Effect Of First Medical Contact And Door-to-ballon Time On The Major Adverse Cardiovascular Events And Complications In Hospitalized Patients With Acute ST Segment Elevation Myocardial Infarction-a Single Center Study

Objective:To explore the First Medical contact time(FMC)and door-to-ballon time(D-to-B)for acute ST-segment elevation myocardial infarction(STEMI),The main adverse cardiovascular events(MACE)and complications related to the hospitalization of patients,to reduce MACE and complications during hospitalization of STEMI patients,improve the survival rate and quality of life of patients,and provide an important clinical basis.Methods:A total of 300 STEMI patients who underwent PCI interventional therapy at the CCU of Cardiology Department of Tianjin Medical University General Hospital from January 2018 to August 2019 were collected as the research subjects.Formulate a clinical questionnaire for STEMI patients and establish an Excel database of clinical data.First,all patients were divided into A1 group(<3h),A2 group(3-12h),A3 group(>12h)3 groups according to FMC time,analyze the general data,past medical history,myocardial infarction site,number of vascular lesions in each group,The incidence of blood vessels of criminals,etc.,analyze the impact of FMC on the main adverse cardiovascular events and complications of STEMI patients hospitalized;Secondly,according to the D-to-B time,all included patients were divided into three groups: B1(<60min),B2(60-90min),and B3(>90min).The general data,past medical history,myocardial infarction site,and blood vessels of each group were analyzed.The number of lesions and the blood vessels of criminals were analyzed.The impact of D-to-B time on major adverse cardiovascular events and complications in STEMI patients was analyzed.Finally,multivariate logistic regression analysis was performed on the related factors of positive results and the factors that may affect the MACE events and complications of STEMI patients,and the independent risk factors that affected the MACE and complications of STEMI patients during hospitalization were analyzed.SPSS19.0 software was used for statistical analysis,measurement data was tested for normality,and the normal distribution was expressed as mean ± standard deviation,and the comparison between groups was by one-way analysis of variance;the non-normal distribution was measured by median and Interquartile range indicates that Mann-Whitney U test was used for comparison between groups.The count data is expressed as a percentage(%),and chi-square test or Fisher exact test is used for comparison between groups.For multivariate analysis,binary logistic regression analysis was used,and the difference was considered statistically significant at P<0.05.Results:1.According to the FMC group comparison,the Tn I value was statistically significant in group A1(1.61±3.14 ng/m L),group A2(4.03±1.65 ng/m L),and group A3(8.05±2.03 ng/m L).(P<0.001).The incidence of complications in the FMC group was statistically significant in the A1 group(8.5%),A2 group(14.5%),and A3 group(18.9%)(P=0.040).The incidence of MACE events in the A1 group(23.7%),A2group(46.4%),and A3 group(27 cases(57.4%)was significantly different between the groups(P<0.001).The longer the FMC,the higher the incidence of MACE events and complications in STEMI patients.2.According to the comparison of D-to-B groups,it was found that the Tn I value was in the three groups of B1 group(1.17±1.8ng/m L),B2 group(1.53±2.6ng/m L),B3group(7.57±31.9,ng/m L)In the inter-comparison,the difference was statistically significant(P=0.014);NT-pro-BNP was in group B1(354.9±565.1pg/m L),group B2(541.36±1164.5 pg/m L),group B3(1239.8±2348.4,pg/m L)There are differences in the comparison between the groups,and the differences are statistically significant(P=0.001).The incidence of complications among the three groups was statistically significant in group B1(3.0%),group B2(11.6%),and group B3(23.3%)(P=0.005).The incidence of MACE was different between groups B1(23.5.0%),B2(33.7%),and B3(53.3%),and the differences were statistically significant(P=0.002).The longer the D-to-B time,Tn I gradually increased,and NT-pro-BNP levels also increased;the incidence of MACE and complications in STEMI patients was higher.3.In multivariate regression analysis of major adverse cardiovascular events,NT-pro-BNP,extensive anterior wall(anterior wall)myocardial infarction,FMC time> 12 hours,D-to-B time> 90 minutes,the difference was statistically significant(P<0.05)is an independent risk factor for adverse cardiovascular events in STEMI patients during hospitalization.4.In the multivariate regression analysis of STEMI complications,extensive anterior wall(anterior wall)myocardial infarction,FMC time>12 hours,D-to-B time>90minutes,the difference was statistically significant(p<0.05),which is STEMI Independent risk factors for patients’ hospitalization complications.Conclusion.1.Shortening the FMC time and D-to-B time can reduce the occurrence of major adverse cardiovascular events and complications in STEMI patients hospitalized.2.NT-pro-BNP,extensive anterior wall(anterior wall)myocardial infarction,FMC time> 12 hours,D-to-B time> 90 minutes are independent risk factors for major adverse cardiovascular events in STEMI patients hospitalized.3.Extensive anterior wall(anterior wall)myocardial infarction,FMC time> 12 hours,and D-to-B time> 90 minutes are independent risk factors for hospital complications of STEM patients.