Analysis Of The Influencing Factors Of MACCE After Primary PCI Operation In Patients With Acute Myocardial Infarction

Objective:To retrospectively analyze the influencing factors of MACCE after primary percutaneous coronary intervention who were admitted to the Affiliated Hospital of Yan'an University from March 2012 to September 2016.Methods:794 cases of AMI were enrolled in the Department of Cardiology of Affiliated Hospital of Yan'an University from March 2012 to September 2016.The patients who did not have MACCE in 1 years after the operation were selected as the control group(n=681),and the patients with MACCE were the experimental group(n=113).The collected data were processed by SPSS22.0 statistical analysis software,the measurement data were expressed in?x±s,single factor analysis was used by independent sample t test,and the ratio of counting data or composition ratio was expressed by?~2test.Then the influential factors of statistical significance were screened and the possible influence factors of MACCE in acute myocardial infarction patients after primary PCI were analyzed by two categories of multiple factor Logistic regression.Result:1.There was no significant difference in the history of hypertension,diabetes mellitus,hyperlipidemia,history of cerebrovascular disease,and family history of cardiovascular and cerebrovascular disease in the two groups(P>0.05).However,the sex ratio of the two groups,the history of smoking in the past,the average age of onset,the time of onset to the opening of blood vessels and the Killip classification of cardiac function at admission were statistically different(P<0.05).2.Compared with the experimental group,there was significant difference in the white blood cell count,BUN and LVEF between the control group and the experimental group(P<0.05).The absolute value of neutrophil,absolute lymphocyte,red blood cell count,hemoglobin count,platelet,average platelet volume,platelet volume distribution width,triglyceride,total cholesterol,high density lipoprotein,low density lipoprotein,creatinine,uric acid,INR,FIB and troponin were no significant difference(P>0.05).3.The control group selected 585 cases(85.90%)of the radial artery and 96 cases(14.10%)of the femoral artery.In the experimental group,96 cases(84.96%)of the radial artery and 17 cases(15.04%)of the femoral artery were treated with PCI.There was no significant difference in the choice of arterial approach(P>0.05).4.In the control group,there were 7 cases(1.02%)of IRA lesions,296 cases(43.47%)of ILA lesions,169 cases(24.82%)of LCX lesions,and 209 cases(30.69%)of RCA lesions.The IRA lesions in the case group were LM1(0.88%),LAD53(46.90%),LCX26(23.01%),and RCA33(29.20%).There was no significant difference between the two groups(P>0.05).5.In the control group,stenosis?50%of the number of disease vessels was 346(50.81%)in single vessels,173(25.40%)in double vessels,and 162(23.79%)in three vessels.In the case group,39 cases(34.51)of vascular lesions with stenosis?50%were single,32cases(28.32%)with double-vessel disease,and 42 cases(37.17%)with triple-vessel disease.There was a statistically significant difference between the two groups(P<0.05).6.Of all the subjects,there were 18 patients without reflow,of which 7 were in group MACCE after 1 years of operation,11 in group MACCE,and P<0.05 from the two group after chi square test.The occurrence of no reflow may be a factor affecting the occurrence of adverse events after emergency PCI.7.There was no significant difference between the two groups in postoperative oral?-blockers,ACEI,and ARB(P>0.05).8.There were 496 cases(72.83%)who had lifestyle intervention after PCI in the control group,and 75 cases(66.37%)had lifestyle intervention after the experimental group.The two groups were analyzed by single factor after X~2 test(P>0.05).There was no statistical significance.9.After single factor analysis,there were statistically significant variables including sex,age,smoking history,heart function Killip grading,onset to vascular opening time,leukocyte count,urea,LVEF,stenosis more than 50%of vascular branches,no reflow and other 10 variables.After two classifications and multiple factor Logistic regression analysis,the influence factors of MACCE were sex,age,onset time,blood vessel opening time,white blood cell count,urea nitrogen,LVEF value,and stenosis more than50%of the vascular branches(P<0.05).LVEF is a protective factor for MACCE in patients with acute myocardial infarction after emergent PCI surgery(OR:0.930).Conclusion:1.The influence factors of MACCE were sex,age,onset time,blood vessel opening time,white blood cell count,urea nitrogen,LVEF value,and stenosis more than 50%of vascular branches.2.LVEF is a protective factor for the occurrence of adverse cardiac and cerebral vascular events in acute myocardial infarction patients after emergency PCI operation.Therefore,it is suggested that emergency PCI operation be performed as soon as possible after the onset of acute myocardial infarction(AMI),reduce the area of myocardial infarction and avoid further reduction of LVEF.