Clinical Characteristics And Early Prognosis Of AMI Patients With Mid-range Ejection Fraction After Emergency PCI

BackgroundIn 2016,the European Society of Cardiology divided heart failure patients with ejection fraction(EF)of 40%to 49%into an independent subgroup,causing widespread concern.Unlike heart failure,there is no classification for acute myocardial infarction according to left ventricular ejection fraction.However,left ventricular ejection fraction has been confirmed to be closely related to the prognosis of patients with acute myocardial infarction.The evidence on clinical characteristics and prognosis of patients with acute myocardial infarction accompanied by EF from 40%to 49%is obviously insufficient.Whether AMI with mid-range EF is significantly different in clinical presentation and prognosis from that of reduced EF and preserved EF is a pending clinical issue to be solved.ObjectivesWe aimed to perform a retrospective analysis of patients undergoing emergency PCI,comparing the clinical characteristics,in-hospital acute heart failure and all-cause death events of AMI patients with mrEF,pEF and rEF.It would provide more clinical evidence on AMI patients with mrEF undergoing emergency PCI.and help clinicians better understand the management and early prognosis of mrEF patients.MethodsContinuous data collection was performed between January 1,2012 and June 30,2017 on acute myocardial infarction patients undergoing emergency PCI therapy who were hospitalized in the Department of Cardiology of the First Affiliated Hospital of Soochow University.Patients were stratified according to their left ventricular ejection fraction within 48h after admission into pEF group(LVEF 50%or higher),mrEF group(LVEF 40%-49%)and rEF group(LVEF<40%).The basic information,past history,conditions on admission,laboratory examination and coronary angiography results were extracted,as well as the occurrence of acute heart failure and all-cause death during hospitalization.The comparison of continuous variables was calculated by ANOVA and Post-hoc tests,and the comparison of categorical variables was conducted by Chi-square tests.Kaplan-Meier curves and Log rank tests were used to assess the effects of mrEF,rEF and pEF on the occurrence of acute heart failure and all-cause death during hospitalization.The Cox proportional hazards model was used for multivariate correction of age,gender,hypertension,diabetes,smoking history and number of affected coronary vessels.SPSS 24.0 software was used for all data analyses,and p<0.05 was considered statistically significant.ResultsThis study eventually enrolled 1270 patients undergoing emergency PCI for acute myocardial infarction.Among them,149 patients(11.7%)were in the rEF group,664(52.3%)in the mrEF group,and 457(36.0%)in the pEF group.1.Comparison of clinical features of patients with different EF groups after emergency PCI:Compared with patients with AMI in rEF group,patients with AMI in mrEF group had younger age,higher proportion of male,higher percentage of smokers,higher proportion of previous episodes of angina,higher systolic blood pressure,higher diastolic pressure at admission,lower NT-pro-BNP,lower CK-MB,lower troponin I,lower hs-CRP,lower alanine aminotransferase,lower creatinine,lower lipoprotein(a),higher hemoglobin,lower white blood cell count,lower neutrophils,lower proportion of multivessel disease,lower X-ray exposure,and there were significant statistical differences(p<0.05).There were no significant differences in the history of diabetes and the proportion of anterior wall infarction(p>0.05).Compared with patients with AMI in pEF group,patients with AMI in mrEF group had higher rates of diabetes mellitus,higher proportion of anterior wall myocardial infarction,higher NT-pro-BNP,higher CK-MB,higher troponin I,higher hs-CRP,higher creatinine,higher white blood cell count,higher neutrophils,longer X-ray exposure time,with significant statistical differences(p<0.05),but there were no significant differences in age,sex ratio,smoking history,history of prior episodes of angina,systolic pressure,diastolic pressure at admission,proportion of alanine aminotransferase,lipoprotein(a),hemoglobin,and multi-vessel disease(p>0.05).2.Early prognosis of patients with different EF groups after emergency PCI:Multivariate Cox regression analysis showed that age(HR1.05,95%CI 1.04-1.07,p<0.001),hypertension(HR1.66,95%CI 1.07-2.56,p=0.02)and number of lesions(HR1.88,95%CI 1.54-2.31,p<0.001)were independent risk factors for acute heart failure during hospitalization.Female(HR1.07.95%Cl 1.05-1.09,p<0.001)and number of lesions(HR1.68,95%CI 1.22-2.31,p=0.002)were independent risk factors for all-cause death during hospitalization;Compared with mrEF,rEF was an independent risk factor for acute heart failure events during hospitalization(HR5.01,95%CI 3.53-7.11,p<0.001),and it was also an independent risk factor for all-cause mortality during hospitalization(HR7.05,95%CI 4.12-12.1,p<0.001);Compared with mrEF,pEF was an independent protective factor for acute heart failure during hospitalization(HR 0.49,95%Cl 0.30-0.82,p=0.01).and it was also an independent protective factor for all-cause death during hospitalization(HR0.33,95%CI 0.11-0.96,p=0.04).ConclusionsmrEF patients with acute myocardial infarction undergoing emergency PCI share many similarities with pEF patients in terms of clinical features,but the prognosis is significantly worse than that of pEF patients,suggesting that we need to pay attention to the management of mrEF patients with AMI;There are significant differences in clinical features and prognosis between mrEF patients and rEF patients.In addition,age,hypertension and number of lesions were independent risk factors for acute heart failure events during hospitalization;female and number of lesions were independent risk factors for all-cause death during hospitalization.