Analysis Of Risk Factors For MACE Of 522 Patients With Acute Myocardial Infarction After Emergency PCI In Hospital

Objective:Through a retrospective analysis of acute myocardial infarction patients,the risk factors and clinical characteristics of major adverse cardiovascular events（MACE）in patients with acute myocardial infarction during hospitalization after revascularization were clarified,in order to provide more reference and evidence for secondary prevention and timely and precise treatment of the disease.Methods:A total of 534 patients diagnosed with acute myocardial infarction and treated with emergency percutaneous coronary intervention（PCI）within 12 hours in the department of cardiology,The First Hospital of Jilin University from January 2018 to January 2021 were retrospectively analyzed,and 522 patients were eventually included.If one of the following occurs during hospitalization after emergency PCI:（1）cardiogenic death;（2）malignant arrhythmia;（3）Heart failure（Killip: Grade III-IV）was included in MACE group（174 cases）,and the rest were included in non-MACE group（348 cases）.The clinical data of the two groups were compared,and statistical analysis was performed by T test,rank-sum test and χ2 test.The indexes with statistical significance in univariate analysis were analyzed by multi-factor binary Logistic regression,and the receiver operating characteristic curve（ROC）was further drawn based on the analysis results.Results:1.Preoperative basic clinical data,angiographic results and treatment characteristics of the two groups:（1）The age and heart rate of patients in MACE group were higher than those in non-MACE group;The proportion of SBP and male was lower than that of nonMACE group（P < 0.05）.（2）In the MACE group,aspartate aminotransferase（AST）,alanine aminotransferase（ALT）,direct bilirubin,high density lipoprotein cholesterol（HDLC）,blood glucose（Glu）,white blood cell count,absolute value of neutrophil,platelet/lymphocytes,D-dimer（D-D）,TNT peak value,NT-pro BNP peak value was higher than that of non-MACE group.The plasminogen and LVEF values were lower than those in non-MACE group（P < 0.05）.（3）The proportion of Gensini score > 80,acute ST-segment elevation myocardial infarction（STEMI）,application of coronary artery dilation drugs and intraoperative complications in MACE group was higher than that in non-MACE group（P < 0.05）.The incidence of intraoperative complications in MACE group was higher than that in non-MACE group（P < 0.05）.The most common intraoperative complication in MACE group was arrhythmia,followed by no reflux.2.Risk factors analysis of MACE in AMI patients during hospitalization after emergency PCIThe occurrence of MACE events during hospitalization was taken as the dependent variable,and the indicators with statistical significance in univariate analysis were as follows: age（years）,time from onset to admission,HR,SBP,AST,ALT,direct bilirubin,HDL-C,Glu,white blood cell count,absolute value of neutrophil,platelet/lymphocyte,D-D,plasminogen,fibrin degradation products,TNT at admission,TNT peak value,NT-pro BNP peak value,LVEF is autovariation multivariate binary Logistic regression analysis.It was concluded that increased white blood cell count,decreased plasminogen,increased peak value of NT-pro BNP,decreased LVEF,Gensini score > 80,STEMI and intraoperative complications（intraoperative arrhythmia）were independent risk factors for MACE in acute myocardial infarction patients during hospitalization after emergency PCI.3.ROC curve of risk factors for MACE during hospitalization after emergency PCIROC was plotted according to the regression analysis results,which showed that the peak value of NT-pro BNP,LVEF,white blood cell count and area under the plasminogen curve were 0.820（95%CI: 0.779-0.860）,0.667（95%CI: 0.615-0.719）,0.605（95%CI: 0.553-0.656）,0.559（95%CI: 0.505-0.612）,all P < 0.05.Conclusion:1.Increased white blood cell count,decreased plasminogen,increased peak value of NT-pro BNP,decreased LVEF,Gensini score > 80,STEMI,and intraoperative complications（intraoperative arrhythmia）were independent risk factors for MACE in AMI patients during hospitalization after emergency PCI.2.The efficacy of NT-pro BNP peak value and LVEF in predicting MACE in AMI patients after emergency PCI was higher than that of WBC count and plasminogen.