| Part ?:The efficacy and prognosis of intra-aortic balloon counterpulsation in the treatment of patients with acute myocardial infarction complicated with pump failureObjective:This study retrospectively analyzed intra-aortic balloon counterpulsation(IABP)in the treatment of acute myocardial infarction(AMI)patients with pump failure in-hospital and follow-up data,in order to analyze its efficacy and prognosisMethods:A retrospective study of 352 patients with AMI combined with pump failure in the Cardiovascular Department of the 920rd Hospital of the People's Liberation Army Joint Logistics Support Force from January 1,2013 to December 31,2017.On the basis of standard medical treatment,IABP group(132 cases)and non-LABP group(120 cases)were divided according to whether IABP was applied or not.The baseline data,coronary angiography results,heart rate,blood pressure,BNP,and cardiac fimction indexes were recorded and analyzed.The incidence of death' and major adverse cardiovascular and cerebrovascular events(MACCE,Includes complex events consisting of death,cardiogenic shock,new or aggravated heart failure,recurrent myocardial infarction,and stroke)were follow-up period of 30 days and 1 year after discharge.Statistical analysis was performed.Results:1.There was no difference in heart rate,systolic blood pressure and diastolic blood pressure between the two groups before IABP treatment(P all were>0.05).After IABP treatment,the heart rate of IABP group was significantly slower than that of non-IABP group,and systolic blood pressure and diastolic blood pressure were significantly increased(P<0.05);There was no difference in BNP between the two groups for the first time and before treatment with IABP(P all were>0.05).After 7 days of treatment,the BNP value of IABP group was lower than that of non-IABP group(P<0.05).There was no diference in LVEF,LVESV and LVEDV between the two groups(P all were>0.05).After 30 days,LVEF in IABP group was higher than that in non-IABP group(P<0.05).2.The success rate of IABP group rescue(90.91%vs 80.83%,P=0.021)was higher than that of non-IABP group.In-hospital mortality(22.16%vs 9.09%,P=0.021)and 30-day mortality(25.83%vs 15.15%,P=0.035)were higher in the non-IABP group than in the IABP group.There was no significant difference in mortality and MACCE between the two groups at 1 year after discharge.(P>0.05).Conclusion:1.IABP adjuvant therapy ean improve hemodynamic disorders in patients with AMI complicated with pump failure,stabilize vital signs,reduce BNP values,and improve cardiac function.2.IABP can reduce the in-hospital and 30-day mortality of patients with AMI combined with pump failure,improve the success rate of rescue,and benefit from prognosis.Part ?:Characteristics of patients with acute myocardial infarction assisted by intra-aortic balloon counterpulsation,analysis of factors affecting prognosis Objective:This study retrospectively analyzed intra-aortic balloon counterpulsation(IABP)in the treatment of acute myocardial infarction(AMI)patients with in-hospital and follow-up data,in order to analyze its characteristics and influence the prognosis of patients with AMI Predictors,to determine the impact of IABP on the prognosis of patients with AMI.Methods:A retrospective study of 352 patients with AMI who met the inclusion criteria in the Cardiovascular Department of the 920rd Hospital of the People's Liberation Army Joint Logistics Support Force from January 1,2015 to December 31,2017.177 patients with AMI treated with IABP were in the IABP group.According to the time and in-hospital treatment conditions,175 patients with AMI who were not treated with IABP were selected as the non-IABP group.Baseline data major treatment time distribution,examination data,coronary lesions,treatment and complications were recorded and analyzed during hospitalization,and death and MACCE were followed up regularly.Statistical analysis of all relevant data.Results:1.Age,prevalence of previous illness(diabetes,hyperuricemia,cerebrovascular disease),the length of hospital stay,heart rate at admission,KilliP ?-? grade,Grace score at admission,and Gensini score were higher in the IABP group than in the non-IABP group(P all were<0.05).The systolic blood pressure and diastolic blood pressure at admission were lower than that in the non-IABP group(P all were<0.01);2.The time of S-to-FMC,S-to-B and D-to-B in IAJ3P group was higher than that in non-IABP group.(P all were<0.05)3.The CK,CK-MB,troponin I,24-hour CK peak,CK-MB peak and troponin I peak were higher in the IABP group than in the non-IABP group(P all were<0.01).LVEF in IABP group was lower than that in non-IABP group(P<0.05).The first BNP value was higher than the non-IABP group,but the difference was not statistically significant(P=0.051).4.The incidence of anterior descending occlusion,extensive anterior myocardial infarction,and left main lesion in the IABP group was higher than that in the non-IABP group(P all were<0.01).5.The incidence of heart failure,cardiogenic shock and malignant arrhythmia in the IABP group were higher than those in the non-IABP group(P all were<0.05).The distribution of malignant arrhythmia was different in the two groups(P<0.01).The incidence of sinus arrest in the IABP group was higher than that in the non-IABP group(P<0.05).The incidence of ?°AVB in the IABP group was lower than that in the non-IABP group(P<0.05).6.The IABP use time is significantly positively correlated with the hospital stay,and a linear regression equation can be established(R2=0.36,P=0.000).7.The mortality and MACCE incidence in the IABP group,30 days,and 1 year follow-up were higher than those in the non-IABP group(P all were<0.01).The survival curve of the IABP group after 3 years of follow-up was lower than that of the non-IABP group(P=0.017).However,after the propensity score matched the baseline data,the difference was not statistically significant.8.Predictors that influence the prognosis of patients with AMI:(1)Logistic regression showed that LVEF(OR=2.3,95%CI,1.36-3.85,P=0.002)was an independent predictor of death after 30 days of follow-up.The ejection fraction decreased was an indicator for predicting 30-day follow-up,with a sensitivity of 74.4%and a specificity of 71.7%(AUC:0.73±0.05,95%Cl,0.64-0.82,P=0.000).(2)Cox proportional hazard regression model analysis showed:age(RR=1.05,95%CI,1.01-1.09,P=0.029)and hospitalization time(RR=1.10,95%CI,1.02-1.78,P=0.019)were predictors of cumulative death after 3 years of follow-up.age>65 years was the index of cumulative death after 3 years of follow-up,with a sensitivity of 68.4%The specificity was 61.6%(AUC:0.65±0.07,95%CI,0.51-0.79,P=0.044);hospitalization time>14 days was the index of cumulative death after 3 years of follow-up,with a sensitivity of 52.6%.The specificity was 76.7%(AUC:0.65±0.07,95%Cl,0.50-0.79,P=0.044).Conclusion:1.AMI patients with adjuvant IABP combined with more clinical rhigh-risk factors:old age,cardiovascular risk factors,obviously pre-hospital delay,long ischemic time,severe coronary lesions,large infarct size,poor cardiac function,complicated complications,extensive anterior myocardial infarction caused by anterior descending occlusion,combined with incidence of left main disease high.2.LVEF was an independent predictor of 30-day follow-up of AMI patients and age and length of stay were predictors of cumulative death at 3 years of follow-up. |
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