Clinical Characteristics And Effect On Prognosis Of STEMI Patients With High Plasma Hcy Level

Objective:To analyze the clinical characteristics of plasma Homocysteine(Hcy)levels in elderly patients with ST-segment elevation myocardial infarction(STEMI),and to explore plasma homocysteine levels in elderly STEMI patients The prognostic impact of PCI surgery(Percutaneous coronary intervention,percutaneous coronary intervention).Methods:Retrospective analysis of 196 elderly STEMI patients who met the inclusion criteria in the Department of Cardiovascular Medicine of the 920th Hospital of the People's Liberation Army Joint Logistics Support Unit from January 1,2017 to December 31,2019,based on standard drug treatment,According to the plasma homocysteine level within 48 hours after admission,patients were divided into high Hcy group(Hcy?15umol/L)(84 cases)and non-high Hcy group(Hcy<15umol/L)(112 cases),recorded and analyzed Patient baseline data,coronary angiography results,heart rate,blood pressure,BNP,cardiac function indicators;follow-up records were made through patient rehospitalization,outpatient review,and telephone return visit,statistics of patient mortality and major adverse heart and brain during hospitalization and follow-up The incidence of vascular events(majoradverse cardiac and cerebro-vascular events,MACCE).The Cox proportional hazards regression model was used to analyze the predictive factors of 1-year cumulative mortality and post-discharge MACCE-free survival rate in elderly STEMI patients after PCI.Results:1.Compared with the non-high Hcy group,the proportion of males with high Hcy was higher(P=0.007),and the prevalence of diabetes,hypertension,and cerebrovascular disease was higher(P<0.01);Killip's grade distribution was different The incidence of KilliP ?-? was high(P=0.000),and there was no statistically significant difference in the remaining baseline data between the two groups.The levels of BNP and creatinine in the high Hcy group were significantly higher at 12 hours after operation,and the differences were statistically significant(P<0.05).Plasma Hcy level was positively correlated with BNP concentration in elderly STEMI patients,the correlation R=0.55,P<0.05,with statistical significance;plasma Hcy level was positively correlated with creatinine level,correlation coefficient R=0.38,P<0.05,with statistical significance.The types of clinical diagnosis,criminal vessels,and the distribution of vascular lesions were different between the two groups(all P<0.01).The patients with high Hcy group had more extensive anterior wall myocardial infarction,left main disease,and multivessel disease than non-Hcy group.has statistical significane.2.Compared with the non-high Hcy group,the ratio of postoperative TIMI blood flow level 3 and ST segment complete fall rate in the high Hcy group was low,and the difference was statistically significant(P<0.05).In this clinical study,a total of 125 patients with cardiac ultrasound follow-up 1 year after discharge were found.The results showed that there was no statistically significant difference between the LVEF(%)and LVEDD(mm)in the non-high Hcy group and the baseline after one year of follow-up(54.43±10.68 vs.55,23±9.48,48.71±5.867vs.49.05±5.18,P>0.05),and the LVEF(%)in the high Hcy group was significantly lower than the baseline after one year of follow-up(50.79±10.32vs.45.32±10.18,P=0.003);The value of LVEDD(mm)after one year of follow-up was significantly higher than the baseline(48.88±6.792 vs.53.08±5.33,P=0.001).3.In this study,the comprehensive analysis of the long-term and long-term mortality and MACCE incidence of elderly STEMI patients found that the post-PCI mortality and 30-day mortality rate of patients in the high Hcy group were higher than those in the non-high Hcy group,but due to too few data There was no statistically significant difference in the case fatality rate and the 30-day case fatality rate between the groups(2.38%vs 1.78%,4.79%vs 2.67%,P>0.05).The MACCE rate and the 30-day MACCE rate of patients in the high Hcy group after PCI were higher than those in the non-high Hcy group(70.23%vs 53.57%,71.42%vs 49.10%,all P<0.05).The difference between the groups was statistically significant.4.The 1-year mortality rate of patients with high plasma Hcy group[17.85%(15/84)vs.7.14%(8/112),P=0.001]and the incidence of MACCE events[34.52%(29/84)1 year after discharge 17.85%(20/112),P=0.000]was significantly higher than the non-high Hcy group,the difference between the groups was statistically significant.The results of Cox univariate analysis showed that high plasma Hcy level was an independent risk factor for the 1-year cumulative mortality of elderly STEMI patients after PCI(HR=0.425,95%CI 0.250-0.723,P=0.002);many Cox risk models The results of factor analysis showed that after correction for baseline data and confounding factors such as BNP and creatinine,it was found that high plasma Hcy levels were still independent risk factors for 1-year cumulative mortality(HR=2.507,95%CI 1.282-3.911,P=0.024);Cox univariate analysis showed that high plasma Hcy levels were independent risk factors for the incidence of MACCE 1 year after discharge(HR=1.433,95%Cl 0.893-2.298,P=0.013).Conclusions:1.The proportion of males with high plasma levels of Hcy is higher in older STEMI patients,with more underlying diseases and higher creatinine levels.2.Patients with high plasma Hcy levels and advanced STEMI have severe coronary artery disease,multi-vessel disease,large myocardial infarction area,microcirculation disorder and poor cardiac function.3.This study shows that high plasma Hcy levels may increase the recent incidence of MACCE in elderly STEMI patients.4.This study shows that high plasma Hcy levels are significantly correlated with long-term MACCE in elderly STEMI patients and are independent predictors of poor prognosis in elderly STEMI patients.