c Tn I,higher BNP,larger left atrial anteroposterior diameter,larger left ventricular end-systolic/end-diastolic diameter,worse LMCA disease.And the history of hypertension,SBP on admission,ST segment elevation,albumin,BNP and LVDs were independent risk factors for left ventricular systolic dysfunction.2.Left ventricular systolic dysfunction in AMI patients with LMCA disease has poor short-term prognosis,longer hospital stay,more prone to cardiogenic shock and in-hospital ventricular tachycardia/fibrillation,and higher 30-day mortality.