| Objective: To evaluate the risk factors of death during hospitalization in patients with ST segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary stenting.Methods: We selected 697 patients with STEMI diagnosed in the Heart Center of Hebei Genaral Hospital from September 2016 to June 2018,including 70 patients with emergency radiography only,21 patients with elective radiography only,35 patients with rescue PCI,133 patients with conservative treatment,428 patients with primary percutaneous coronary intervention,30 patients with simple balloon dilatation and 6 patients with incomplete data.A total of 392 patients with STEMI were included in the study.The clinical data of these patients were retrospectively analyzed and divided into survival group and death group according to the occurrence of hospital death.The risk factors related to death were screened out by Logistic regression analysis.Results:⑴ The statistical analysis of the counting data of the survival group and the death group showed that the proportion of female,Killip ≥ III grade,diabetes and atrial fibrillation in the death group was higher than that in the survival group.The p value of female,Killip ≥ III grade,diabetes and atrial fibrillation history was less than 0.05,indicating that there was statistical difference between the two groups.The analysis of hypertension history,stroke history,PCI history,MI history and angina pectoris history between the two groups showed that the p value was greater than 0.05,indicating that there was no statistical difference.⑵ The statistical analysis of the measurement data of the survival group and the death group showed that the age of the death group was higher than that of the survival group and the p value was less than 0.05,and there was statistical difference between the two groups;the BMI,systolic blood pressure and diastolic blood pressure of the death group were lower than those of the survival group and p value was less than 0.05,there was statistical difference between the two groups;the heart rate of the death group was higher than that of the survival group,and the p value was more than 0.05,there was no statistical difference.⑶ Statistical analysis of drug use before and after operation between the survival group and the death group showed that the two groups were treated with ACEI/ARB,β-blocker,double anti-load(aspirin + clopidogrel or aspirin + tegregrel),CCB and PPI preparation after operation,and the p values were all more than 0.05,and there was no significant difference between the two groups.The proportion of preoperative use of statins in the death group was lower than that in the survival group,and the p value of the two groups was less than 0.05,and the difference was statistically significant.The proportion of aspirin + tegrilol,ACEI/ARB,β-blockers,statins and spironolactone in the death group was lower than that in the survival group,and the p value was less than 0.05,the difference was statistically significant.⑷ The examination and analysis of the two groups showed that the white blood cell count,neutrophil count,erythrocyte distribution volume width,creatinine,uric acid and phosphokinase-isozyme peak in the death group were higher than those in the survival group,and the p values of the two groups were less than 0.05,there was statistical difference.The serum calcium concentration,glomerular filtration rate and ejection fraction in the death group were lower than those in the survival group,and the p value was less than 0.05,and there was statistical difference,while the total cholesterol,high density lipoprotein,triglyceride,serum sodium and low density lipoprotein in the death group were higher than those in the survival group,and the p values were all more than 0.05,and there was no statistical difference.⑸ The analysis of operation-related data of the two groups showed that the syntax score,complete occlusion of criminal vessels,multi-vessel disease and the proportion of postoperative TIMI blood flow ≤ grade 2 of the death group was higher than that of the survival group,and the p value was less than 0.05,there was a statistical difference between the two groups.The symptom-to-balloon transit time,criminal vessels(LM,LAD,LCX),simultaneous treatment of non-criminal vessels,high thrombus load and the proportion of multiple stents in the death group were higher than those in the survival group,while the criminal vessel RCA,collateral circulation and thrombus aspiration ratio in the death group were lower than those in the survival group,and the p values were all more than 0.05,and there was no statistical difference between the two groups.⑹ The statistical analysis of the intraoperative situation of the two groups showed that the proportion of slow blood flow,cardiac arrest,acute cardiac tamponade,aortic balloon counterpulsation and bivalirudin in the death group was higher than that in the survival group,while the proportion of heparin in the death group was lower than that in the survival group.and the p values were all less than 0.05,and there was significant difference between the two groups.The incidence of ventricular fibrillation and tirofiban and propofol during operation were higher than those in the survival group,and the p values were all more than 0.05.There was no statistical difference between the two groups.⑺ The statistical analysis of postoperative complications in the two groups showed that the percentages of cardiogenic shock,cardiac arrest,ventricular fibrillation,atrial fibrillation,ventricular tachycardia,ventricular septal perforation,high atrioventricular block and gastrointestinal bleeding in the survival group were higher than those in the survival group,and the p value was less than 0.05.There was statistical difference between the two groups.The proportion of recurrent myocardial infarction and ventricular aneurysm in the death group was also higher than that in the survival group,and the p value was more than 0.05.There was no significant difference between the two groups.⑻ Taking the occurrence of death during hospitalization as the dependent variable,the above univariate analysis had statistical difference or no statistical difference,but the factors related to death in clinical practice were independent variables,which were included in the multivariate Logistic regression equation.The results showed that the age ≥ 65 years old(OR=3.552,95%CI 1.086～11.62,P=0.036),EF ≤ 40%(OR=6.754,95%CI 1.982～23.02,P =0.002),CK-MB peak ≥ 251IU/L(OR=4.243,95%CI1.219 ～ 14.77,P=0.023),S-to-B≥195min(OR=3.490,95%CI 1.079～11.29,P =0.037),and postoperative TIMI blood flow ≤ 2 grade(OR=8.425,95%CI 2.899～24.49,P<0.001)were correlated with postoperative death in hospital.It is an independent risk factor for in-hospital death.Conclusion:Old age,poor cardiac function,elevated peak value of CK-MB,longer time from onset of symptoms to opening of coronary artery and slow blood flow after p PCI were the risk factors of hospital death in patients with STEMI after primary stenting. |
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