| Acute Coronary Syndrome（ACS）is a major disease with high mortality and disability in China and the world.STEMI has become a worldwide medical issue with increasing mortality and morbidity every year.Global Registry of Acute Coronary Events（GRACE）study have shown that,the patients with AMI shared the mortality of 1%in 1-year,and 20%in 5-year.Meanwhile,the morbidity and mortality of young and middle-aged subjects maintain an upward trend.According to Annual Report on Cardiovascular Health and Diseases in China（2020）,there are 330 million people suffering from cardiovascular disease in our country.Among them,11.39 million are diagnosed with coronary heart disease,taking the first place in the causes of death of urban and rural residents.In recent years,with the development of chest pain center,intravenous thrombolysis and percutaneous coronary intervention（PCI）have significantly improved the treatment effect of STEMI.However,according to many years of STEMI treatment practice and evidence-based medical evidence,the occurrence of various adverse cardiac events significantly reduces the benefits of clinical intervention.Therefore,it has gradually become a hot topic in cardiovascular research in recent years to accurately identify high-risk patients and assess risks as soon as possible,and formulate clinical prediction models by combining multiple possible relevant factors when necessary;It has practical significance for optimizing treatment strategies,formulating follow-up plans and improving patients’prognosis.Consequently,based on the real-world data,this serial study was designed to evaluate the relevant predictive parameters of adverse cardiac events in patients with AMI in three parts:part one was aimed to predict and evaluate the risk factors of ventricular arrhythmia in STEMI patients by developing and validating the nomogram model;furthermore,on the basis of previous findings of our center,the relation between serum potassium and the incidence of ventricular arrhythmia was discussed as well.Part two was designed to analyze the possible related factors,especially CHA2DS2-VASc-HSF score,which would affect the thrombolytic effects in STEMI patients receiving intravenous fibrinolysis.Part three was carried out to assess the contributing factors of adverse prognosis during hospitalization in young and middle-aged STEMI patients.Among those elements,the predictive value of stress hyperglycemia ratio was explored.Part One Development and Validation of Predictive Risk Nomogram Model for Early Ventricular Arrhythmias in patients with STEMI in a Single CenterObjective:This study was designed to predict,evaluate and validate the risk of early ventricular arrhythmia（VA）in ST-segment elevation myocardial infarction（STEMI）patients in the form of nomogram model.Methods:Consecutive STEMI patients admitting to the Second Hospital of Hebei Medical University from September 2018 to October 2020,were enrolled retrospectively in this study.The participants were divided into VA group and NVA group,depending on the occurrence of ventricular arrhyth-mias.The demographic data,laboratorial indices,procedural parameters,and major adverse cardiac events（MACEs）during hospitalization were analyzed and compared between the two groups.Multivariate logistic regression was performed to analyze the independent risk factors of VA.Nomogram model was built based on those factors.ROC was applied to demonstrate the discrimination.Besides,the internal validation and calibration of the model were also carried out.Meanwhile,the predictive value of serum potassium was assessed using ROC analysis.Result:Totally 426 patients were enrolled in this study,with 352 cases in NAV group and 74 cases in VA group.There existed significant differences between the two groups in the following variables,such as age,Killip grade,biochemical parameters（WBC count,neutrophil,serum potassium,glomerular filtration rate,glucose,et al）,GRACE and CRUSADE scores,LAD proportion,and pre-procedural TIMI blood flow（P<0.05）.The multivariate logistic regression analysis showed that,Killip grade（X1）,serum potassium>3.5mmo/L（X2）,WBC count>10.0*109/L（X3）,glucose>8.0 mmol/L（X4）and creatinine>80.0μmol/L（X5）were independent risk factors of early VA in STEMI.Regression equation was Logit P=-0.693+0.73*X1（Killip grade）-2.588*X2（serum potassium>3.5mmo/L）+0.737*X3（WBC count>10.0*109/L）+0.753*X4（glucose>8.0 mmol/L）+0.626*X5（creatinine>80.0μmol/L）.AUC of the developed model was 0.830.After internal validation,the mean AUC was 0.804.AUC of serum potassium was 0.760（95%CI:0.692-0.829）,with a sensitivity of 0.676 and a specificity of 790.The cut-off value of blood potassium level was 3.83,and Youden index was 0.466.MACEs incidence during hospitalization and 30-days follow-up was recorded.Patients in VA group had a higher incidence of MACE,compared with NVA group.Among them,there was a statistical difference in heart failure occurrence（14.8%vs.7.7%,P=0.048）.Summary:1.In