Predictive Value Of IQP On Coronary Artery Disease And Prognosis In Patients With Acute ST Segment Elevation Myocardial Infarction

Objectives:The purpose of this study is to analyze the clinical characteristics of STEMI patients with IQP,and explore the predictive value of IQP for coronary artery disease and all-cause mortality after discharge in STEMI patients.Methods:1、188 patients with STEMI confirmed by the Cardiovascular Clinic of Bethune First Hospital of Jilin University from January 2017 to June 2017 were selected consecutively.All the selected patients underwent emergency PCI and were treated according to the standard medical scheme after operation.2 、 Collect general data of patients(gender,age,myocardial infarction site,Killip classification,hypertension history,diabetes history,smoking history,length of stay,systolic blood pressure,diastolic blood pressure,heart rate)Laboratory test results at admission(troponin,myoglobin,creatine kinase isoenzyme,brain natriuretic peptide,D-dimer,troponin peak,low density lipoprotein cholesterol,high density lipoprotein cholesterol,triglyceride,total cholesterol),the first ECG at admission(QRS wave duration,whether IQP occurs,and the extent of prolongation of IQP)Angiographic results(dominant type of coronary artery,number of diseased vessels,degree of vascular stenosis,culprit vessels,TIMI grade of blood flow of intervention vessels,Gensini score),postoperative cardiac color Doppler ultrasound results(ejection fraction,left ventricular end diastolic diameter,left atrial diameter),and survival of patients followed up to 5 years after discharge.3、 Differences in general data,test tests,coronary lesions,and prognostic information between patients who were IQP positive and those who were IQP negative were analyzed and compared.4、Differences in general data,test tests,coronary lesions,and prognostic information between patients who presented in the mild IQP group,the moderate IQP group,and the severe IQP group were analyzed and compared.5 、 The independent influencing factors of all-cause mortality within 1,3 and 5 years in patients were explored by univariate and multivariate analysis.Results:1、A higher proportion of patients in the IQP positive group compared with the IQP negative group were male,had a greater probability of myocardial infarction location as extensive anterior wall,and had a higher peak troponin(P < 0.05);The severe IQP group had a higher proportion of Killip class III and IV,a greater probability of developing inferior MI,higher BNP,and lower cardiac color coded EF values than the mild IQP and moderate IQP groups(P <0.05).2、Compared with patients in the IQP positive group,those in the IQP negative group had a greater proportion of diseased vessels with preoperative TIMI flow grade 0,a greater proportion of those with two vessel disease,three vessel disease,more severe vessel stenosis in LAD and LCX,a greater probability that the culprit vessel was lad,a greater number of stents implanted,a higher Gensini score,and a higher risk of death within five years(P < 0.05).3、The proportion of diseased vessels with preoperative TIMI flow grade 0 was greater in the moderate IQP and severe IQP groups compared with the mild IQP group;The severe IQP group had a greater probability of the culprit vessel being the RCA,a greater proportion of coronary three vessel disease,and a greater degree of stenosis of the RCA than the mild,moderate IQP group;The proportion of double vessel disease was greater in the moderate IQP group compared to the mild IQP group;More severe LAD stenosis;From the mild IQP group to the severe IQP group,the stenosis degree of the LCX increased,and the Gensini score increased sequentially.4、Univariate and multivariate analyses yielded that age(or =0.951;95% CI: 0.914-0.990,P = 0.013),a IQP > 40 ms i.e.,severe IQP(or = 2.617;95% CI: 1.157-5.920,P = 0.013)were independent predictors of all-cause mortality within 3 years in patients with acute STEMI;Age(or = 0.902;95% CI: 0.866-0.939,P < 0.001),a IQP > 40 ms i.e.severe IQP(or = 4.380;95% CI: 1.777-10.797,P = 0.001)were independent predictors of all-cause mortality within 5 years in acute STEMI patients.Conclusions:1、The IQP positive group had a significantly higher proportion of STEMI patients being male,probability of MI location being extensive anterior wall and peak troponin concentrations than the IQP negative group;The proportion of Killip classes III and IV,and BNP values in the severe IQP group were significantly higher than those in the mild IQP and moderate IQP groups,and EF values in the severe IQP and moderate IQP groups were significantly lower than those in the mild IQP and moderate IQP groups.2、Patients in the IQP positive group had a greater proportion of diseased vessels with pre procedural TIMI flow grade 0,a greater proportion of lesions with two-and three vessel disease,a greater degree of vessel stenosis in the lad and LCX,a greater probability of the culprit vessel being lad,a greater number of stents implanted,and a higher Gensini score,suggesting that patients with IQP positive STEMI have a greater degree of coronary disease than those with negative IQP.3、As the degree of IQP prolongation increased LCX,the degree of stenosis in the RCA,the proportion of three vessel coronary lesions and the Gensini score also increased,suggesting that the greater the degree of IQP prolongation in STEMI patients,the greater the degree of coronary lesions.