Analysis Of The Influencing Factors Of Major Adverse Cardiovascular Events In Patients With Severe Coronary Artery Calcification Undergoing Coronary Rotational Atherectomy

Objective to investigate the major adverse cardiovascular events（MACE）in coronary heart disease patients with severe coronary artery calcification undergoing coronary rotational atherectomy（CRA）,and to explore the factors influencing the adverse prognosis of patients with severe coronary artery calcification（CAC）undergoing CRA.Methods From January 2017 to March 2020,Patients with CAC confirmed by CAG and underwent PCI and CRA beacause the guidewire can’t pull in further or the predilated ballon and stent can’t implant properly during the procedure in the department of cardiology of Anhui medical university affiliated Anhui provincial hospital were collected.313 patients were collected while 69 of them is contraindicated based on the condition above:（1）diagnosed as acute coronary syndrome or acute myocardial infarction,had a significant high myocardial injury marker such as troponin.（2）combined with decompensated heart failure,arrhythmia treated with medicine or unstable condition in hemodynamic.（3）previously myocardial infarction.（4）received coronary artery bypass graft,cardiac valve repairment,cardiac transplantation.（5）combined with severe liver and renal dysfunction.（6）cerebral stroke in the past 3 month when underwent RA;（7）had a malignant tumor or other systematic disease,prospective life time is less than 1 year.（8）the failure RA.（9）stopped use antiplatelet drug for reducing the risk of hemorrage because the operation caused by other disease.（10）Rehospitalized not for heart disease.（11）lost to follow-up and etc.（Gender,Age,Hypertension,Diabetes Mellitus,Smoking history,Cerebrovascular Disease,Connective Tissue Disease,Ischemic Heart Disease,Chronic Renal Failure,previous PCI）,laboratory examination results（Troponin,N-terminal pro-Brain Natriuretic Peptide,Alanine aminotransferase,Creatitine,Blood Glucose,Hemoglobin,Total Cholesterol,High Diversity Lipoprotein Cholesterol,Low iversity Lipoprotein Cholesterol）,echocardiography result（Left Ventricular Ejective Fraction）,drug taken after operation（including anti-Hypertension drugs such as Angiostein Converting Enzyme Inhibitor/Angiostein Receptor Blocker,β Receptor Blocker,Calcium Channel Blocker and Diuretics,Anti-Platelet Drugs such as Aspirin,Clopidogrel,Ticagrelor,Lipid regulating Drugs such as Stains）,the target CRA vessel during coronary intervention procedure（Left Coronary Artery and its branch artery Left Anterior Descending artery and Left Circumflex Artery,Right Coronary Artery）,the complication during coronary intervention procedure（Such as no Reflow or Slow Reflow,Aortal Dissection,Perforation,Atrial Ventricular Block,Cardiac Tamponade）were collected in detail.In 1,3,6,12,24 month,a phone follow-up was made regularly to ask the occurrence of the major adverse cardiovascular event and the detailed event contents and record the relative prognosis data.All the above data were analyzed by SPSS 23.0 software to explore each factor influence the prognostic result presented by major adverse cardiovascular event.Results Exclude the patient had a contraindication above（69 cases）,244 cases were included.According to the occurrence of MACE,the patients were divided into well prognosis group（184 cases）and poor prognosis group（60 cases）.Hypertension,low density lipoprotein cholesterol level（LDL-C）,left coronary artery（LCA）rotational atherectomy and taking diuretics were different significantly between two groups in the severe coronary artery calcification patients（P < 0.05）.Logistic regression analysis shows that hypertension and LCA rotational atherectomy are the independent risk factors.Taking diuretics is the independent protective factor.Survival analysis shows the survival rate is lower in the patients with hypertension,who underwent left coronary rotational atherectomy or who didn’t take diuretic regularly after operation.Conclusion Hypertension,low-density lipoprotein level and target vessels of intervention may be important prognostic factors in patients with CAC after CRA.The use of diuretics may improve the clinical prognosis of these patients to a certain extent.