| Background and objective:Acute myocardial infarction(AMI) has an increasing mortality rate in China in recent years,and its pathogenesis is increasingly “young”,"ageing" and "ruralization".AMI has become an extremely critical manifestation of coronary heart disease(CHD) because of its morbidity,high mortality and poor prognosis.In the existing reperfusion therapy of AMI,primary percutaneous coronary intervention(pPCI) has become the preferred method.Modern technology and medical standards is improving continuously,but the mortality rate of AMI has not shown a downward trend.Recurrent myocardial infarction(re-stalk) after pPCI is one of the causes which lead to the high mortality of AMI.There are many factors that cause re-infarction in patients with AMI,including thrombosis,intimal hyperplasia,vascular distraction and remodeling,as well as genetic factors,self-basic diseases,patient habits,coronary vascular characteristics,type of implants,postoperative medication and so on.This article retrospectively analyzed the case-control study data with re-infarction patients and patients with first-infarction after AMI pPCI,and explored the related factors of re-infarction after pPCI in patients with AMI,provided a basis for reducing the incidence of re-infarction after pPCI in patients with AMI.Methods:This study used a retrospective analysis method,from July 2015 to April 2018,a total of 1195 patients who were diagnosed with AMI and received pPCI in Henan Provincial People's Hospital,and 1112 patients(93.05%) were screened for 1 year.Among them,217 patients were excluded due to other reasons such as incomplete data or lost to follow-up.A total of 895 patients were enrolled.Among them,42 patients had recurrent AMI.According to the age and gender,according to the principle of l:3 individual matching,126 patients who underwent pPCI surgery and had the same gender but no re-infarction in the same period(within one week) were set as the control group.Using Graphpad Prism5,SPSS 22.0 statistical software,from heart rate,diastolic blood pressure,systolic blood pressure,cardiac function(Kllip) classification,history of hypertension,history of diabetes,smoking history,drinking history,genetic history of family cardiovascular disease,white blood cells,neutrophilel granulocytes,hemoglobin,platelets,admission to blood glucose,uric acid,creatinine,potassium concentration,Cradiac troponin I,Creatine kinase MB,triglycerides,total cholesterol,low-density lipoprotein cholesterol high-density lipoprotein cholesterol,fibrinogen,international normalized ratio,left ventricular ejection fraction,left ventricular end diastolic diameter,number of diseased vessels,number of stents,total length of stent,minimum diameter and type of stent,postoperative regular medication,post-infarction angina,regular physical exercise In this regard.Establishing a Logistic regression modelto analyze the risk factors for myocardial infarction after pPCI in patients with AMI.Results:Univariate analysis1.Analysis of clinical featuresCompared with the non-RMI group,the RMI group had statistical significance(P<0.05) in smoking history and cardiac function(Killip grade)?2.However,between the two groups,heart rate,diastolic blood pressure,systolic blood pressure,drinking history,history of diabetes,history of hypertension and genetic history of family cardiovascular disease are not statistically significant(P>0.05).2.Auxiliary examination of patientCompared with the non-RMI group,the RMI group was statistically significant in terms of white blood cells,neutrophilel granulocytes,platelets,Creatine kinase MB,low-density lipoprotein cholesterol,and international normalized ratio(P <0.05).However,between the two groups,hemoglobin,Cradiac troponin I,high-density lipoprotein cholesterol,total cholesterol,triglycerides,fibrinogen,uric acid,creatinine,serum potassium concentration,admission blood glucose,left ventricular ejection fraction,left ventricular end diastolic diameter and other indicators are not statistically significant(P>0.05).3.Interventional surgery data of patientCompared with the non-RMI group,the RMI group had statistical significance(P<0.05)in the number of stents ?2,total stent length,and minimum stent diameter.However,between the two groups,the number of lesions and stent types are not statistically significant(P>0.05).4.Postoperative situation of patientCompared with the non-RMI group,the RMI group had statistical significance in post-infarction angina and regular physical exercise(P<0.05).However,there were no statistically significant differences between the two groups(P>0.05).Multivariate analysis:Cardiac function(Kllip) classification,low-density lipoprotein cholesterol,number of stents ? 2,total length of stent,post-infarction angina are independent risk factors for recurrent myocardial infarctionqafterapPCIqinwAMIwpatients.Thewratiow(OddsdRatio,OR) wwas4.344(95%CI=1.585-11.905,P=0.004),1.884(95%CI=1.125-3.153,P=0.016),8.580(95%CI=1.254-59.687,P=0.028),1.083(95%CI=1.032-1.137,P=0.001),14.453(95%CI=5.023-41.587,P=0.000),There was a negative correlation between the minimum diameter of the stent and the RMI in patients with AMI.The OR value was 0.093(95% CI = 0.022-0.383,P = 0.001).Conclusions:Cardiac function(Kllip) classification,low-density lipoprotein cholesterol,number of stents ? 2,total length of stent,post-infarction angina and minimum diameter of the stent may be the independent risk factors for re-infarction after PCI in patients with AMI. |
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