The Analysis Of The Influence Factors Of Left Ventricular Systolic Dysfunction Developed In Patients With Acute Myocardial Infarction

ObjectivesTo explore the risk factors of left ventricular systolic dysfunction in patients with acute myocardial infarction.MethodsPatients(870 male patients, 156 female patients, aged 61±13 years) with acute myocardial infarction who were admitted to Chest Pain Center of the First Affiliated Hospital of Soochow University and received emergency percutaneous coronary intervention during January 2011 and May 2015 were consecutively evaluated. The severity of coronary artery stenosis, hospitalization data, personal history, medications and so on were retrospectively collected. Patients were divided into non-LVSD group(EF> 40%) and LVSD group(EF ≤ 40%) based on LVEF values measured by echocardiography. Correlation analysis, logistic regression and ROC curves were used to compare the differences between the two groups.Results1. A total of 1026 patients were included. Among them, the incidence of left ventricular systolic dysfunction was 21.5%. Patients in LVSD group have advanced age, more female, higher heart rate and lower systolic blood at admission. The incidence of previous atrial fibrillation history was higher in LVSD group than that in non-LVSD group(6.3% versus 2.7%, P= 0.01). the comparison of laboratory parameters revealed NLR, WBC, NE, RDW, Hs-CRP, FPG, c Tn I and CK-MB were higher in LVSD group than that in non-LVSD group, and the levels of LY, PAB and e GFR were lower in LVSD group than that in nonLVSD group. In addition, criminal vessels of acute myocardial infarction of patients in LVSD group were more likely to be LM/LAD. The proportion of criminal vessels in proximal segment and Gensini scores were higher in LVSD group. During the hospitalization, the conditions of patients were compared between the two groups. We found that the hospitalization duration was longer in LVSD group than that in non-LVSD group. The 30-day mortality, proportion of Killip class II-IV, the incidence of right bundle branch block and complications during hospitalization(new-onset atrial fibrillation/ventricular tachycardia and ventricular fibrillation/acute left ventricular failure) were significantly higher in LVSD group than that in non-LVSD group. The proportion of patients with anterior myocardial infarction in LVSD group was higher than that in non-LVSD group.2. Correlation analysis showed NLR was negatively correlated with LVEF(r = 0.271, P< 0. 001). Correlation coefficient between NLR and LVEF was even higher in patients with anterior wall myocardial infarction.3. Multivariate regression analysis showed NLR(OR: 1.071, P< 0.001), Hs-CRP(OR: 1.063, P= 0.002), PAB(OR: 0.994, P= 0.004), c Tn I(OR: 1.014, P< 0.001), heart rate at admission(OR: 1.019, p = 0.001), systolic blood pressure at admission(OR: 0.998, P = 0.008) and the incidence of new-onset atrial fibrillation(OR: 2.109, P= 0.023) were independent risk factors for LVSD in patients with acute myocardial infarction.4. Area under the ROC curve of acute left ventricular failure/30-day mortality during hospitalization predicted by NLR were 0.743(95% CI: 0.710~0.773) and 0.780(95% CI: 0.750~0.809)(higher than that of c Tn I and Gensini score).Conclusion1. Patients with acute myocardial infarction complicated by left ventricular systolic dysfunction are mostly characterized with advanced age, female, low systolic blood pressure, higher heart rate, history of atrial fibrillation, higher incidence of arrhythmia and mortality during hospitalization, as well as worse prognosis.2. NLR was significantly increased in patients with acute myocardial infarction complicated by left ventricular systolic dysfunction. NLR was negatively corrected with left ventricular ejection fraction in patients with acute myocardial infarction. NLR was an independent risk factor for LVSD developed in patients with anterior wall myocardial infarction during acute phase of myocardial infarction. Predictive values of NLR for acute left ventricular failure and 30-day mortality were superior than those of troponin I and Gensini score.3. Other independent risk factors for LVSD in patients with anterior wall myocardial infarction during acute phase of myocardial infarction were Hs-CRP, PAB, c Tn I, admission heart rate, systolic blood pressure and new-onset atrial fibrillation.