Effects Of Beta Blockers On Major Adverse Cardiovascular Events In Patients With Acute St Segment Elevation Myocardial Infarction After Percutaneous Coronary Intervention

Objective: To retrospectively analyze the use of beta blocker in patients with acute ST segment elevation myocardial infarction and successful percutaneous coronary intervention(PCI),and to explore the factors for nonpersistence with medication of beta blocker and the relationship with major cardiovascular adverse cardiac events.Methods :(1)Select the hospitalized patients who were first diagnosed as acute ST segment elevation myocardial infarction in a national class III hospital in Guangxi from January 1,2018 to June 31,2020,who were successfully treated with percutaneous coronary intervention and taking beta blocker as the research object.Follow up the patients who meet the inclusion criteria.If adverse cardiovascular events occur during follow-up,The follow-up was terminated and the time of cardiovascular adverse events was recorded.If there were no cardiovascular adverse events,the follow-up was to the deadline,and the end time of follow-up was December 31,2021.(2)During the follow-up period,the use of beta blocker and the occurrence of adverse cardiovascular events were observed.The observation indexes of the follow-up subjects include:(1)basic information: gender,age,education level,occupation,marital status,nationality,BMI level,etc;(2)past history: whether there were hypertension,hyperlipemia,diabetes history,smoking history,history of renal insufficiency,family history of cardiovascular disease,etc.(3)Date of admission,type of acute myocardial infarction(anterior wall,non anterior wall),severity of myocardial infarction at admission(Killip grade),complications,time of PCI,severity of coronary artery disease,time of initial oral beta blocker,length of hospital stay,cure or improvement at discharge,detailed medication of beta blocker in out of hospital follow-up treatment cases,medication of aspirin,clopidogrel / tegrilol,And the specific use of statins and other drugs.(3)According to the above baseline data,spss25.0 to explore the correlation between variables and cardiovascular adverse events and the influencing factors of nonpersistence with medication of beta blocker.Results:(1)A total of 303 follow-up questionnaires were distributed this time,including 232 effective follow-up questionnaires,with an effective rate of76.5%.The deadline for survey and follow-up is December 31,2021,of which the longest and shortest effective follow-up is 47 months.It can be seen from table 1 that the age of onset of patients with effective follow-up is 32-87 years old,with a median of 63 years old(62.46 ± 11.56),including 189 male patients(81.47%)and 43 female patients(18.53%).Among all successful follow-up cases,88 cases(37.93%)took nonpersistence with medication of beta blocker and 189 cases(81.47%)took persistence with medication of beta blocker.87cases(37.50%)took nonpersistence with medication of statins and 145 cases(62.50%)took persistence with medication of statins.6 cases(2.59%)stopped taking aspirin and 226 cases(97.41%)did not stop taking aspirin.There were 0cases(0.00%)nonpersistence with medication of clopidogrel / tigritol and 232cases(100%)persistence with medication of clopidogrel / tigritol.(2)there were statistically significant differences in cardiovascular adverse events with cultural education,smoking history,diabetes history,renal insufficiency history,number of coronary stent,Killip classification,whether persistence with medication of beta blocker,whether there were statistically significant differences between persistence with medication of statins and whether there were adverse cardiovascular events(all P < 0.05).By using Kaplan Meier method to draw the survival curve,the conclusions are as follows: the prognosis of Killip grade I STEMI patients is better than that of grade II,III and IV patients;The prognosis of patients with persistence with medication of beta blocker was higher than that of non persistent patients;The prognosis of patients with persistence with medication of statins is better than those who stop taking statins.(3)factors influencing nonpersistence with medication of beta blocker: culture education,smoking history,and diabetes history.The direct cause of drug withdrawal is mainly worried about side effects or conscious "ineffectiveness".Conclusions:(1)Nonpersistence with medication of beta blocker will increase the risk of cardiovascular adverse events in patients with STEMI after PCI.(2)the degree of cultural education,smoking history and diabetes history are the influencing factors for nonpersistence with medication of beta blocker.