Analysis Of The Risk Factors In Patients With Left Ventricular Aneurysm Post Acute St-segment Elevation Myocardial Infarction

ObjectiveTo investigate the risk factors of acute ST segment elevation myocardial infarction(ST-segment elevation myocardial infarction,STEMI)complicated with left ventricular aneurysm(Left ventricular aneurysm,LVA).MethodsThere were 240 patients with STEMI who underwent primary Percutaneous Coronary Intervention(p PCI)treatment in our hospital from January 2017 to June 2018.According to the results of emergency echocardiography,the patients with were divided into LVA group(n = 32)and non-LVA group(n = 208).Using the Graphpad Prism5,SPSS 22.0 statistical software to analysis the result of the age,sex,hypertension,hyperlipidemia,diabetes,smoking history,drinking history,number of diseased vessels,infarct site of culprit vessels,collateral circulation,preoperative TIMI(Thrombolysis In Myocardial Infarction)blood flow and postoperative TIMI blood flow grading,previous myocardial infarction,history of PCI treatment,history of angina pectoris,total ischemic time(Total ischemic time,TIT)(h),Killip cardiac function classification,heart rate,systolic blood pressure,diastolic blood pressure at admission and perioperative adverse events,and the white blood cell count,neutrophil count,platelet count,serum potassium,serum sodium,creatine kinase isoenzyme(CKMB)which were recorded at the admission,and the number of ST segment elevation leads,the total amplitude of ST segment elevation,the highest lead of ST segment elevation,pathological Q wave,Left ventricular ejection fraction(LVEF)and left ventricular end-diastolic diameter(LVEDD)were recorded by bedside echocardiography on admission to emergency.Establishing a Logistic regression model to retrospectively analyze the risk factors of LVA formation.Results?.Univariate analysis1.Analysis of clinical features.The constituent ratio of previous angina pectoris in LVA group was 15.63%,which was significantly lower than that in non-LVA group(51.92%)(?2=14.67,P=0.002).At the same time,compared with non-LVA group,sex(female),total ischemic time,Killip grade(?II grade),CK-MB value,blood sodium,ECG indexes: the total amplitude of ST segment elevation,the proportion of V2/V3 ST segment elevation to the highest lead,the incidence of ST segment elevation in ?4 adjacent leads,and the presence or absence of pathological Q wave were statistically significant(P<0.05).However,there was no significant difference between the two groups in age,hypertension,diabetes,hyperlipidemia,smoking,drinking,previous history of myocardial infarction,previous history of PCI,systolic and diastolic blood pressure at admission,numeration of leukocyte,neutrophil count,platelet count,serum potassium,creatinine and the incidence of perioperative adverse events(P>0.05).2.Grading analysis of total ischemic time.The TIT of the two groups was compared according to<6h,6h-12 h,>12h.The linear trend ?2 test showed that there was significant difference among the three groups(?2 =12.40,P=0.000),that is to say,with the prolongation of the total ischemia time,The incidence of LVA increased gradually.3.Analysis of DSA image data.Compared with the non-LVA group,In LVA group,myocardial infarction site(anterior wall),infarct site of culprit vessels(proximal segment),TIMI blood flow grade before p PCI(grade 0)and TIMI blood flow grade after p PCI(?2 grade)were statistically significant(P<0.05).However,there was no significant difference in the presence of collateral circulation and multi-vessel disease between the two groups(P>0.05).4.Echocardiography data analysis.The results of emergency echocardiography at admission showed that there were significant differences in left ventricular ejection fraction(LVEF)and left ventricular end-diastolic diameter(LVEDD)between the two groups(P<0.05);p PCI within 2 weeks after treatment,LVA was single,and all of them were located at the apex of left ventricle.Intracardiac thrombus was found in some patients(5 cases,15.6%).?.Multivariate analysisTotal ischemic time,ST segment elevation ? 4 adjacent leads,TIMI blood flow ?2 grade after p PCI and Killip grade ?II grade were independent risk factors for LVA.The ratio(Odds Ratio,OR)respectively was 1.272(95% CI=1.131-1.430,P=0.000),11.568(95% CI=3.827-34.964,P=0.000),1.954(95% CI=1.238-19.823,P=0.024),8.045(95% CI=2.848-22.719,P=0.000);Previous angina pectoris was a protective factor for LVA,OR was 0.100(95% CI=0.026-0.386,P=0.001).ConclusionsThe formation of LVA is related to many factors.Clinicians should evaluate the risk of LVA in time.Timely p PCI treatment and achieve postoperative TIMI 3 grade may of great significance to prevent the occurrence of LVA.