Correlation Between In-hospital Death And Culprit Vessels In Patients With Acute Myocardial Infarction Complicated With Cardiogenic Shock And Analysis Of Independent Influencing Factors

Objective:We want to explore the correlation between in-hospital death and culprit vessels in patients with acute myocardial infarction complicated with cardiogenic shock,and analyze the independent influencing factors of in-hospital death to provide clinical evidences for the early treatment of cardiogenic shock.Research methods:This study retrospectively collected the clinical data of 339 patients with CS hospitalized in the cardiovascular intensive care unit(CICU)of the First Hospital of Jilin University from January 1,2019 to October 30,2022,and according to the criteria of inclusion,a total of 191 AMI-CS patients was included.We collected messages including the general clinical data of the study subjects,the blood vessels of the offenders,percutaneous coronary intervention(PCI)revascularization related indicators,laboratory indicators,electrocardiogram,cardiac ultrasound indicators,CICU treatment,in-hospital adverse events and outcome endpoint events,etc.(1)According to criminal vascular lesions: left main artery(LM),left anterior descending artery(LAD),left circumflex artery(LCX)and right coronary artery(RCA),the research subjects were divided into 2 groups(LAD/LM group and other lesion groups),and the baseline data of each group,hospital admission,offender vascular status,PCI revascularization,electrocardiogram,cardiac ultrasound indicators,CICU treatment,in-hospital adverse events,and in-hospital outcomes were analysed,to find out if there is a statistical difference between them.(2)According to the in-hospital outcome events,the study subjects were divided into death group and survival group,and the general clinical data,hospital admission,offender vascular status,PCI revascularization,laboratory indicators,electrocardiogram,cardiac ultrasound index,CICU treatment,and in-hospital adverse events of the two groups were analyzed,and the relevant risk factors affecting AMI-CS in-hospital death were analyzed,and independent risk factors for predicting AMI-CS in-hospital death were explored.Research results:1.The median heart rate of the LAD/LM group was higher than that of other vascular groups,and there was a statistical difference,P <0.001.Compared with other vascular groups,the LAD/LM group was more inclined to choose radial artery in the surgical approach,and 94 cases(72.31%)in the LAD/LM group chose transradial artery access vs 34 cases(55.74%)in transfemoral artery access group,P<0.05,which was statistically significant.The incidence of chronic total occlusion of coronary arteries in LAD/LM group was significantly lower than that in other vascular groups,with 49 cases(37.69%)vs 34 cases(55.74%),P<0.05.The preoperative vascular TIMI blood flow fraction(P=0.05)and the postoperative vascular TIMI blood flow classification(P=0.001)showed differences in the vascular comparison of the two groups.In the selection of intraoperative temporary pacemaker implantation,the LAD/LM group was significantly lower than that of other vascular groups 3(3.06%)vs 15(16.13%),P<0.05.The peak peak median troponin in the LAD/LM group was significantly higher than that of 285(103.25,509)ng/ml vs 164(56.30,236)ng/ml,P<0.001 in the other vascular groups.Compared with other vascular groups,the median left ventricular ejection fraction was lower in the LAD/LM group,42(37,47)% vs 50(40,56)%,P<0.001,while the median left ventricular end-diastolic diameter was higher,50(48,54)mm vs 48(44,52)mm,P=0.004,which was statistically significant.There was a difference between LAD/LM and other vascular groups in the use of intra-aortic balloon pump(IABP),with 57(58.16%)vs 26(27.96%)and P<0.001.There was also a difference in the median time to IABP use,P<0.001.In comparing the outcome of in-hospital death,LAD/LM compared with other vascular groups,P>0.05,so the different vessels in patients with AMI-CS did not appear to have an effect on in-hospital death.2.The higher the blood flow grade of TIMI after PCI,which means blood flow recovery was an independent protective factor for AMI-CS nosocomial death(odds ratio,OR=0.55,95% confidence interval,95%CI,0.339-0.891,P=0.015);Elevated residual base in extracellular fluid was an independent protective factor against nosocomial death in AMI-CS(OR=0.927,95%CI 0.873-0.984,P=0.013).In contrast,direct bilirubin was elevated(OR=1.204,95% CI 1.051-1.379,P=0.007),troponin I peak(OR=1.002,95% CI 1.001-1.003,P=0.003),more than two vasoactive agents(OR=3.485,95% CI 1.256-9.673,P=0.017)and mechanical ventilation(OR=3.484,95% CI 1.448-8.384,P=0.005),was an independent risk factor for death in AMI-CS.Conclusion:1.The different infarct related artery of patients had no effect on in-hospital death of AMI-CS.2.TIMI blood flow recovery and extracellular fluid residual alkali increase after PCI surgery were independent protective factors for AMI-CS in-hospital death,while elevated direct bilirubin,increased troponin I peak,and the use of more than 2vasoactive drugs and mechanical ventilation were independent risk factors for AMI-CS in-hospital death.