| Objective:This study retrospectively analyzed the clinical data of 119 patients with acute myocardial infarction with SYNTAX score ≥ 33 who underwent emergency coronary angiography during hospitalization,the occurrence of adverse events after discharge,and their survival,and evaluated the efficacy of preventive IABP in this group of patients,providin reference for clinical work.Methods:A total of 119 non-shock patients who were diagnosed with acute myocardial infarction in the Department of Cardiovascular Medicine of the First Hospital of Jilin University from January 2019 to December 2020 and underwent emergency coronary angiography showed coronary SYNTAX score ≥ 33 were enrolled.According to whether the IABP was implanted and the time of implantation,the patients were divided into prevention group,control group and remedy group.The general clinical data of the patients were collected,the occurrence of adverse events after discharge was counted,the survival outcomes of the patients were obtained,The follow-up date was until January 2022.SPSS 28.0 software was used for statistical analysis,and P≤0.05 indicated statistical significance.Results:（1）Basic clinical data of the three groups of patients: A total of 119 patients with acute myocardial infarction with high SYNTAX scores were included in the analysis,including 33 in the IABP prevention group,59 in the control group,and 27 in the IABP remedy group.Baseline data showed that there were no significant differences in age,gender,previous history of hypertension,history of diabetes,history of cerebrovascular disease,history of hyperlipidemia,smoking history,time from onset to culprit vessel opening,preoperative systolic blood pressure,preoperative heart rate,BNP,serum potassium,blood lipid level,hemoglobin,white blood cell count,APTT,left ventricular end-diastolic diameter and peak troponin among the three groups of patients（P>0.05）.There were statistically significant differences in D-dimer,stress blood glucose,creatinine,lactate,and platelet count among the three groups（P<0.05）.（2）There were no significant differences in coronary artery and PCI conditions among the three groups: SYNTAX score,myocardial infarction type,culprit vessel,preoperative TIMI classification of blood flow,collateral circulation,intraoperative thrombus aspiration,inumber of treated vessels during operation,and number of implanted stents（P>0.05）.（3）Comparison of short-term postoperative survival among the three groups: the1-month,6-month and 1-year survival rates in the prevention group were 97.0%,97.0% and93.9% respectively;The 1-month,6-month and 1-year survival rates in the control group were 89.8%,89.8% and 88.1% respectively;The 1-month,6-month and 1-year survival rates in the salvage group were 55.6%,55.6% and 51.9% respectively.Compared the short-term survival of the three groups,the difference was statistically significant（P < 0.001）.The short-term survival of the IABP remedy group was significantly worse than that of the prevention group and the control group,and the survival of the prevention group was the best.（4）Comparison of major adverse cardiovascular events incidence within 6 months after operation between the prevention group and the control group: the incidence of major adverse cardiovascular events in the prevention group was 42.4%（14 cases）: 5 cases of intraoperative / postoperative shock,2 cases of malignant arrhythmia,7 cases of heart failure,0 cases of angina pectoris or recurrent myocardial infarction;The incidence of the control group was 57.6%（34 cases）: 10 cases of intraoperative / postoperative shock,9 cases of malignant arrhythmia,12 cases of heart failure,3 cases of angina pectoris or recurrent myocardial infarction;There was no significant difference between the two groups（P>0.05）.（5）Survival analysis of patients in the three groups: Kaplan Meier survival analysis showed that the long-term survival rate of patients in IABP prevention group was higher than that in control group and remedy group,and the difference was statistically significant（P<0.001）.（6）Regression analysis based on COX proportional hazards model: COX multivariate regression analysis showed that BNP and HDL were significantly correlated with postoperative prognosis（P≤0.05）,and BNP was an independent risk of poor postoperative prognosis in patients with acute myocardial infarction with high SYNTAX score factor,HR=1.001（95%CI:1.000-1.001）,P=0.050;and HDL is an independent protective factor for poor postoperative prognosis in patients with acute myocardial infarction with high SYNTAX score,HR=0.113（95%CI:0.014-0.933）,P=0.043.Conclusion:（1）Prophylactic implantation of IABP may significantly improve short-term postoperative survival in patients with acute myocardial infarction with high SYNTAX score during interventional therapy.（2）Prophylactic placement of IABP in acute myocardial infarction patients with high SYNTAX score did not significantly reduce the incidence of adverse cardiac events at 6months after surgery.（3）Prophylactic placement of IABP in acute myocardial infarction patients with high SYNTAX scores may be beneficial for long-term survival.（4）BNP was an independent risk of poor postoperative prognosis in patients with acute myocardial infarction with high SYNTAX score factor,HR=1.001（95%CI:1.000-1.001）,P=0.050;and HDL is an independent protective factor for poor postoperative prognosis in patients with acute myocardial infarction with high SYNTAX score,HR=0.113（95%CI:0.014-0.933）,P=0.043. |
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