Risk Factors And Predictive Analysis Of Acute Coronary Syndrome Combined With Malignant Ventricular Arrhythmias

ObjectiveMalignant ventricular arrhythmia(MVA)is an arrhythmia that occurs when the patient is hemodynamically unstable or has a poor prognosis,mainly in cases of sustained ventricular tachycardia(VT)or ventricular flutter or ventricular fibrillation(VF).MVA is the most serious comorbidity of acute coronary syndrome(ACS),which appears rapidly in the course of ACS,with rapid progression and high mortality.Currently,there are few clinical studies on independent risk factors for combined MVA in ACS,and there is a lack of validated laboratory indicators to predict the risk of combined MVA after ACS,leading to increased mortality in ACS patients.The purpose of this retrospective study is to investigate the independent risk factors associated with ACS combined with MVA,and to attempt to use the independent risk factors screened in this study to predict ACS combined with MVA,so as to shorten the time to diagnosis of MVA and provide timely treatment to save patients’ lives,and to provide effective interventions for the independent risk factors associated with ACS combined with MVA,thus improving the prognosis of ACS patients.The prognosis of patients with ACS can be improved by effective intervention of the independent risk factors associated with ACS combined with MVA.MethodsThis study included 321 patients with ACS who visited the emergency department or cardiovascular medicine department of the First Hospital of Jinan University from June 2016 to June 2022 as study subjects.The patients’ clinical data,such as history of diabetes,history of hypertension and other underlying medical history,GRACE risk score,and laboratory indices,were retrospectively analyzed.The patients with ACS were divided into 70 cases(21.81%)in the MVA group and 251 cases(78.19%)in the control group based on whether they had MVA in combination.For the data conforming to the count data,the chi-square test was used;for the measurement data conforming to the normal or approximately normal distribution,the independent sample t-test was used;for the non-normally distributed measurement data,the rank sum test was used for the comparison between groups;univariate analysis was performed to screen out the indicators with P < 0.2 using the above statistical methods,and then the full subset regression was used for further variable screening;the relevant independent risk factors screened out by univariate analysis were The independent risk factors screened by the single-factor analysis were analyzed using binary Logistic regression to identify the independent risk factors associated with ACS combined with MVA,and the independent risk factors screened by the multi-factor analysis were used to predict the risk of ACS combined with MVA using the Receiver operating characteristic curve(ROC).The optimal threshold value and area under the curve(AUC)were calculated for each index,and the specificity and sensitivity of the independent risk factors for predicting ACS combined with MVA were also calculated.Results1.patients in the MVA and non-MVA groups had frequent ventricular contraction(PVC),ventricular wall motion hypoplasia,disease staging,cardiac function classification,GRACE risk score,GRACE risk score classification,serum creatinine(SCR),serum magnesium ions(Mg2+),uric acid,random blood glucose,high density lipoprotein(HDL),alpha-hydroxybutyrate dehydrogenase(α-HBDH),white blood cell(WBC),neutrophil(Neutrophil)count,and blood glucose.Neutrophils(NEU),Lymphocyte count(LYM),Red blood cell distribution width(RDW),Platelet volume distribution width(PDW),brain natriuretic peptide(BNP),and neutrophils to lymphocytes ratio(NLR)were statistically significant(P < 0.05).2.Binary Logistic regression multifactor analysis in this study showed that:GRACE risk score(P<0.021,OR=1.021,95%CI=1.003-1.038),SCR(P=0.011,OR=1.012,95%CI=1.003-1.022),NEU count(P<0.004,OR=1.185,95%CI=1.054-1.332)were independent risk factors for combined MVA after ACS.3.Med Calc software was used to produce ROC curves and interaction point plots for GRACE risk score,NEU count and SCR,and to calculate the critical values and AUC of GRACE risk score,NEU count and SCR,and to calculate the specificity and sensitivity of independent risk factors for predicting combined MVA in ACS.The AUC value for SCR was 0.789,the best critical value was 97,the best critical value corresponded to a sensitivity of 61.4% and a specificity of 84.9%,and the AUC value for NEU count was 0.730,the best critical value was 6.78,the best critical value corresponded to a sensitivity of 78.6% and a specificity of 57.8%.The specificity was57.8%.ConclusionThis study shows that.(1)high GRACE risk scores,high NEU counts,frequent PVCs and advanced age are independent risk factors for combined MVA after ACS.(2)High GRACE risk scores(>177),high NEU counts(>6.78),advanced SCR(>97mmol/L)and suggest a higher likelihood of combined MVA after ACS and have some predictive power in combined MVA in ACS.(3)Patients with ACS who have independent risk factors associated with combined MVA should be closely monitored early and followed up more frequently.