| Objective:At present,there are few studies on the influencing factors of left ventricular function(LVF)recovery after percutaneous coronary intervention(PCI)in ST-segment elevation myocardial infarction(STEMI),and this study compares the clinical characteristics of cardiac function recovery in patients with acute STEMI and 3months after direct PCI,and explores the independent influencing factors of left ventricular function recovery 3 months after direct PCI in patients with acute STEMI,in order to provide reference for clinical diagnosis and treatment.Methods:Retrospective collection of patients with acute STEMI and PCI diagnosed at Xianyang Hospital of Yan’an University between January 2016 and December 2018.Patients were divided into three groups based on the results of admission echocardiography and reexamination of LVEF after 3 months of discharge:(1)LVF normal group: LVEF ≥ 50% at admission and reexamination after 3 months;(2)LVF recovery group: admission LVEF<50%,after 3 months LVEF ≥ 50%;(3)LVF reduction group: LVEF ≥ 50% or LVEF<50% at admission examination,but LVEF<50% at reexamination 3 months later.The clinical data of the enrolled patients and the echocardiographic results after 3 months of follow-up were recorded in detail.After adjusting for variables,multiple logistic regression models were used to analyze the factors affecting the recovery of ejection fraction in patients with LVEF<50%.Results:(1)A total of 631 patients were included in this study,with an average age of 61.87 ± 11.47 years.Among them,there were 495 males,100 in the LVF reduction group(15.8%),90 in the LVF recovery group(14.3%),and 441 in the LVF normal group(69.9%).The total number of smoking patients was 345,accounting for approximately 54.7%;A total of 330 people suffer from hypertension,accounting for approximately 52.3%;There are 101 people with diabetes,accounting for about 16.0%.(2)Compared with the clinical baseline data of patients in the three groups,patients in the LVF reduction group were older,with a higher proportion of men,a faster resting heart rate,a higher Killip grade,a higher proportion of patients with diabetes,and a higher proportion of beta receptor blockers,ACEI /ARB /ARNI and other drugs(P<0.05).(3)Comparison of laboratory examination results among three groups of patients: The LVF reduced group had higher levels of NT pro BNP,creatinine,D-dimer,c Tn I,TG,LDL-C,and LPa,while the proportion of β receptor blockers,ACEI /ARB /ARNI and other drugs used was higher(P<0.05);The normal LVF group had a lower Killip rating,shorter symptom to PCI time,and shorter goal kick time(P<0.05).(4)The comparison of coronary angiography results among the three groups of patients showed that the patients with reduced IILVF had a higher proportion of LAD lesions and had more severe angiographic CAD(according to the Gensini score).The difference between the three groups was statistically significant(P<0.05),while the difference in the number of diseased vessels among the three groups was not statistically significant(P=0.850).(5)The comparison of echocardiographic indicators among the three groups of patients showed that at admission,LVEDD in the LVF reduced group was larger than that in the LVF normal group,and LVEF was lower than that in the LVF normal group(P<0.05).Compared with admission,LVEF significantly increased and LVEDD significantly decreased in the LVF recovery group during follow-up.The above parameters in the LVF reduction group deteriorated compared to before during follow-up;Although the LVEF of patients with normal LVF decreased,it still falls within the normal range.(6)Multiple logistic regression analysis was conducted on the factors influencing the recovery of left ventricular function in STEMI patients after PCI.The univariate analysis results showed that slow heart rate in the early stage of STEMI,normal LVEDD,low levels of Lpa,LDL-C,D-dimer,peak level of troponin,high baseline EF value,low killp grade,short symptom to PCI time,short goalpoint time,and low Gensini score were all predictive factors for LVEF recovery(P<0.05).After adjusting for all variables and incorporating them into a multiple logistic regression model,the results showed that shorter symptom to PCI time(OR=0.064,95% CI 0.002-0.132,P=0.001),lower peak troponin(OR=0.441,95% CI0.252-0772,P=0.008),and higher baseline EF value(OR=3.839,95% CI1.73-8.517,P=0.003)were important predictors of LVEF recovery after PCI treatment in acute STEMI.Conclusion:(1)The Gensini score in the cardiac function recovery group of STEMI patients after direct PCI was significantly lower than that in the cardiac function reduction group;(2)Low peak troponin,higher baseline EF,and shorter symptom to PCI time increase the likelihood of LVF recovery. |
