Analysis On The Risk Factors Of Heart Failure Of The AMI Patients After Recanalization Of IRA With Preserved Systolic Function Of Left Ventricle

Background:With the development of cardiac catheterization technology, the emergency percutaneous coronary intervention(PCI) in acute myocardial infarction(AMI) is widely used in clinical application. As the first method to treat AMI,it can make the ischemic myocardium achieve reperfusion rapidly to save the dying myocaardium. However, patients treated with reperfusion in the early stage with preserved left ventricular systolic function were found to have heart failure in clinical practice, and some patients were even too serious to die, which can reduce the benefit of emergency PCI operation in patients with AMI. Therefore, we hope we can find the risk factors and prognosis of this condition through the study.Objective: To investigate the risk and predictive factors for occurrence of heart failure after recanalization of IRA(infarct-related artery) during PCI(percutaneous coronary intervention) for acute myocardial infarction(AMI) patients with preserved systolic function of left ventricle.Methods:1.413 AMI patients with preserved systolic function of left ventricle who were treated by the PCI from April 2010 to April 2015 in hospital were divided into heart failure group(n=214) and control group(n=199).2.The case-control study was to collect clinical data of enrolled patients, such as sex, age, history of hypertension, history of hyperlipidaemia, history of diabete, neutrophile(N), N-terminal pro-brain natriuretic peptide(NT-pro-BNP), high sensitive C reactive protein(Hs-CRP) and so on. Meanwhile, features of coronary angiography were collected, such as the number of coronary artery lesion branches, IRA, the obstruction site of the IRA, the flow grade of the recanalization of IRA and so on. In addition, we collected the intervention treatment way such as use tirofiban hydrochloride, thrombus suction pipe and intra-aortic balloon pump.3.Risk factors such as clinical data and features of coronary angiography related to heart failure were analyzed by single and multifactorial logistic regression analysis and the predicted effect was determined by ROC curve.Results:1.413 patients were enrolled in the study and divided into two groups. The heart failure of AMI patients with preserved systolic function of left ventricle was positively associated with sex, age, history of hypertension, hospital days, Hs-CRP, N, left atrial diameter(LA),left ventricular end-systolic dimension(LVS), vascular opening time, the morbidity of paroxysmal atrial fibrillation,major adverse cardiovascular events(MACE) and in-hospital mortality, where the difference between groups is statistically significant(p<0.05).2. There were 214 patients in the case group, where there were 122 patients with one-vessel lesion, 52 patients with two-vessel lesion and 40 patients with multi-vessel lesion. The highest rate of IRA was found in left anterior descending artery(LAD), then right coronary artery(RCA), then left circumflex artery(LCX), and the lowest in left main coronary artery(LM). When we focused on the IRA site, 116 patients were in the proximal of the vessels, 86 patients were in the middle of the vessels and 12 patients in the distal of the vessels. The difference between the two groups are significant in vessels of coronary artery, IRA, IRA sites. There were no difference between two groups in the flow after recanalization of the IRA, using tirofiban hydrochloride or thrombus suction pipe or intra-aortic balloon pump.3.Multifactorial logistic regression analysis showed that women,the infarct artery of left main coronary artery or left anterior descending branch, proximal vessel infarction, multi-vessel lesion, neutrophil, hs-CRP,vascular opening time and history of hypertension are independent predictor of heart failure.4.ROC curve analysis for this prediction model showed that the area under the curve was 0.783(95%CI 0.739~0.828,P<0.001).Conclusion:1.Women,the infarct artery of left main coronary artery or left anterior descending branch, proximal vessel infarction, multi-vessel lesion,high neutrophil, high hs-CRP,long vascular opening time and history of hypertension are the risk factors of the patients with preserved systolic function of left ventricle of heart failure after PCI.2.The in-hospital mortality and MACE are higher in the heart failure AMI patients with the preserved systolic function of left ventricle after recanalization of IRA and worse prognosis.