| Objective:To investigate the factors related to cardiac function outcome in patients with heart failure within 24 hours after acute myocardial infarction and one month after myocardial infarction.Methods:A total of 267 patients with acute ST-elevation myocardial infarction(STEMI)admitted to China-Japan Union Hospital of Jilin University for emergency coronary intervention treatment with percutaneous coronary intervention(PCI)from June 2015 to April 2017 were collected.Age,sex,body Mass Index(BMI),past history(hypertension,diabetes,old myocardial infarction,stroke history),smoking history and ischemia associated arrhythmia within 24 hours,DtoB time,coronary arteriography(number of coronary artery lesion branches and infarct related vessels),laboratory parameters(leukocyte count,neutrophil ratio,hemoglobin,admission blood glucose,creatinine),cardiac troponin,total cholesterol,low density lipoprotein cholesterol,high density lipoprotein cholesterol,triglyceride),the use of ?-blocker ACEI / ARB,lipid-lowering drug and tirofiban in 24 hours after PCI were retrospectively analyzed at 24 and 1 month after PCI.In the first part,267 patients with STEMI were divided into two groups according to the left ventricular ejection fraction(LVEF)of heart failure group and non-heart failure group.The data of two groups were analyzed by univariate analysis,and the factors that might affect the occurrence of heart failure after STEMI operation were screened out.Then the related risk factors of p < 0.05 were included in multivariate logistic regression analysis to further explore the independent risk factors of heartfailure after PCI in patients with STEMI.In the second part,the subgroup analysis of heart failure group was carried out.According to the LVEF value after short-term follow-up,the patients in the heart failure group were divided into two groups: the still existing heart failure group(LVEF ? 50)and the non-heart failure group(n = 50).The data of the two groups were analyzed by single factor analysis.The factors that may influence the occurrence of heart failure after STEMI were screened out,and then the risk factors of heart failure were analyzed by multivariate logistic regression analysis,and the independent risk factors affecting the short-term recovery of heart function after myocardial infarction were further explored.Reasults:(I)Comparison between heart failure group and non-heart failure group within 24 hours in STEMI patients after PCI1.Comparison of baseline data,Heart failure group had higher obesity rate than non-HF group.There was statistical difference between the two groups(P<0.05);Gender,age,history of hypertension,history of diabetes,history of myocardial infarction,history of stroke were not significantly different(p > 0.05).2.Compared with hospital admission examinations,the cardiac troponin value in patients with heart failure was higher [0.67(0.08,23.25)] than that in the non-heart failure group [0.24(0.04,3.32)].Difference(P<0.05),The proportion of leukocyte,neutrophil,random blood glucose,creatinine and blood lipid were not significantly different(p > 0.05).3.Analysis of coronary artery disease,26 patients with multi-vessel coronary artery disease in heart failure group,29 patients in non-heart failure group,the number of patients with infarction related vessels,51 patients in heart failure group and 82 patients in non-heart failure group,there was statistical difference between the two groups(p < 0.05).4.Compared with the time of blood vessel opening and ischemia-related arrhythmia,the time of DtoB in heart failure group(83.67±37.73)was longer than that in non-heart failure group(69.84±27.76),suggesting that the earlier the blood vessels were opened,the less likely it was that heart failure occurred.P=0.001;The incidence of arrhythmia in heart failure group(25.6%)was also higher than that in non-heart failure group(13.8%),P=0.0345.For the above P<0.05 related factors: obesity,number of lesions,anterior descending coronary artery disease,Dto B time,cardiac troponin I,arrhythmia for multivariate logistic regression analysis.Shows: STEMI patients with anterior descending coronary artery disease,multivessel disease,and long DtoB time have a higher probability of heart failure(P<0.05).At the same time,higher troponin levels at admission were also an independent predictor of HF in STEMI patients(P=0.011).(II)78 patients with heart failure after myocardial infarction were grouped by left ventricular ejection fraction at 1 month.There were still 27 patients(34.6%)with heart failure(LVEF ? 50%)and non-heart failure patients(LVEF >50%).51 patients(65.4%).1.There was no significant difference between the baseline data of the two groups and the results of laboratory examination(p > 0.05).2.The results of coronary angiography were analyzed in 16 patients(59.3%)with multivessel coronary artery disease in heart failure group,10patients(19.6%)in non-heart failure group,the number of patients with infarction-related vessels in the anterior descending coronary artery,and 22 patients with heart failure(81.5%),non-heart failure group in 29 cases(56.9%),there was a statistical difference between the two groups(P<0.05)3.The DtoB time of heart failure group(97.96 ±40.03)was longer than that of non-heart failure group(74.02 ± 30.84).There was no significant difference in the incidence of arrhythmia(P < 0.05).4.Finally,a multivariate logistic regression analysis of the above-mentioned P<0.05 related factors: the number of lesions and theanterior descending coronary lesions showed that single-vessel disease was an independent predictor of short-term cardiac function recovery in patients with heart failure after MI.(P=0.036)Conclusion:1.cardiac troponin I elevation is an independent risk factor for short-term cardiac dysfunction in patients with acute myocardial infarction;2.Multi-vessel disease and anterior descending artery disease are more prone to heart failure;3.Patients longer DtoB time can increase the risk of heart failure patients;4.Single vessel disease in patients with acute heart failure after acute myocardial infarction cardiac function predictors of short-term recovery. |
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