Recent MACE Of PCI In Patients With Acute STEMI And The Related Risk Factors Involved

Background:In recent years,the incidence of coronary heart disease increased rapidly every year.Among the many types of coronary heart disease,acute myocardial infarction(AMI)is an important cause of sudden cardiac death.A large number of studies have found that percutaneous coronary intervention(PCI)is the safest and most effective way to treat STEMI.The timely and effectively opening of infarct related artery(IRA)by PCI can quickly improve the recovery of ischemic myocardium in the infarcted blood flow,reduce myocardial cell apoptosis,improve electrophysiological and ventricular remodeling,thereby reducing the MACE events.With the rapid development of emergency PCI,the morbidity and mortality of STEMI patients have decreased significantly,but some patients have poor prognosis.Objective:To investigate the risk factors affecting the prognosis of patients with STEMI after emergency PCI and improve the therapeutic effects of STEMI and reduce the morbidity of STEMI,we analyzed the clinical characteristics of patients with acute STEMI and the characteristics of coronary artery interventional therapy.Methods:Object: We enrolled 500 cases of acute STEMI patients with emergency PCI in the Department of Cardiology,the First Affiliated Hospital of Soochow University,from October 2013 to October 2015.All selected cases were eligible for inclusion criteria and exclusion criteria.Grouping : According to the different prognosis(MACE during hospitalization,including angina,re-myocardial infarction,arrhythmia,heart failure,cardiac death,etc.),patients were divided into MACE group(n = 160 cases)and NO-MACE(n = 340 cases).Observation indicators: We collected the clinical data such as sex,age,white blood cell count(WBC),neutrophile(N),high sensitive C reactive protein(HIC),troponin(Tn),and so on.We analyzed the coronary angiographic features of enrolled patients,such as IRA,IRA vascular obstruction sites,vascular blood vessels after recanalization and other blood flow classification.The other data collected are the coronary artery thrombosis,coronary injection of tirofiban and other treatment.Statistical methods: Univariate logistic regression analysis was performed to determine the indicators associated with clinical prognosis.Multivariate logistic regression analysis was used to screen out the related risk factors of MACE in STEMI patients with emergency PCI.Results:1.There were statistical significances in the sex composition,smoking history,age,Killip grade,systolic blood pressure,heart rate,and use of ?-blockers before PCI(P < 0.05).2.In the two groups of patients on the second day of admission,MACE is more likely to occur in the patients who have higher figure of WBC,NE,RDW,UA,HSCRP,GLU(P<0.05).The higher left ventricular ejection fraction(LVEF)detected by ultrasonic cardiogram,the smaller incidence rate of MACE(P<0.05).There was no significant difference in HGB,TC,TG,HDLC,LDLC,CKMB,heart left atrial diameter(LA),left ventricular end-systolic dimension(LVS)and left ventricular end-diastolic dimension(LVD)between two groups.3.Between the two groups in the treatment of PCI,Shortening the time of onset to myocardial reperfusion,or coronary injection of tirofiban could reduce the incidence rate of MACE(P <0.05).While the IRA(infarct-related artery)for left main or left anterior descending branch and IRA thromboembolism located in the proximal segment of vascular can all increase MACE occurrence proportion(P<0.05).There was no significant difference in the number of stent implantation and use of intracoronary thrombectomy.4.The multivariate logistic regression analysis was performed based on univariate analysis of IRA,IRA thromboembolic position,intracoronary injection of tirofiban,WBC,UA,RDW,HSCRP,incidence of myocardial reperfusion time.The results showed these were independent influencing factors.Conclusion:1.After PCI treatment directly in patients with acute STEMI,whether MACE occur recently is affected by a variety of factors.women,elderly,smokers are more likely to occur MACE in the near future,while lower Killip grade,higher systolic blood pressure at admission,slower heart rate patients occurred less MACE.PCI preoperative use of ?-blockers can also reduce the occurrence of MACE recently.The higher levels of blood biochemistry components on the first day of postoperative,including WBC,NE,RDW,UA,HSCRP,GLU,can often indicate that the patients are more likely to occur MACE recently,resulting in poor prognosis.2.The elevated levels of WBC,UA,RDW and Hs-CRP,the infarcted vessels and the location of infarction are independent risk factors influencing the prognosis of STEMI patients.The intracoronary injection of tirofiban in the PCI is a protective factor affecting the prognosis.