Analysis On The Risk Factors Of AMI,VRM And VRM Accompanied By CHF After AMI

This article retrospectively analysed 209 cases in which the patients were with acute myocardial infarction (AMI) in order to investigate the risk factors of AMI, ventricular remolding (VRM) and ventricular remolding accompanied by congestive heart failure (CHF) after AMI. Understanding these risk factors can help clinical doctors judge the developing trend of diseases in early days of AMI, and look for better medicine and other treatment's methods to improve AMI patient's near and long-term prognosis. VRM after AMI was diagnosed by echocardiography and CHF was diagnosed by clinical symptoms and echocardiography 's EF. Patients that took place AMI first time were admitted to the first hospital of jilin University from January of 2003 to December of 2004, in which we selected 209 patients with complete medical cases and the time from attack to admission was less than 24 hours. These patients were divided into three groups: not VRM group, having VRM but not CHF group and VRM accompanied by CHF group. At the same time we choosed 60 non-coronary heart disease as control group. At first, the age, sex, smoking and past history (essential hypertension, diabetes mellitus, hyperlipidemia), cardiac arrhythmia (sino-atrial block, asystole, II, III degree atriaventricular block, frequent ventricular premature beat, ventricular tachycardia, ventricular flutter, ventricular fibrillation and fast atrial fibrillation), position and type of AMI, Killip class of admission, treatment and laboratory indexes were respectively analysed in the control group (60cases) and AMI group (209cases), not having VRM group (76cases) and having VRM group (133cases) after AMI, as well as having VRM but not CHF group(72cases) and VRM accompanied by CHF group (61cases). Then we got the independent risk factors of AMI, VRM and VRM accompanied by CHF after AMI according to Logistic multivariate regression analysis. At last we drew the ROC curves of VRM and VRM accompanied by CHF after AMI according to the above two Logistic models, and calculated areas below ROC curves. Result showed: 1. WBC's going up (odds ratio1. 956, 95%CI 1.548 to 2.471), hyperlipidemia (odds ratio 2.443, 95%CI 1.002 to 6.378), essential hypertension (odds ratio 3.700, 95%CI 1.626 to 8.419), and smoking (odds ratio 3.992, 95%CI 1.731 to 9.206) were the independent risk factors of AMI; 2. FIB≥400mgs/dl (odds ratio 2.00, 95%CI 1.003 to 5.832), MO ≥8% (odds ratio 3.945, 95%CI 1.264 to12.308), cardiac arrhythmia (odds ratio 4.885, 95%CI 1.769 to 13.484), the anterior or multiple position of AMI(odds ratio 18.338, 95%CI 5.167 to 65.703), as well as CK-MB≥14% (odds ratio 24.530, 95% CI 8.113 to 74.169) were independent risk factors of VRM after AMI; 3. GR≥80% (odds ratio 2.599, 95%CI 1.060 to 6.370), III,IV class of Killip in admission (odds ratio 4.679, 95%CI 1.833 to 11.945), CK-MB≥20% (odds ratio 7.700, 95%CI 3.154 to 18.795) were independent risk factors of VRM accompanied by CHF after AMI; 4. According to the two logisticmultivariate analysis models we got the areas below ROC curves in VRM after AMI to be worth to 0.954 (namely the credibility of diagnosing VRM after AMI was 95.4% according to this model), while the areas in VRM accompanied by CHF after AMI to be worth to 0.844 (namely the credibility of diagnosing VRM accompanied by CHF after AMI was 84.4% according to this model). Analysing these cases synthesizely showed: Although hyperlipidemia history was an independent risk factor of AMI, blood fat standard of AMI in earlier period couldn't respond the true blood fat level of the patients, which was lower than the usual. So we couldn't judge prognosis according to the leval of blood fat in the earlier period, also couldn't decide whether we should carry up the treatment of declining blood fat or not; FIB's going up was VRM's independent risk factor, but was not the independent risk factor of VRM accompanied by CHF. We considered that the class of Killip of CHF patient was worse in earlier period, and the right heart function would also be subjected to the influence, so the liver was lightly extravasated, then the produce of FIB would reduce; The WBC played very important role in the AMI, and the different composition had different function. MO had important meaning to the change of the heart appearance, while GR had more meaning to the the change of heart function; At present, specialists usually estimated and diagnosed VRM with echocardiography. Concerning VRM's serum diagnosis, currently still had no good index sign; According to logistic multivariate regression analysis models we got the...