Study On The Correlation Of Endothelial Function Measurement With Risk Factors And Prognosis In Patients With Acute ST-segment Elevation Myocardial Infarction

Objective:To investigate the relevance and predictive value of endothelial function measurements for risk factors and major cardiovascular events in patients with acute ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI),in order to guide treatment of STEMI patients.Methods:We included 92 STEMI patients(74 males and 18 females)who received PCI treatment at the Chest Pain Center of China-Japan Union Hospital,Jilin University from July 2011 to July 2018.Immediately after the surgery,optical plethysmography was used to analyze the finger pulse volume(PAV),with a mean follow-up of(32.01±24.26)months.Taking the median of PAV value as the critical point and taking PAV = 1.09 as the critical point,the research objects were divided into 44 cases in the high-PAV group and 48 cases in the low-PAV group.Record patients' gender,age,on admission heart rate,systolic pressure,diastolic blood pressure,pulse pressure difference,BMI,Killip classification,hospitalization days,history of hypertension,diabetes,cerebral infarctionmedical history,history of hyperlipidemia,smoking history and other detailed information,records on white blood cell count,hemoglobin and fasting glucose,creatinine,triglyceride,total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol and lipoprotein(a)and postoperative left ventricular ejection fraction,auxiliary examination index.The clinical characteristics of the two groups were analyzed,the incidence of major cardiovascular adverse events(MACE)at the site of myocardial infarction,in and out of hospital were recorded,and the correlation between risk factors was analyzed.Main observation indexes MACE [including all die for sex,again hair,severe heart failure,myocardial infarction(Killip classification ? level or higher),unstable angina,malignant arrhythmia,ventricular arrhythmia,second ? and above atrioventricular block),acute cerebral apoplexy].SPSS 19.0 statistical software was used for statistical analysis,and normality test was performed on the data.Measurement data in line with normal distribution were tested by T test,and all were expressed as(x±s).The measurement data of non-normal distribution is represented by the mean(quartile)M(Q25,Q75).Enumeration data were expressed as percentage,and chi-square test was used for comparison between groups.ROC curve was drawn to evaluate the accuracy of PAV in MACE in the predictive hospital.Cox regression model was used to analyze the correlation between endothelial dysfunction and survival time(time ofdeath in patients and time of last follow-up in the remaining patients).Logistic binary regression curve was used to analyze the correlation of multiple risk factors in hospital MACE.Using the method of Kaplan-Meier analysis,and USES the Log-Rank test is outside the courtyard between the two groups the incidence of MACE,and draw the survival curves.Among all the comparative data,P<0.05 was considered statistically significant.Results:1.Statistical analysis of the basic data of the two groups showed that the pulse pressure difference between the high-pav group and the low-pav group was 50(39,60)and 42(36,50)respectively,and the Z value was-2.356,P=0.018.Creatinine in the high-PAV group and low-PAV group was 85.52(69.62,93.32)and 86.60(65.05,83.66),respectively,and z-value was-2.646,P=0.008.The difference in pulse pressure between the two groups was significant(P < 0.05).The difference of creatinine between the two groups was significant(P < 0.01).In two groups,age,sex,hypertension,diabetes,patients with cerebral infarction,hyperlipidemia,smoking history,admission heart rate,systolic blood pressure,diastolic blood pressure,and admission to hospital admission Killip class acuity ?,BMI,white blood cell count,fasting blood sugar,triglyceride,total cholesterol,high-density lipoprotein cholesterol,low density lipoprotein cholesterol and lipoprotein a and myocardial infarction were nosignificant difference(P > 0.05).2.During the follow-up period(32.01±24.26)months,43 patients(46.74%)had major adverse cardiovascular events,and the PAV of patients with OUT-OF-hospital MACE was significantly lower than that of patients without OUT-OF-hospital MACE(1.05±0.20 vs.1.20±0.26).3.The PAV value was significantly correlated with the incidence of MACE in the hospital(P < 0.01,OR < 1).High PAV value predicted MACE in STMEI patients without hospitalization,and the higher the PAV,the less MACE occurred.4.ROC curve analysis of PAV predicting MACE in STEMI patients showed that AUC under the curve was 0.805,P < 0.01,95%CI(0.706,0.903),which was statistically significant.5.Cox proportional analysis showed that P=0.002,OR < 1,95%CI:0.016-0.393.PAV value is an objective factor to predict the prognosis of STMEI patients.6.Influence of the two groups on the cumulative incidence of MACE out of hospital: Log-rank test for comparison: chi-square value=4.492,P=0.03,MACE incidence between the two groups was statistically significant.Conclusion:1.Endothelial function as assessed by PAV in STEMI patients was associated with patient pulse differential pressure and creatinine levels.2.The level of PAV is related to MACE,with PAV=1.09 as the critical point,and endothelial dysfunction is related to MACE in STEMI patients.