the early stage of STEMI,hypokalemia is closely related to the occurrence of ventricular arrhythmia.2.Nomogram model with Killip grade,WBC count,serum potassium,creatinine and glucose could predict the risk of early VA in STEMI patients accurately.3.Ventricular arrhythmia was related to the occurrence of short-term adverse cardiac events in STEMI patients,for which the clinicians should pay attention.Part Two Factors Affecting Thrombolytic Effects in STEMI Patients Receiving Intravenous Fibrinolysis and Predictive Value of CHA2DS2-VASc-HSF ScoreObjective:This part was designed to analyze the possible related factors,especially CHA2DS2-VASc-HSF score,which would affect the thrombolytic effects in STEMI patients receiving intravenous fibrinolysis.Methods:From September 2018 to March 2021,STEMI patients undergoing coronary angiography（CAG）following intravenous thrombolysis were enrolled in this retrospective analysis.According to the re-opening of infarct-related artery（IRA）,the subjects were divided into recanalization group and non-recanalization group.The demographic data,biochemical indices,reperfusion and angiographic parameters,risk scores,as well as MACEs during hospitalization were collected and compared between the two groups.Multivariate logistic regression was applied to select the independent risk factors affecting thrombolytic effects.Meanwhile,clinical models were built to evaluate the correlation between CHA2DS2-VASc-HSF score and the recanalization of IRA.ROC of CHA2DS2-VASc-HSF score was plotted,as well as its AUC,sensitivity,specificity and cut-off value.Result:A total of 222 patients were enrolled with 17 2cases in recanalization group and 50 cases in non-recanalization group.There were statistical differences in the following items:body surface area,history of diabetes,cardiac function,unfractionated heparin administration,onset to Needle,FMC to Needle,serum creatinine,Fasting Blood Glucose（FBG）,high sensitive-CRP,potassium,APTT,and three score systems（ALL P<0.05）.For angiographic features,patients in non-recanalization group had higher thrombus score,PCI proportion,glycoprotein inhibitor,and CK-MG peak value（P<0.05）.Besides,patients in non-recanalization group had higher incidence of heart failure（P<0.05）.The multivariate logistic regression analysis showed that,unfractionated heparin administration,APTT,history of diabetes,Killip grade,and CHA2DS2-VASc-HSF score were independent factors affecting the thrombolytic effects in STEMI patients.For ROC,the cut-off value of CHA2DS2-VASc-HSF score was 4.5with a sensitivity of 0.600 and a specificity of 0.970,and AUC of 0.860.Summary:1.For STEMI patients receiving intravenous thrombolysis,early administration of unfractionated heparin for anticoagulation is in favor of coronary recanalization.2.Unfractionated heparin administration,APTT,history of diabetes,Killip grade,and CHA2DS2-VASc-HSF score were independent factors affecting the thrombolytic effects in STEMI patients.3.Fail intravenous thrombolytic therapy is closely related to the development of heart failure.4.CHA2DS2-VASc-HSF score has good predictive value for intravenous thrombolytic.Part Three The prognostic significance of glycemic changes in young and middle-aged patients with acute ST-segment elevation myocardial infarctionObjective:This part was to carried out to assess the contributing factors of adverse cardiac during hospitalization in young and middle-aged STEMI patients.Among those elements,the predictive value of stress hyperglycemia ratio（SHR）was explored.Methods:Consecutive STEMI patients less than 65-years old admitting to the Second Hospital of Hebei Medical University from September 2018 to March 2021,have been enrolled in this retrospective analysis.The candidates were divided into two groups according to the occurrence of MACE,which were MACE Group,and non-MACE Group.The general clinical data,laboratory tests,and procedural information of both groups were compared.Multivariate logistic regression was performed to analyze the independent risk factors of adverse cardiac during hospitalization in young and middle-aged STEMI patients.Besides,the correlation between SHR and MACEs were assessed.ROC of FBG and SHR were built,based on which AUC,sensitivity,specificity and cut-off value were calculated.In addition,the patients were split up into groups depending on the median levels of SHR.The incidence of MACEs and bleeding complications were noted.Result:A total of 269 patients were enrolled with 230 cases in non-MACE group and 39 cases in MACE group.There were significant differences in the following items:cardiac function,anterior wall MI,GRACE and CRUSADE scores,onset to FMC,SHG incidence,SHR,serum potassium,hs-CRP,glucose,BNP,and creatinine（ALL P<0.05）.The multivariate logistic regression analysis showed that serum potassium,FBG,SHR,LVEF values were independent risk factors of adverse cardiac events in young and middle-aged patients with STEMI.To predict