Study On The Related Factors And Prediction Of Early Adverse Events After STEMI Emergency Surgery

First part Study on the related factors and prediction of MACE after PCI in patients with acute ST-segment elevation myocardial infarctionObjective In this study,we observed the occurrence and related factors of MACE during hospitalization after emergency PCI in acute ST-segment elevation myocardial infarction,and studied the correlation and predictive value of inflammatory factors,platelet parameters and MACE.Methods 218 patients with acute ST-segment elevation myocardial infarction treated with direct PCI in the Department of Cardiology,Central Theater Command General Hospital from October2017 to October 2019 were collected.Patients were divided into event group(48 cases)and non-event group(170 cases)according to the occurrence of adverse cardiac events during hospitalization.The difference in clinical data between the event group and the non-event group was compared,and then the statistically significant factors were analyzed by binary Logistic regression to explore the independent related factors of MACE.The receiver operating characteristic(ROC)curve was used to analyze the early predictive value of inflammatory factors and platelet parameters on the occurrence of MACE in patients with acute myocardial infarction after PCI.ROC curve was drawn by statistical software,area under ROC curve was compared,and Jordan index was calculated to find the best critical value.Pearson test was used to analyze the correlation between inflammatory factors and platelet parameters.Results 1.Compared with the non-event group,the age of the event group was higher(P<0.05),the proportion of patients with diabetes mellitus was higher(P<0.05),the levels of serum Cr and NT-pro BNP were significantly higher(P <0.05),and the length of hospitalization was longer(P<0.05).There was no significant difference between the two groups in gender composition,hypertension history,smoking history,TC,LDL-C,HDL-C,TG,UA,CK-MB peak,c Tn T peak,anterior wall myocardial infarction ratio,and LVEF(P> 0.05).2.In terms of the location of IRA lesions,compared with the non-event group,the incidence of lesions in the right coronary artery and left main coronary artery was higher in the event group(P<0.05),compared with the sub groups of IRA,the incidence of MACE in the proximal lesions of anterior descending artery was higher than that in the distal lesions(P<0.05).There was no significant difference between the proximal lesions and the distal lesions of circumflex artery and right coronary artery(P>0.05).In terms of opening time of IRA,the proportion of opening time less than 4H in the event group was lower,while the proportion more than 8h was significantly higher(P < 0.05),and the proportion of single branch lesions and double branch lesions of non-IRA in the event group was higher(P<0.05).3.In terms of inflammatory factors and platelet parameters,compared with the non-event group,there was no significant difference in serum levels of NLR,PLT,MPV and PLCR in the event group(P>0.05),while the levels of hs-CRP and PDW were significantly higher in the event group(P<0.05).4.Binary Logistic regression analysis was carried out for statistically different factors,and increased age,the extension of IRA opening time,the increase of NT-pro BNP,hs-CRP and PDW levels were the independent risk factors of MACE in STEMI patients after PCI during hospitalization(P<0.05).5.ROC curve was used to calculate the area under the hs-CRP and PDW curves.The AUC predicted the MACE by hs-CRP was 0.840,the optimal critical value of hs-CRP was 5.49,the sensitivity was 0.871,the specificity was0.679,and the AUC predicted the MACE by PDW was 0.690,the optimal critical value of PDW was 12.55,the sensitivity was 0.935,and the specificity was 0.462.Further analysis of the correlation between hs-CRP and PDW found that there was no certain correlation(P>0.05).Conclusions 1.Increased age,longer opening time of IRA,and increased levels of NT-pro BNP,hs-CRP,and PDW were independent risk factors of MACE in STEMI patients during hospitalization after PCI.2.There was a certain relationship between the infarct location of acute STEMI and early MACE,among which,the prognosis of right coronary artery lesions and left main artery lesions was poor,the incidence of MACE in proximal lesions of anterior descending artery was high,and there was no significant difference between the proximal and distal lesions of the circumflex artery and right coronary artery.3.The earlier the infarct-related vessels are opened and the time of total myocardial ischemia is shortened,which is of great significance for the early prognosis of STEMI.4.When acute STEMI is associated with multi-vessel lesions,in addition to actively opening infarct-related vessels,it is also necessary to strengthen the evaluation of non-infarct-related vessels lesions,which can effectively reduce the occurrence of MACE.5.Hs-CRP and PDW have a certain predictive value for the occurrence of early MACE,and can be regarded as independent predictors of MACE during hospitalization after emergency PCI for acute STEMI patients.Combined monitoring can help identify high-risk STEMI.The second part Relationship between traditional Chinese medicine syndrome differentiation of patients with acute ST-segment elevation myocardial infarction and early adverse cardiac eventsObjective To investigate the distribution of traditional Chinese medicine syndromes in patients with acute ST-segment elevation myocardial infarction and its relationship with adverse cardiac events during hospitalization.Methods 112 patients with ST-segment elevation myocardial infarction who underwent emergency PCI in the Department of Cardiology,Central Theater Command General Hospital From April2018 to April 2019 were divided into three groups according to the traditional Chinese medicine syndrome differentiation standard of coronary heart disease: the empirical group,the empirical and deficiency syndrome group,and the deficiency syndrome group.The adverse cardiac events which occurred to patients with different traditional Chinese medicine syndromes during the hospitalization were recorded.It was analyzed that the relationship between traditional Chinese medicine syndromes and adverse cardiac events.Results 1.There were 34 cases(30.36%)in the empirical syndrome group,46 cases(41.07%)in the empirical and deficiency syndrome group,and 32 cases(28.57%)in the deficiency syndrome group.2.Among the 112 patients with acute myocardial infarction,a total of 30 patients had adverse cardiac events during hospitalization after emergency PCI.There were 5 cases(14.70%)in the empirical group,15 cases(32.61%)in the empirical and deficiency syndrome group,and 10 cases(31.25%)in the deficiency syndrome group.It was found that compared with the empirical group,the incidence of adverse cardiac events which occurred to the empirical and deficiency syndrome group,the deficiency syndrome group were higher(P< 0.05),but there was no statistically significant difference between the empirical and deficiency syndrome group,and the deficiency syndrome group(P>0.05).Conclusion The traditional Chinese medicine syndromes of acute ST-segment elevation myocardial infarction are mainly the empirical and deficiency syndrome.The empirical and deficiency syndrome,and the deficiency syndrome are more likely to have adverse cardiac events,with poor early prognosis,while the empirical syndrome are less likely to have adverse cardiac events,with relatively good early prognosis.