Clinical Prognosis Of Patients With ST-elevation Myocardial Infarction Undergoing PCI At Different Time After 48 Hours Of Onset

Objective:.To investigate the effect of delayed PCI at different time on cardiac function changes,ventricular remodeling,and prognosis in patients with ST-segment elevation myocardial infarction(STEMI)who missed primary reperfusion,and to clarify whether there is optimal time for delayed reperfusion.At the same time,to find out independent risk factors for the prognosis in patients with myocardial infarction who underwent delayed PCI.Methods:.The first part of current study retrospectively enrolled 451 patients with ST-elevation myocardial infarction from January 2012 to December 2017 in our hospital,and delayed PCI was performed at 48 hours to 30 days after onset.All patients were given standard antiplatelet therapy and anti-ischemic therapy after admission.According to the time when delayed PCI was performed,they were divided into two groups: the early group(48 hours to 10 days after onset,n=234)and the late group(≥10 days after onset,n=217).The primary endpoint was major adverse cardiovascular events during hospitalization and after 1 year(all-cause death,cardiac death,nonfatal reinfarction,target vessel revascularization,heart failure NYHA class IV,acute heart failure,malignant arrhythmia and stroke).Secondly,all adverse events and the time of occurrence were recorded until December2018 and Kaplan-Meier event-free survival analysis was performed in the two groups.At last,univariate and multivariate regression analyses were performed to identify independent risk factors that influence the prognosis of delayed PCI.The second part of current study retrospectively enrolled244 patients with ST-elevation myocardial infarction who underwent ultrasonocardiogram one year after deyaled PCI,from January 2012 to December 2017 in our hospital.According to the time when delayed PCI was performed,they were divided into two groups: the early group(48 hours to 10 days after onset,n=126)and the late group(≥10 days after onset,n=118).Left ventricular ejection fraction(LVEF),left ventricular endsystolic volume(LVESV),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic diameter(LVESD),left ventricular enddiastolic diameter(LVEDD)and left ventricular posterior wall thickness(LVPW)were compared between the two groups,to observe changes in left ventricular function and ventricular remodeling.Results: In the first part,the incidence of adverse events at discharge in the early and late groups was 2.1% and 2.8%(P>0.05).The incidence of adverse events after 1 year was 9.4% and 9.2%,respectively(P>0.05).There was no significant difference between the two groups.Survival analysis was performed(cardiovascular adverse events as the endpoint)in the two groups.Until December 2018,41 cases(17.5%)occurred in the early group and 30cases(13.8%)occurred in the late group,there was no significant difference in event-free survival curves between the two groups(P>0.05).Univariate and multivariate regression analysis found that age,diabetes,and Killip classification were independent risk factors for prognosis of delayed PCI in STEMI patients.In the second part,after 1 year of follow-up,LVEF increased significantly in the early and late groups compared with the hospitalization period(The early group,60.59±8.12% vs 56.52±9.25%,P<0.05;The late group,56.99±10.17% vs 54.45±10.30%,P<0.05).LVESV and LVESD decreased significantly in both groups compared with 1 year ago(The early group LVESV,50.14±21.01 ml vs 54.76±24.78 ml,P<0.05;LVESD,34.08±5.47 mm vs 35.23±5.85 mm,P<0.05;The late group LVESV,56.97±26.87 ml vs 60.05±26.19 ml,P<0.05;LVESD,35.70±6.48 mm vs36.55±6.40 mm,P<0.05),and LVEDV 、 LVEDD 、 LVPW remained unchanged(P>0.05).However,it was found that the change of LVEF、LVESV、LVEDV、LVESD、LVEDD after 1 year had no significant difference between the two groups(ΔLVEF,4.06±6.19% vs 2.54±7.17%,P>0.05;ΔLVESV,-4.62±13.34 ml vs-3.08 ± 15.86 ml,P>0.05;ΔLVEDV,-2.51 ± 21.16 ml vs-2.86 ± 20.51 ml,P>0.05;ΔLVESD,-1.15 ± 3.13 mm vs-0.85 ± 3.91 mm,P>0.05;ΔLVEDD,-0.36 ± 3.22 mm vs-0.45 ± 3.47 mm,P>0.05;ΔLVPW,-0.14 ± 1.07 mm vs-0.18 ± 1.12 mm,P>0.05).Conclusions: Delayed PCI in patients with ST-elevation myocardial infarction can significantly improve cardiac function and ventricular remodeling.However,Delayed PCI performed at different time has no significant difference in the degree of benefit and prognosis.Delayed PCI may be time-independent.In addition,independent risk factors for prognosis in STEMI patients include age,diabetes,and Killip classification.