Analysis Of MACE Risk Factors In High-risk ACS Patients Assisted By IABP

Background: Acute coronary syndrome(ACS)is a common cardiovascular disease,a serious type of coronary heart disease,usually manifested as Episodic chest pain,It mainly includes acute ST-segment elevation myocardial infarction(STEMI),acute non-ST-segment elevation acute coronary syndrome(NSTE-ACS),and NSTE-ACS includes non-ST-segment elevation myocardial infarction(N-STEMI)and unstable angina pectoris(UA).Exacerbations of ACS can lead to arrhythmias,heart failure,and sudden death.Although the treatment of ACS is improving,the fatality rate of ACS patients is still high,about 45% to 70%.Active and effective treatment can significantly reduce related complications,reduce mortality,and improve the long-term prognosis of these patients.Intra-aortic balloon pump(IABP)has obvious advantages in improving hemodynamics,increasing coronary blood flow,reducing left ventricular afterload and providing effective circulatory support in patients with ACS and HEART failure.Despite early use of IABP,Major adverse cardiac events(MACE)are still likely to occur in high-risk ACS patients.including stroke recurrence,acute coronary events,and vascular death,independent of established stroke risk factors.Currently,there are few studies on risk factors of MACE in patients with high-risk ACS assisted by IABP at home and abroad.In this study,the general clinical data of 350 patients with high-risk ACS assisted by IABP were analyzed,and the influencing factors of cardiovascular adverse events were analyzed to provide clinical guidance for further diagnosis and treatment.Objective: To analyze the influencing factors of MACE in patients with high-risk ACS treated with IABP during hospitalization.Methods: This is a retrospective study.Patients admitted to Qingdao Municipal Hospital from October 2014 to December 2019 for IABP-assisted revascularization of high-risk coronary arteries,According to the incidence of MACE events during hospitalization,MACE group and non-MACE group were divided into two groups,81 cases in the MACE group and 269 cases in the non-MACE group.The data collected included general information: sex,smoking history,age,duration of IABP,length of hospital stay.Complications: history of hypertension,history of cardiogenic shock,history of diabetes,history of hyperlipidemia,history of myocardial infarction,history of peripheral vascular disease,history of stroke.History of surgery: History of Percutaneous coronary intervention(PCI),coronary artery bypass-grafting(CABG)and post-IABP CABG.Clinical symptoms: STEMI,N-STEMI,and UA.Lesion target vessel and stenosis degree of lesion target vessel.Laboratory examination: Data such as blood creatinine,heart rate,systolic blood pressure,diastolic blood pressure,and Left Ventricular Ejection Fraction(LVEF),(?)±S was used to represent data conforming to normal distribution,independent sample T test was used for comparison between the two groups,median and quartile were used to represent data not conforming to normal distribution,and non-parametric test was used for comparison between the two groups.The count data were expressed as the number of cases and percentage,and the chi-square test was used to analyze and compare the two groups.P < 0.05 was considered as statistically significant difference.Multiple factors were analyzed by binary logistic regression model for independent risk factors affecting the risk of MACE in high-risk ACS patients assisted by IABP.Area under the curve(AUC)was determined by Receiver Operator characteristic curve(ROC)to compare the clinical predictive value of biomarkers and disease severity scores.Further verify the value of related factors to the occurrence of MACE.Results: 1.The results of baseline data analysis show that: there was no significant difference in gender,diastolic blood pressure,N-STEMI,history of diabetes,history of stroke,history of peripheral vascular,history of myocardial infarction,history of previous CABG,history of previous PCI,target vessels of lesion(LM,LAD,LCX,RCA)and duration of IABP(P>0.05).There were statistically significant differences in age,smoking,hypertension,hyperlipidemia,cardiogenic shock,STEMI,UA,systolic blood pressure,heart rate,creatinine,LVEF,IABP of CABG and duration of IABP between two groups(P<0.05).2.Multivariate binary logistic regression analysis showed that: Age(OR=1.099,95%CI: 1.026-1.178,P<0.05),high degree of coronary artery stenosis(OR=1.097,95%CI: 1.007-1.194,P<0.05),high serum creatinine(OR=1.008,95%CI: 1.002~1.013,P<0.05),hyperlipidemia(OR=3.430,95%CI: 1.452-8.097,P<0.05),combined with cardiogenic shock(OR=20.080,95%CI: 8.045-50.119,P<0.05),smoking history(OR=3.175,95%CI: 1.250-8.067,P<0.05),Low LVEF(OR=0.897,95%CI: 0.850~0.947,P<0.05)were independent risk factors for MACE in high-risk ACS patients assisted by IABP.3.In order to determine whether the prediction of the above risk factors can be applied to clinical application,ROC curve was established,and AUC was as follows: Age(AUC: 0.669,95%CI: 0.603-0.735),smoking history(AUC: 0.602,95%CI: 0.533-0.670),hyperlipidemia(AUC: 0.722,95%CI: 0.658~0.787),stenosis degree(AUC: 0.627,95%CI: 0.561~0.693),cardiogenic shock(AUC: 0.846,95%CI: 0.726-0.851),creatinine(AUC: 0.789,95%CI: 0.726-0.851),LVEF(AUC: 0.168,95%CI: 0.115~0.221).Conclusions In the treatment of patients with high-risk ACS assisted by IABP,advanced age,smoking history,hyperlipidemia,high degree of coronary artery stenosis,combined with cardiogenic shock,high serum creatinine and low LVEF are independent risk factors for MACE events in patients with high-risk ACS.