Predictive Value Of Vitamin D,ACTH And Cortisol On Short-term Cardiovascular Events In Patients With Myocardial Infarction After Emergency PCI

Objective:At present,the incidence of acute myocardial infarction(AMI)in China continues to rise,and some patients will still have adverse cardiovascular events(MACE events)such as recurrent angina pectoris,malignant arrhythmia,repeated heart failure and even sudden death after active treatment.Therefore,for these patients,we need to find some indicators that can predict the occurrence of MACE events,pay more attention to these patients,and reduce adverse events as much as possible.This paper intends to explore the clinical value of vitamin D,corticotrophin(ACTH)combined with plasma cortisol level in predicting adverse cardiovascular events in AMI patients after emergency percutaneous coronary intervention(PCI)in 3months.Methods : From November 2020 to November 2021,120 patients who were diagnosed with AMI and received emergency coronary angiography and PCI after taking aspirin,clopidogrel bisulfate or Tegrelor,and 60 patients who received coronary angiography and PCI for unstable angina pectoris in the same period were selected.The differences of general clinical data and related laboratory indexes between the two groups were compared.The acute myocardial infarction group was divided into MACE group and non-MACE group according to whether MACE event occurred after operation.To further analyze the differences of vitamin D,ACTH and lying cortisol in myocardial infarction group.After PCI,patients were given general tests such as vitamin D,ACTH,lying cortisol,blood routine,liver and kidney function,troponin on an empty stomach the next morning.They were sent for inspection immediately after blood collection.The test reagents were tested by Roche Diagnostic Company’s 25-hydroxyvitamin D test kit,adrenocorticotropic hormone test kit and cortisol test kit(all of which are electrochemiluminescence method).The data were statistically processed,and the patients were followed up by outpatient clinic and telephone at the 3rd month after discharge,and whether there was any or not.Results:The levels of cortisol(474.04±157.64)and ACTH(34.55±13.65)in patients with myocardial infarction were higher than those in control group(424.32± 120.70 and ACTH25.62±9.69),and the difference was statistically significant.The ACTH(30.64±9.36)and cortisol(545.02±153.02)in MACE group were higher than those in non-MACE group(ACTH24.03±9.29 and cortisol 451.42±153.07),P = 0.002 and 0.006,respectively.The level of vitamin D(16.87±8.79)was lower than that of non-MACE group(22.00±8.54),P = 0.006,and the differences were statistically significant.Vitamin D,ACTH combined with cortisol can predict the occurrence of MACE after PCI.Conclusion:Patients with myocardial infarction after emergency PCI,if ACTH,cortisol are significantly increased,or vitamin D level is significantly lower,the probability of adverse events occurring within 3 months is higher.Serum vitamin D,ACTH and cortisol levels can all predict the occurrence of adverse events in AMI patients within 3 months,and the combination of them can improve the sensitivity of prediction compared with single index.