Risk Factors For In-hospital Mortality In Patients With Initial Acute ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Objective To investigate the risk factors for in-hospital mortality in patients with initial acute ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).In order to Increase vigilance for risk factors and make early Intervention,we could reduce the occurrence of adverse events and hospital mortality of STEMI patients.Methods A total of 453 patients with initial STEMI who were treated with emergency PCI in Fujian Provincial Hospital from January 2017 to November2019 were analyzed retrospectively.According to occurrence of in-hospital death,they were divided into death group and survival group.The basic data of the two groups were recorded.The general condition,clinical indicators,laboratory examinations,coronary angiography reports and complication,drug treatment of the two groups were compared.Logistic regression analysis was used to explore independent risk factors for in-hospital mortality.Results Among the 453 STEMI patients,32 patients die and 421 patients survival in the hospital.There were 380 males and 73 females,and the in-hospital mortality rate was 7%.There was a statistically significant difference between death group and survival group.Compared those in survival group,death group showed a higher rate of patients with perioperative hypotension,herat function killip grade ≥2,new-onset AF(NOAF),high degree atrioventricular block,malignant ventricular arrhythmia(MVA)and TIMI grade≤ 1(P <0.05);The age,admission heart rate,fasting blood glucose,white blood cell count,D-dimer,creatinine,uric acid,urea nitrogen,high-density lipoprotein cholesterol(HDL),NT-pro BNP and peak value of troponin I of the death group was higher than that of the survival group(P <0.05);And the LVEF,systolic blood pressure,diastolic blood pressure,hemoglobin,triglycerides,low-density lipoprotein cholesterol(LDL)Of the death group was lower than that of the survival group(P <0.05).Binary logistic regression analysis showed NOAF(RR:4.883;95%CI 1.519-15.704,P=0.008),MVA(RR:4.234;95%CI 1.094-16.390,P=0.037),D-dimer(RR:1.172;95%CI 1.036-1.1.325,P=0.011),triglycerides(RR:0.158;95%CI 0.043-0.585,P=0.006),white blood cell count(RR:1.184;95%CI 1.057-1.327,P=0.003),blood urea nitrogen(RR:1.213;95%CI 1.036-1.1.420,P=0.016),peak value of troponin I(RR:1.001;95%CI 1.000-1.002,P=0.008)proved to be independent predictors of patients with STEMI after emergency PCI for in-hospital mortality.Conclusion NOAF,MVA,lower triglycerides,elevated white blood cell count,D-dimer,peak value of troponin I and blood urea nitrogen could be independent predictors of in-hospital mortality among the patients with initial STEMI after emergency PCI.