Analysis Of Risk Factors For Ventricular Fibrillation In Patients With Acute Inferior Myocardial Infarction Undergoing Emergency Percutaneous Coronary Intervention

Objective:To investigate the risk factors of occurrence of intraoperative ventricular fibrillation(VF)in patients with acute inferior myocardial infarction undergoing emergency percutaneous coronary intervention(PCI).Methods:A retrospective approach was conducted and 572 patients with acute inferior myocardial infarction admitted to Cangzhou City People's Hospital from May 2016 to May 2018 were enrolled.They were divided into VF group(50cases)and non-VF group(520cases)according to whether the intraoperat-ive complication of ventricular fibrillation occurred.The clinical data of the two groups of patients were collected:age,gender,former smoker,history of alcohol intake,history of diabetes,history of hypertension,history of aspirin use,history of beta blocker use,history of pre-infarction angina pectoris,prehospital cardiac arrest,blood pressure,heart rate,killp classification at admission,symptom onset to balloon dilatation time(SOTBT),white blood cell count(WBC),C-reactive protein(CRP),,low density lipoprotein cholester-ol(LDL-C),high density lipoprotein cholesterol(HDL-C),triglycerides(TG),random blood glucose,serum creatinine(Scr),peak of troponin I(Tn I),peak of creatine kinase isoenzyme(CK-MB),Brian natriuretic peptide(BNP),blood potassium concentration,P wave time,PR interval time,QT inter-val,corrected QT interval(QTc),T wave peak to end time(Tp-e),ratio of T wave peak to end time to QT interval(Tp-e/QT),single lead ST segment elevation high maximum,total ST increase in all leads,Infarction size(IS),ratio of infarction size to blood potassium concentration(IS/[K]),presence or absence of J wave.The related risk factors were analyzed by univariate and multivariate analyses to explore the preoperative risk factors related to ventricular fibrillation intraoperative occurrencein patients with acute inferior myocardial infarction undergoing emergency percutaneous coronary intervention.The receiver operating characteristic(ROC)curve was drawn to evaluate the test efficiencies of all kinds of risk factors.Results:1 The univariate analysis showed that the ratio of Killip>I grade,infarction size/blood potassium concentration(IS/[K])and symptom onset to balloon time(SOTBT)in the VF group were significantly higher than those in the non-VF group[Killip>I grade:36.5%(19/52)vs 24.0%(125/520),IS/[K]:3.2 ± 0.3 vs 2.5 ± 0.8,SOTBT(hours):6.3(2.1,8.0)vs 4.6(1.8,6.5)],differences were statistically significant(P<0.05);the T-peak to T-end interval/ QT interval(Tp-e/QT)and blood potassium level of the VF group were signifi-cantly lower than those of the non-VF group[Tp-e/QT:0.3±0.1 vs 0.4±0.1;blood potassium concentration(mmol/L):2.8±0.5 vs 4.1±1.2(both P<0.05)].2 Multivariate logistic regression analysis showed that the SOTB>6hours [odds ratio(OR=8.337)],Killip>?grad(OR=1.721),hypokalemia(OR=1.031)and high IS/[K](OR=9.167)were independent risk factors for intraoperative occurrence of ventricular fibrillation in patients with acute inferior myocardial infarction during emergency PCI.3 ROC curve analysis showed that the area under the ROC curve of serum potassium,IS/[K],SOTBT>6hours and Killip>?grade for predicting the intraoperative occurrence of ventricular fibrillation during emergency PCI for patients with acute inferior myocardial infarction had certain values.Their area under curve of ROC were 0.633,0.837,0.821,0.682 respectively,suggesting that IS/[K] and SOTBT>6 hours had moderate predictive values,and serum potassium,Killip>?grade had relatively low predicative values;when the optimal cut off value of IS/[K] was 2.8,the sensitivity was 85.5% and the specificity was 80.0%.Conclusion:SOTBT>6 hours,Killip>I grade,hypokalemia,high IS/[K] are independent risk factors of intraoperative occurrence of ventricular fibrillation in patients with acute inferior myocardial infarction undergoing emergency PCI.