Risk Factors And Prognostic Factors In Patients With ST-segment Elevation Myocardial Infarction And Multi-vessel Coronary Artery Disease

Purposes:To investigate the risk factors and the short-term and long-term prognostic factors in patients with ST-segment elevation myocardial infarction(STEMI)and multi-vessel coronary artery disease(MVD).Methods:This study contained three parts:analysis of risk factors in patients with STEMI and MVD,analysis of factors affecting the short-term prognosis in patients with STEMI and MVD,analysis of factors affecting the long-term prognosis in patients with STEMI and MVD.1.Part one:661 cases of STEMI patients who underwent emergency percutaneous coronary intervention(PCI)from January 2014 to June 2018 were divided into the STEMI with single-vessel coronary artery disease group and the STEMI with MVD group according to the results of coronary angiography.General clinical data of the patients were collected,such as gender,age,hypertension,diabetes,hyperlipidemia,stroke,angina pectoris and smoking history.Logistic regression analysis was performed to screen out the risk factors in patients with STEMI and MVD.2.Part two:341 patients with STEMI and MVD who underwent emergency PCI from January 2014 to June 2018 were selected.After excluding 72 patients with lost follow-up,a total of 269 patients with STEMI and MVD were included in the second part of the study.Patients were followed up for the occurrence of major adverse cardiovascular events(MACE)during hospitalization and within 30 days after discharge.According to the occurrence of short-term MACE,patients were divided into the group without short-term MACE and the group with short-term MACE.General clinical data,laboratory examination,echocardiography,characteristics of coronary angiography and medication were collected.Logistic regression analysis was performed to screen out the factors affecting the short-term prognosis in patients with STEMI and MVD.3.Part three:341 patients with STEMI and MVD who underwent emergency PCI from January 2014 to June 2018 were selected.After excluding 72 patients with lost follow-up and 13 patients with short-term death,a total of 256 patients with STEMI and MVD were included in the third part of the study.Patients were followed up for the occurrence of MACE from 30 days after discharge to one year after discharge.According to the occurrence of long-term MACE,patients were divided into the group without long-term MACE and the group with long-term MACE.General clinical data,laboratory examination,echocardiography,characteristics of coronary angiography and medication were collected.Logistic regression analysis was performed to screen out the factors affecting the long-term prognosis in patients with STEMI and MVD.Results:1.Part one:The 661 STEMI patients included were divided into the STEMI with single-vessel coronary artery disease group(n=320)and the STEMI with MVD group(n=341)according to the results of coronary angiography.The age of patients with STEMI and MVD(62.61±12.18 vs 58.00±14.30,p=0.002)was higher,the number of male patients was higher,the history of hypertension(227(66.6%)vs 168(52.5%),p<0.001)and diabetes(99(29.0%)vs 70(21.9%),p=0.035)were higher,suggesting that male,elderly,hypertensive,and diabetic patients may be more likely to have STEMI and MVD.Multivariate logistic regression analysis showed that age(OR=1.222,95%CI(1.210-1.235),p<0.001)and hypertension(OR=1.533,95%CI(1.104-2.128),p=0.011)were independent risk factors in patients with STEMI and MVD.STEMI patients with older age and the history of hypertension were more likely to have multi-vessel coronary artery disease.2.Part two:The 269 patients with STEMI and MVD included were divided into a group without short-term MACE(n=197)and a group with short-term MACE(n=72)according to the occurrence of short-term MACE.Univariate logistic regression analysisand multiariable logistic regression analysis showed that white blood cell(WBC)(OR=1.109,95%CI(1.001-1.229),p=0.048),Lipoprotein(a)(LP(a))(OR=1.002,95%CI(1.000-1.003),p=0.012),diastolic blood pressure(DBP)(OR=0.972,95%CI(0.947-0.998),p=0.036),Killip grading(OR=2.976,95%CI(1.937-4.573),p<0.001),IRA opening time(OR=1.103,95%CI(1.023-1.190),p=0.011)and thrombolysis in myocardial infarction(TIMI)grading(OR=0.137,95%CI(0.025-0.741),p=0.021)were independent factors affecting the occurrence of short-term MACE in patients with STEMI and MVD.WBC,LP(a),IRA opening time and Killip grading of patients with poor short-term prognosis were significantly higher than patients with good short-term prognosis,TIMI grading and DBP were significantly lower than those in patients with good short-term prognosis.3.Part three:The 256 patients with STEMI and MVD included were divided into the group without long-term MACE(n=138)and the group with long-term MACE(n=118)according to the occurrence of long-term MACE.Univariate logistic regression analysis and multiariable logistic regression analysis showed that aspertate aminotransferase(AST)(OR=1.272,95%CI(1.153-1.435),p=0.011)andN-terminal pro-B-type natriuretic peptide(NT-proBNP)(OR=1.357,95%CI(1.022-1.713),p<0.001)were independent risk factors affecting the occurrence of long-term MACE in patients with STEMI and MVD.Conclusions:1.Age and hypertension are risk factors in patients with STEMI and MVD.2.The higher the WBC is,the higher the LP(a)is,the higher the Killip grading is,the longer the IRA opening time is,the lower the DBP is,and the lower the TIMI blood flow grading of patients is,the worse the short-term prognosis in patients with STEMI and MVD are.3.The higher the AST and NT-proBNP of patients are,the worse the long-term prognosis in patients with STEMI and MVD are.