The Outcomes Of Acute Myocardial Infarction Patients Comorbiding With Hypertention And Hyperhomocysteinemia

Objective : Hypertension(HBP)and hyperhomocysteinemia(HHcy)were common risk factors for cardio-cerebrovascular diseases,and had a significant synergistic effect on the incidence of coronary heart disease,stroke and other diseases.However,the outcomes of acute myocardial infarction(AMI)patients comorbiding with HBP and HHcy were unclear.The purpose of this study was to investigate the relationship between HBP、HHcy and the severity and prognosis of AMI.Methods: A total of 648 Patients suffering from AMI diagnosed in our hospital from September 1,2013 to August 31,2016 were enrolled for the study.These patients underwent process of PCI emergency or during the hospital,and their inpatient medical records and postoperative follow-up data were complete.All patients were divided into 4 groups according to the presence or absence of HBP,as well as the serum Hcy levels:(1)HBP with Hcy ≥ 15 umol/L(HBP+HHcy:n=202);(2)HBP With Hcy <15 umol/L(HBP+No-HHcy:n=155);(3)Hcy≥15 umol/L with no HBP(No-HBP+HHcy:n=153),(4)Hcy<15Umol/L with no HBP(No-HBP+No-HHcy:n=136).All patients general data,ECG and echocardiographic,coronary angiography,hospitalization and major adverse cardiovascular events during 1 year of follow-up were analyzed.All analyses were conducted using the statistical software SPSS statistics 21,and bilateral P < 0.05 was considered to be statistically significant.Results : 1)The baseline clinical characteristics show that patients of HBP+HHcy group had higher NT-ProBNP,Cr,UA,and lower LVEF levels(P<0.05);There were no significant differences between the four groups in anti-platelet and lipid-lowering treatments.Compared with the non-HBP group,the β-blockers and ACEI/ARB drugs in the HBP group were used more.2)Coronary angiography : There was no significant difference in culprit coronary lesions vascular localization between the four groups;when compared with the No-HBP+No-HHcy group,We found that AMI comorbiding with HBP andHHcy patients had more severe multi-coronary artery disease,more frequent non-culprit coronary lesions complete clogging,and a more frequent use in intra-aortic balloon pump(IABP)(P<0.05).3)During hospitalization and 1-year follow-up,when compared with other three groups,These patients of HBP+HHcy group had a higher incidence of hospitalization and follow-up MACEs(P<0.05),and a significant increases in the duration of CCU stay and in-hospital stay(P<0.05).when compared with the No-HBP+No-HHcy group,the HBP+HHcy group had a higher cardiovascular mortality(P<0.05).4)Kaplan Meier analysis of cumulative survival at 1-year follow-up demonstrated that the significant survival down-regulated in HBP comorbiding with HHcy group comparing with other three groups.The results of Cox proportional hazard model adjusting for other potential predictors of the follow-up MACEs are shown that after adjusting for many covariates,age ≥ 65 years(HR=2.054,95%CI=1.023-3.084,P=0.019),diabetes mellitus(HR=0.898,95%CI=0.439-2.023,P=0.022),low LVEF(HR=1.254 95%CI=1.003-3.360,P=0.013),and multi-vessel disease(HR=1.721 95%CI=1.468-2.054,P=0.001)were independent predictors of1-year MACEs.Also,AMI patients with HBP or HHcy alone,especially AMI patients comorbiding with HBP and HHcy,significantly increased the risk of MACEs at 1-year follow-up in AMI patients,but not an independent risk factor.Conclusions:We found that when compared with HBP or HHcy alone,AMI patients with HBP and HHcy had more severe coronary artery lesions,worse cardiac function,and higher incidence of hospitalization and follow-up MACEs.