those events,the cut-off value of SHR was≥1.114 with a sensitivity of 82.1%and a specificity of 79.1%,and AUC of 86.29%.Besides,there were 136 cases in LSHR group and 133 cases in HSHR group.The incidence of repeated angina and cardiac failure were higher in HSHR（P<0.05）.Summary:1.Serum potassium,LVEF、FBG and SHR were independent risk factors of adverse cardiac events in young and middle-aged patients with STEMI.2.SHR could predict the risk of the adverse prognosis of young and middle-aged STEMI patients independently.Part Four Risk Factors of In-stent Restenosis in Patients with Acute Coronary Syndrome underwent Percutaneous Coronary Intervention and Predictive Value of Fibroblast Growth Factor 23Objective:To analyze the risk factors of in-stent restenosis（ISR）in patients with ACS underwent percutaneous coronary intervention（PCI）and the predictive value of fibroblast growth factor 23（FGF-23）.Methods:Patients with ACS underwent PCI with drug-eluting stents implantation were consecutively enrolled from January 2018 to December2019 were collected.The demographic data,cardiovascular risk factors,biochemical index,cardiac function,angiographic data were collected for analysis.FGF-23 level in the serum samples was detected via enzyme linked-immuno-sorbent Assay before PCI.Coronary angiography was performed before PCI and at 6-24 months after PCI.According to whether ISR occurs or not of the last coronary angiography divided patients into the ISR group and non-ISR group.Multivariate Logistic regression was used to analyze the related factors of ISR.Risk prediction model was built based on those factors.ROC was applied to demonstrate the discrimination.Meanwhile,the predictive value of FGF-23 was assessed using ROC analysis.Result:A total of 214 patients were enrolled with 176 cases in non-ISR group and 38 cases in ISR group.Compared with patients in non-ISR group,those in ISR group had more diabetes mellitus,hypercholesteremia and hyperuricemia,more multivessel artery lesions,two target lesions and target lesion at LCX,longer length of target lesion and length of stent（all P<0.05）.The two groups exist difference in number of laboratory indicators（all P<0.05）:creatinine,FBG,hs-CRP,IRI,LDL-C and NT-pro BNP in the ISR group were obviously higher than those in the non-ISR group well HDL-C were lower.Moreover,ACEI/ARB in the ISR group were significantly lower than non-ISR group（ALLP<0.05）.The multivariate logistic regression analysis showed that FGF-23[1.005（1.002～1.007）,P=0.001],LDL[4.458（1.759～11.294）,P=0.002],CRP[1.261（1.117～1.424）,P<0.001],diabetes mellitus[23.645（6.374～87.782）,P<0.001],two target lesions[6.305（2.015～19.728）,P=0.002],length of target lesion[1.128（1.054～1.208）,P=0.001]were independent risk factors of ISR（all P<0.05）.The risk prediction model was established based on these independent predictive factors,AUC of the developed model was 0.932（95%CI0.895-0.968）with a sensitivity of 84.2%and a specificity of 88.1%.For the prediction of ISR,the cut-off value of FGF-23 was≥798.985 pg/ml with a sensitivity of 84.2%and a specificity of 75.6%,and AUC of 0.932.Summary:1.FGF-23,LDL-C,hs-CRP,diabetes mellitus,two target lesions and length of target lesion were independent risk factors of ISR in ACS patients underwent percutaneous coronary intervention.The ISR risk prediction model which established based on these independent predictive factors exhibited an excellent predictive value for ISR.2.FGF-23 could be considered as predictors of ISR in ACS patients underwent percutaneous coronary intervention.Conclusions:1.Nomogram model could predict the risk of early VA in STEMI patients accurately.2.In the early stage of STEMI,hypokalemia,Killip grade and glucose is closely related to the occurrence of ventricular arrhythmia.Ventricular arrhythmia was related to the occurrence of short-term adverse cardiac events in STEMI patients,for which the clinicians should pay attention.3.Early and effective reperfusion therapy of STEMI can reduce the incidence of recent heart failure.For STEMI patients receiving intravenous thrombolysis,early administration of unfractionated heparin for anticoagu-lation is in favor of coronary recanalization.4.Unfractionated heparin administration,APTT,history of diabetes,Killip grade,and CHA2DS2-VASc-HSF score were independent factors affecting the thrombolytic effects in STEMI patients.CHA2DS2-VASc-HSF score has a good predictive value for intravenous thrombolytic.5.Short term adverse cardiac events in young and middle-aged STEMI patients are related to stress-induced blood glucose changes.SHR could predict the risk of the adverse prognosis of young and middle-aged STEMI patients.6.The ISR risk prediction model which established based on FGF-23,LDL-C,Hs-CRP,diabetes mellitus,two target lesions and length of target lesion has a good prediction value for ISR in ACS patients underwent percutaneous coronary intervention. 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