To Explore The Risk Factors And Time Distribution Of Major Adverse Cardiovascular Events In Patients With Acute Myocardial Infarction After PCI

Objective: To investigate the risk factors and time distribution of in-hospital major adverse cardiovascular events(MACE)in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).The risk factors of MACE and the correlation between each risk factor and MACE in hospital were analyzed,and the time distribution of MACE occurrence was further discussed.By analyzing the basic clinical data of AMI patients,the high-risk groups that may develop MACE were identified in the early stage of patients’ treatment,and the possible time period of MACE occurrence was predicted.In order to reduce the risk of hospital death of AMI patients after PCI,advance intervention was carried out for high-risk patients.Methods: In this study,a total of 299 subjects were selected according to the inclusion and exclusion criteria for AMI patients admitted to the Department of Cardiovascular Medicine of the First Hospital of Lanzhou University from January 2022 to June 2022.Patients were divided into two groups according to the occurrence of MACE,namely,the MACE group(19 cases)and the non-MACE group(280 cases),and the difference in baseline data between the two groups was compared.Binary logistic regression was used to analyze the risk factors of in-hospital MACE,and then the receiver operating characteristic curve(ROC)was described and the area under the curve(AUC)was calculated to evaluate the predictive value of each risk factor to in-hospital MACE.According to the time point of occurrence of in-hospital MACE in AMI patients,19 patients in the MACE group were further divided into 3 groups: 0-6 hours group(11cases),6-24 hours group(5 cases),and ≥24 hours group(3 cases).The incidence of in-hospital MACE in each time period was calculated,and the difference of baseline data among the three groups was compared,and the main risk factors affecting the time distribution of in-hospital MACE and the types of MACE in different time periods were analyzed.Results: ⑴ Compared with the non-MACE group,the systolic blood pressure and diastolic blood pressure were significantly lower,the age was older,and the number of Killip III-IV patients in the MACE group was more(all P < 0.05),while there was no statistical significance in gender,hypertension,diabetes,smoking and other aspects between the two groups(all P > 0.05).⑵ Compared with non-MACE group,CRP,NEUT,NLR,AST,BUN,D-dimer,Tn I,Myo and NT-pro BNP in MACE group were higher(all P < 0.05).RBC,HGB,MCV,MCHC,WBC,LYM,MONO,PLT,PLR,and MHR、TC,TG,HDL,LDL,LP(A),LP(B),ALT,Crea,K+,CK-MB,PT,PTA,INR and other laboratory indexes in 2 groups had no statistical significance(all P >0.05).(3)There was no significant difference in LVEDV,LVESV,internal diameter of pulmonary artery trunk and left atrial diameter between the two groups(P > 0.05).LVEF was lower in the MACE group than in the non-MACE group(P < 0.05).⑷Compared with the non-MACE group,the degree of coronary artery lesions in the MACE group was more serious,the number of stents implanted during PCI was more,the intraoperative thrombus aspiration rate and the implantation rate of IABP were higher(all P < 0.05).There was no significant difference in the number of coronary vascular lesions and the proportion of STEMI patients between the two groups(all P > 0.05).(5)The statistically significant indicators of difference analysis were incorporated into binary Logistic regression analysis.The results showed that high age,Killip III-IV cardiac function and intraoperative implantation of IABP pump were independent risk factors for the occurrence of in-hospital MACE.The ROC curve showed that the AUC for predicting the occurrence of MACE by age was 0.670(95%CI: 0.561-0.778,P=0.013),with the highest sensitivity(73.7%)and specificity(55%).The AUC for predicting MACE was 0.677(95%CI: 0.527-0.828,P=0.010),the sensitivity was 36.8%,and the specificity was 98.6%.The Killip III-IV grade of cardiac function predicted the occurrence of MACE with an AUC of 0.316(95%CI:0.093-0.338,P=0.000),sensitivity of 31.6%,and specificity of 17.9%.That is intraoperative implantation of IABP pump has a high predictive value for the occurrence of MACE in hospital.It was found that the incidence of MACE in the group 0 to 6 hours,6 to 24 hours and ≥24 hours were 57.9%,26.3% and 15.8%,respectively.There were no significant differences in baseline data,laboratory indicators,results of cardiac color ultrasound and indicators related to interventional surgery among the three groups(P > 0.05).The level of NT-pro BNP in 6-24 h group was significantly higher than that in 0-6 h group and ≥24 h group(P<0.05);The number of coronary artery lesions in 0-6 h group was significantly higher than that in6-24 h group and ≥24 h group(P < 0.05).In terms of the type of MACE,cardiogenic shock was the main cause in the 0-6 h group,and heart failure was the main cause in the 6-24 h group.There was no significant difference in the incidence of all types of MACE in the ≥24 h group(P < 0.05).Conclusions: Higher age,Killip III-IV grade of cardiac function and intraoperative implantation of IABP pump are independent risk factors for the occurrence of MACE in hospital,among which intraoperative implantation of IABP pump has a higher predictive value for the occurrence of MACE.The number of coronary artery lesions and serum NT-pro BNP level were the main factors affecting the time distribution of MACE in hospital of AMI patients.The type of MACE in the 0-6 h group was mainly cardiogenic shock,while the type of MACE in the 6-24 h group was mainly heart failure.There was no significant difference in the incidence of all types of MACE events in the ≥24 h group.