Correlation Factors For Major Adverse Cardiac And Cerebrovascular Events (MACCE) In Patients With Acute ST-elevation Myocardial Infarction After Primary Percutaneous Coronary Intervention Operation

[Background]With the development of our national economy and the transformation of people’s lifestyle, coronary heart disease shows a rising trend, more than500000new cases every year.Acute myocardial infarction (AMI) is the main causeof sudden cardiac death, manifestedas severe and persistentretrosternal pain. In addition, rest and nitroglycerin cannotcomplete remission, accompanied by activition of serum myocardial enzyme and dynamicchanges of electrocardiogram, even hemodynamic deterioration. According to ECG STsegment changes of acute myocardial infarction, AMI was devided into ST segmentelevation myocardial infarction (STEMI) and non ST segment elevation myocardialinfarction (NSTEMI). Thereinto, the most effective treatment method for STEMI iseffectively and persistent reperfusion of infarction related artery as early as possible,including thrombolysis and stent implantation of percutaneous coronary intervention (PCI)treatment. Compared with thrombolysis, direct PCI can recanalize the infarction relatedvessel more effectively, reduce serious bleeding complications, and is the most effectivetreatment to reduce mortality in patients with STEMI. However, due to the most STEMI patients accompanied by high-risk factors, the application of double and even tripleantiplatelet therapy, even use of heparin and low molecular weight heparin therapy, majoradverse cardiac and cerebrovascular events (MACCE) may occur in the period of perioperation, affecting the efficacy of PCI.[Aims]Retrospective analysis of acute ST segment elevation myocardial infarction patientsunderwent direct PCI from September2008-September2009in Xijing Hospital to clarifythe related factors of major adverse cardiac and cerebral events (MACCE) duringhospitalization.[Methods]1. Subjects:316STEMI patients underwent direct PCI from September2008-September2009in Xijing Hospital were selected as subjects. Case-control study was used,308cases were complied with the inclusion criteria and exclusion criteria.2. Trial division: according to the occurrence of MACCE during hospitalization，thepatients were divided into control group (274cases) and case group (34cases).3. Objective: To observe and record the general clinical situation, PCI related data,laboratory examination index, and antithrombotic drugs and other related data.4. Statistical analysis: SPSS12.0was used to analyze the data. The measurement data wererepresented with x±S. Groups were compared using independent samples t test.Count data were expressed as a percentage, and single factor analysis was detected byχ2test between two groups. Screening the significant factors, and then the multi factorLogistic regression model was used to analyze the related factors of STEMI patientsunderwent direct PCI complicated with MACCE. Considering the influence of timefactor on the logistic regression, and in order to more accurately evaluate and compareresearch data, multivariate analysis of Cox regression model was further used to analyzethe related factors of STEMI patients underwent direct PCI complicated with MACCE.P＜0.05was considered statistically significant.[Results] 1. There was no significant difference (P>0.05) between the two groups in gender, historyof hypertension, diabetes mellitus, hyperlipidemia, history of cerebrovascular diseaseand smoking history; Whereas there were significant differences (P<0.05) in age andkillip classification. Basically the two groups of patients were comparable.2. PCI treatment were compared between the two groups: there was no significantdifference (P>0.05) in onset-emergency PCI time, maximum pressure of IRA balloondilation, maximum pressure of IRA stenting, IRA surgery thrombus aspiration,intraoperative intracoronary tirofiban and sodium nitroprusside, IRA lesion,70%≤stenosis<100%of non-acute infarct-related arteries in several areas; whereas there wassignificant difference in direct IRA stenting and stenosis≥70%of the lesions arteries (P<0.05). Moreover, there was significant difference in the maximum pressure after IRAballoon dilation, IRA intraoperative slow flow and no-reflow, CTO vessel count, IRATIMI flow grade surgery, IRA operative final TIMI flow grade (P<0.01).3. The comparison of laboratory test between two groups: There was no significantdifferences in WBC, PLA, HGB, APTT, FIB, BUN, TC, TG, LDL-C, HDL-C, cTNI(P>0.05); while there was significant difference in PT, Cr, CK (P<0.05). Moreover,there was significant difference in GRAN, UA, CK-MB counting and LVEF (P<0.01).4. The comparison of antithrombotic drugs between two groups of patients: There was nosignificant differences in the total intravenous tirofiban and clopidogrel loading dose(P>0.05); while there was significant differences in Heparin weight ratio, clopidogrelmaintenance dose, aspirin maintenance dose, low molecular weight heparin maintainingtime (P <0.05).5. The influence factors of MACCE occurrence between the case groups: Logisticregression model was used to take multivariate analysis for the related factors ofMACCE occurrence.20univariate analysis variables was taken, and1risk factor wasfiltered out for the occurrence of MACCE, that was high levels of CK-MB in perioperation period (B=0.02, OR=1.02,95%CI:1.01~1.03, P<0.05).2key protectivefactors were screened for the occurrence of MACCE, that was IRA operative final TIMIgrade high level (B=-4.23, OR=0.02,95%CI:0.00~0.18, P<0.01) and the peak of LVEF in peri operation period (B=-0.38, OR=0.46,95%CI:1.26~1.69, P<0.01).6. kaplan-meier method was used to analyze the survival curves between case group andcontrol group after2weeks of PCI. MACCE occured in the case group, however, therewas no MACCE in the control group, there was significant difference between thecontrol group and case group (P<0.01).7. The influence factors of MACCE occurrence in the case group: Considering theinfluence of time factor on the logistic regression, and in order to more accuratelyevaluate and compare research data, multivariate analysis of Cox regression model wasfurther used to analyze the related factors of STEMI patients underwent direct PCIcomplicated with MACCE.2risk factors for the MACCE occurence were screened out,i.e. multi-CTO arteries (B=0.74, OR=2.10,95%CI=1.06-4.13, P<0.05)， and thepeak of CK-MB in peri operation period (B=0.01, OR=1.01,95%CI:1.00~1.01, P<0.05).2protective factors for the MACCE occurence were screened out, i.e. high TIMIgrade of final IRA operative flow (B=-1.33, OR=0.27,95%CI:0.15~0.46, P<0.01) andthe high left ventricular ejection fraction (B=-0.21, OR=0.81,95%CI:0.76~0.87,P<0.01).[Conclusion]1. The high TIMI flow grade after IRA operation was the protective factor in STEMIpatients underwent direct PCI complicated with MACCE, which meant that the higherof TIMI, the better prognosis in STEMI patients with PCI.2. High levels of LVEF in peri operation period was the protective factor in STEMIpatients underwent direct PCI complicated with MACCE. Good LVEF was thefoundation to guarantee the supply of important cardiovascular and renal andgastrointestinal and other organs, and also the basis of reducing MACCE events.3. The peak of high levels of CK-MB was the risk factors in STEMI patients underwentdirect PCI complicated with MACCE. Effective restraintion of the peak period ofCK-MB during operation, especially the reduction of myocardial reinfarction hadimportant significance on the survival and prognosis for patients with STEMI.4. Multi-CTO was the risk factors in STEMI patients underwent direct PCI complicated with MACCE. For patients with multivessel CTO lesions in patients with STEMI,reducing IRAslow flow and no reflow was the key to improve survival rate.