Analysis Of The Risk Factors Of MVRA Happened To Patients Who Fall In Acute STEMI During The Perioperative Period Of PPCI

?Background and Objective? The incidence of acute myocardium infarction(AMI)increases year by year,and the mortality rate is close to 30% in the acute phase.The common causes of death include acute heart failure?malignant arrhythmia and the cardiac rupture,etc.Because of the characteristics of coronary artery lesion,the latest guidelines recommend that primary PCI(PPCI)is an efficient therapeutic method for patients who fail in STEMI.This study is to find out the possible risk factors of malignant rapid ventricular arrhythmia(MRVA)which happens to the patients with STEMI during the perioperative period of PPCI.?methods? This study was conducted in the First Hospital Affiliated to Dalian Medical University.We payed close attention to the patients who were attacked by acute STEMI and were underwent PPCI from January 1,2015 to December 31,2015.According to the symptom whether they suffered the MRVA during the perioperative period of PPCI,the patients were separated into two groups.In the case group,the patients suffered the MRVA.In the control group,the cases did not suffer the symptom.The data of the patients were collected and analyzed.?Results and discussion?1.There are 344 cases that are recorded in the study.Among them,50 patients who suffered MRVA during the perioperative period of PPCI are in the case group,and the others are in the control group.The incidence of MRVA happened during the perioperative period of PPCI is 14.53%.2.According to the data,the differences between the two groups in gender,age,smoking history,whether suffering high blood pressure(HBP)?diabetes mellitus(DM)or hypercholesteremia are not significant in statistics(P?0.005).3.And the difference of the ion concentration does not have significance,too(P?0.005).4.As to the infarction related artery(IRA),the difference is significant if the IRA is the left main coronary artery(LM)(P=0.003),and the incidence higher in the case group than that in the control group.If the IRA is the left circumflex artery(LCX),it is significant(P =0.039)too.On the other hand,the incidence is lower in the case group than that in the control group.We also payed attention to the obstructions of the coronary artery.If the thrombus is located in the 1#?5#?6#?7#?13#(P valuse are <0.001?<0.001?0.049?0.008?0.039),the difference between the two groups are significant.However,if the thrombus is located in the 2#?3#?4#?8#?9#?10#?11#?12#,the difference between the two groups are not significant.If the thrombus is located in the 1#?5#?6#,the incidence is higher in the case group than that in the control group.If the sites of the occluded arteries are 7#?13#,the incidence is lower in the case group than that in the control group.5.There are significant differences between the two groups in the length of the IRA(P= 0.004).The incidence of the length longer than 20 millimeters is higher in the case group.6.Besides,as to the collateral circulation to IRA,the difference is significant(P value is less than 0.001).There are more cases in the control group that at less one collateral circulation is contacted to IRA.7.While,whether there are one ?two or three coronary arteries damaged,it means nothing.8.According to the process of the PPCI,there are no significant differences between the two groups in the revascularization before PCI,the implantation of temporary pacemaker,or the post-dilatation of the stent.In the other hand,the difference in the phenomenon of slow flow or none flow of coronary artery is significant instatistics(P value is less than 0.001).The incidence is higher in the case group than that in the control group if the phenomenon of slow flow or none flow appeared.9.As to cardiac functional grading,there are significant differences between the two groups while the cardiac functional is ?and ?(P values are 0.021?<0.001).The incidence is higher in the case group than that in the control group when the cardiac functional is ?.While the incidence is lower in the case group when the cardiac functional is ?.10.Logistic regression analysis exposes that the length of IRA?slow flow?none flow?cardiac functional grading are the independent factors associated with MRVA presented the perioperative period of PPCI.?Conclusion?1.The length of IRA?slow flow?none flow?cardiac functional grading are the risk factors associated to MRVA which occured in PPCI.It is easy for the MRVA to take place if the length of IRA is more than 20mm?the phenomenon of slow flow?none flow appeared during the operation or the cardiac functional grading is higher.2.As to the thrombus which is located in the 5#?LAD 6#?RCA 1#,the incidence is higher among the patients who suffered the MRVA during the perioperative period of PPCI than those who were not attacked by MRVA.3.It is less likely for the MRVA to take place if there are blood flow arriving at the IRA by the collateral circulation.