Prognostic Value Of Dyspnea In STEMI Patients Undergoing PCI And Its Impact On Risk Of Cardiovascular Mortality In General Adult Residents

Objective: This study aims to demonstrate the overall cardiovascular disease(CVD)mortality trend in China over the past decades,and to assess the prognosis value of dyspnea at admission in acute ST-segment elevation myocardial infarction(STEMI)patients undergoing percutaneous coronary intervention(PCI),and to systematically evaluate the risk of cardiovascular mortality(CVM)as well as all-cause mortality(ACM)among general adult residents.Methods: 1.Statistical analysis of CVDs mortality in China: CVDs mortality date for urban and rural areas of China from 1990 to 2019 were extracted from official statistics databases and shown by statistical chart,as well as the coronary heart disease mortality date for urban and rural areas of China from 2002 to 2019.Then we also collected date of the amount of procedures of PCI and coronary artery bypass grafting(CABG)for coronary heart disease in China from 2002 to 2019;2.Prognosis value of dyspnea at admission in patients with acute ST-segment elevation myocardial infarction(STEMI)receiving PCI:A total of 190 patients with STEMI who were admitted to the Department of Cardiology of Affiliated Hospital from Nov.1,2017 to Dec.31,2020 and underwent PCI were selected as the research subjects,and then the included patients were divided into dyspnea group and non-dyspnea group according to present of dyspnea symptoms at admission.Basic data and relevant laboratory examination data,the incidence of cardiovascular adverse events and mortality in hospital after PCI were compared between two groups.Logistic regression analysis was used to analyze the related risk factors for poor outcomes;3.Systematic review and meta analysis of the effect of dyspnea on CVM and ACM among general adult residents: we searched for cohort studies with criteria including(1)general adult residents as the research object;(2)dyspnea symptom as exposure;(3)CVM and ACM as the primary outcome indicators and(4)hazard ratio(HR)as the effect value.Values of HRs of all included studies as well as the corresponding 95% CI were combined into summary analysis,along with subgroup analysis by gender and age.3.Results: 1.In the past 30 years,the overall mortality rate of CVDs in China showed an increasing trend.The mortality rate of heart disease in China had exceeded that of cerebrovascular disease since the year of 2013.The mortality rate of coronary heart disease in China,including acute myocardial infarction(AMI),also showed an increasing trend from 2002 to 2019.During the period of 2002-2019,the amount of procedures of PCI for coronary heart disease in China showed a rapid trend of growth.2.Among 190 patients with STEMI undergoing PCI,there were 31 patients in dyspnea group and 159 patients in non-dyspnea group.The level of heart rate on admiss,serum creatinine(Cr),N terminal pro B type natriuretic peptide(NT-pro BNP),D-dimer and the incidence of Killip cardiac function ≥grade II in dyspnea group were higher than those in non-dyspnea group(P<0.05).There were 22 composite adverse events occurred among all patients with STEMI undergoing PCI,including 7 cases in dyspnea group and 15 cases in non-dyspnea group(22.6% vs 9.4%,P=0.074).In terms of cardiovascular adverse events,there were 4 cases of malignant arrhythmia in the dyspnea group while 2 cases in non-dyspnea group(12.9% vs 1.3%,P=0.005).The incidences of acute heart failure,cardiogenic shock,acute kidney injury and all-cause mortality between two groups show no significance difference(P>0.05).The result of Logistic regression analysis showed that dyspnea is an independent risk factor for the occurance of composite adverse events in STEMI patients undergoing PCI when adjusting for age,sex and CVDs risk factors history(OR:3.243;95%CI: 1.147,9.165;P=0.026).However,this effect was disappeared when adjusting more variables such as levels of body temperature,WBC,Cr,NLR,thrombolytic therapy and so on.And heart rate >100 times per minute at admission,level of D-dimer >0.55 μg/m L and Killip classification for heart failure≥II were independent risk factors for the occurance of composite adverse events in STEMI patients undergoing PCI(P<0.05).3.A total of 17 studies were included with 9 studies for assessing the risk of CVM and 16 studies for assessing the risk of ACM.A total of 401,682 valid subjects were finally included into analysis.Risk of CVM was 1.57 times higher in the general population with dyspnea than in those without dyspnea during the follow-up period(pooled HR)(95%CI: 1.27,1.93;P<0.001),and this risk was similar for men and women(Male HR: 1.33;95%CI:1.11,1.59;P=0.002.Female HR: 1.61;95%CI: 1.29,1.99;P< 0.001).On the other hand,risk of ACM in the general population with dyspnea symptoms was 1.48 times higher than in those without dyspnea(pooled HR)(95%CI: 1.34,1.64;P< 0.001),and also this risk was similar for men and women(Male HR: 1.40;95%CI: 1.29,1.52;P< 0.001.Female HR: 1.36;95%CI: 1.15,1.61;P< 0.001),and the risk was also similar for residents aged<65 years old and those aged≥65 years old.(Age<65 HR:1.35;95%CI: 1.22,1.48;P<0.001.Age≥65 HR:1.52;95%CI:1.11,2.08;P = 0.01).Conclusions:(1)China still faces severe challenges of CVDs mortality burden,and heart disease has climbed to be the leading cause of death in China;(2)Despite of the drastically increased volumes of PCI,the annual mortality rate of coronary heart disease in China is still rising;(3)Dyspnea may be associated with the poor inhospital prognosis of STEMI patients undergoing PCI.The prognostic value of dyspnea in patients with STEMI undergoing PCI warrants future study;(4)Dyspnea is associated with the risk of increasing CVM and ACM among general adult residents.