Analysis On The Influence Factors Of Perioperative Heart Failure In Patients With Acute STEMI Undergoing Emergency PCI

Objective：To analysis the related factors of perioperative heart failure inpatients with acute STEMI undergoing emergency PCI.Method:According to the inclusion and exclusion criteria we have made,the study involves227patients who suffered the first acute STEMI andaccepted the treatment of emergency PCI in period of2012January to2013December. The average age of all patients was58.86±11.55yearsold. The227patients include180males and47females. Record thegeneral information of all patients in detail including age, gender, thehistory of hypertension and diabetes and high cholesterol and smoking.Record the pain to balloon time (h) and the the site of myocardialinfarction including anterior, antetheca and paries inferior. Accordingto the operation report, record the use of thrombus aspiration andtirofiban and record the postoperative TIMI grade of blood flowand thethe infarct related coronary artery including rami anterior descendens,right coronary artery and left circumflex branch and if with multi vesseldisease. According to the result of routine blood test which is availableat the time of admission, specific numerical is recorded about white blood cell count, the percentage of neutrophils, neutrophils tolymphocytes ratio (NLR) and mean platelet volume (MPV). Within2hours after PCI again for the12lead ECG and record the level of STresolution(STR) compared with the ECG before PCI. Measure the STsegment elevation from the post40ms of J point and make the TPsegment for the equipotential lines. Select the lead in which the level ofthe ST segment elevation is the biggest and record the ST resolution rateof the lead2hours after PCI. According to the rate of STR, defined theSTR≤50%and the STR＞50%. Record the cardiovascular eventsincluding death, ventricular fibrillation, ventricular tachycardia, highdegree atrioventricular block and first occurred atrial fibrillation. Recordleft ventricular ejection fraction according to the cardiac ultrasoundechocardiography one week after PCI.Define LVEF≤45%as heartfailure group and LVEF＞45%as the non heart failure group. All thedata were analyzed by statistical software SPSS17.0. Count data wasexpressed by the number(percentage) and measurement data wasexpressed by the mean±standard deviation. When analysis thedifference of single factor between two groups, using Chi square test toanalysis count data and using the two independent samples t test toanalysis the measurement data. Using the multi factor regressionanalysis to study the related factors of perioperative heart failure inpatients with acute STEMI undergoing emergency PCI. Using the linear correlation analysis to study the relationship between related factors andLVEF. The difference was statistically significant when p＜0.05.Result:Compared with the non heart failure group, in heart failure group,the average age (61.08±12.62vs57.66±10.78) is bigger, the averagetime of chest pain to balloon(5.41±3.24vs4.41±2.80) is longer, theproportion of the anterior descending branch as the infarct relatedcoronary artery(65%vs48%) is higher, the proportion of using thetirofiban(24%vs38%) is lower, the proportion of postoperative TIMIgrade of blood flow＜3(11%vs3%)is higher, the total number ofwhite blood cell (11.43±3.05vs10.48±3.02)is bigger,and there was astatistically significant difference between the two groups(p＜0.05).Compared with the non heart failure group, in heart failure group,theproportion of the anterior wall as the site of myocardial infarction (60%vs35%)is higher,the percentage of neutrophils (82.20±8.16vs73.58±13.45) is higher, the neutrophil to lymphocyte ratio (8.66±4.13vs5.25±3.47) is higher, and there was a statistically significant differencebetween the two groups (p<0.01). Multi factor regression analysisshowed that STR≤50%2hours after PCI and long time of chest pain toballoon are two relatively independent risk factors of heart failure duringperioperative period of emergency PCI. Linear correlation analysisshowed that age was negatively correlated with LVEF value(r=-0.190， p=0.004). Chest pain to balloon time was approximately negativecorrelated with LVEF value(r=-0.129, p=0.051). The total number ofwhite blood cell was negatively correlated with LVEF value(r=-0.134，p=0.044). Percentage of neutrophils was negatively related to the valueof LVEF(r=-0.355，p＜0.001). The neytrophil to lymphocyte ratio wasnegatively related to the value of LVEF(r=-0.429，p＜0.001). Comparedwith the group of STR>50%, in the group of STR≤50%, the rate ofcardiovascular events during hospitalization (14%vs6%) was higher,and there was a statistically significant difference between the twogroups (p<0.05).Conclusion:1. STR≤50%and long time of chest pain to balloon areindependent risk factors of perioperative heart failure in patients withacute STEMI undergoing emergency PCI.2.Using of tirofiban has good protective effect on perioperativecardiac function in patients with acute STEMI undergoing emergency PCI.3. The immediate postoperative blood TIMI grade <3、the anteriorwall as the site of myocardial infarction、the anterior descending branchas the infarct related coronary artery are the risk factors of perioperativeheart failure in patients with acute STEMI undergoing emergency PCI.4. The increased neutrophils to lymphocytes ratio(NLR) is a riskfactor of perioperative heart failure in patients with acute STEMI undergoing emergency PCI. And NLR has good correlation withperioperative left ventricular ejection fraction.