Changes Of MiR-26a Before And After Stemi Intervention And Its Correlation With Mace

Objective: In this study,patients with acute ST segment elevation myocardial infarction(STEMI)were selected as the research object to explore the correlation between the change of miR-26 a and major adverse cardiovascular events(MACE).Methods: From January 2017 to January 2020,patients admitted to cardiovascular department of Xiangtan first people’s hospital due to chest pain and diagnosed with acute myocardial infarction for the first time were selected as study group,According to the inclusion criteria: 1.Age≥ 18 years old;2.Ischemic chest pain within 12 hours of attack;3.ECG showed ST segment elevation or necrotic Q wave.Coronary angiography confirmed the presence of culprit disease or coronary artery thrombosis;4.After admission,emergency PCI was performed and reperfusion was successful.The 60 year old people who were willing to participate in this study and had normal physical examination results in the hospital physical examination center were selected as the control group.At the same time:(1)patients with other types of stmei except type I myocardial infarction;(2)Except for acute coronary syndrome(ACS),any disease that causes the increase of cardiac troponin(CTN),including acute myocarditis,pericarditis,cardiomyopathy,aortic dissection and other heart diseases,as well as non heart diseases such as subarachnoid hemorrhage,acute pulmonary embolism,chronic obstructive pulmonary disease(COPD);(3)STEMI patients who refused PCI;(4)Severe liver and kidney diseases;(5)Combined with malignant tumor and infection;(6)Severe thrombocytopenia and recent severe hemorrhagic diseases cannot be treated by interventional therapy.In this study,78 patients in the study group and 49 patients in the control group met the inclusion and exclusion criteria.The miR-26 a values of the study group at the moment of admission were collected.The median value was 0.891 by binary classification method,and then divided into high value group(n = 53)and low value group(n = 25).The changes of serum cTnI level,EF index of echocardiography and the relationship between miR-26 a and MACE during hospitalization were compared between high value group and low value group.Results:1.Except miR-26 a and cTnI,there was no difference in other baseline data between the study group and the control group(P > 0.05).Mi R-26 a was lower than that of the control group(P < 0.05),cTnI was higher than that of the control group(P < 0.05);2.There was no significant difference in infarct related vessels,the number of diseased vessels,syntax score and the time from onset to guide wire passage between the two groups(P > 0.05).No reflow and intraoperative complications in low value group were more than those in high value group(P < 0.05).PTCA,IABP and temporary pacemaker implantation in low value group were more than those in high value group(P < 0.05),while stent implantation in high value group was more than that in low value group(P < 0.05);3.The EF values of echocardiography in low value group and high value group were normal one day after operation,and there was no difference(P > 0.05),but the level of miR-26 a in low value group decreased significantly(P < 0.05),while the level of miR-26 a in high value group recovered gradually,only slightly decreased.There was significant difference between the two groups(P < 0.05).On the 6th day after operation,miR-26 a in low value group increased gradually,but it was still lower than that before operation(P < 0.05).There was no difference between the high value group and the control group(P >0.05).4.The AUC of miR-26 a,cTnI and EF were 0.878,0.840 and 0.785,respectively,P < 0.05.The lower the miR-26 a value,the more MACE events.5.Logistic regression analysis showed that EF < 50%,no reflow and decreased miR-26 a level were independent risk factors for MACE,while age > 65 years and troponin > 0.5 were not independent risk factors for MACE.The risk of MACE was increased when miR-26 a was lower than 0.891(or = 7.07,higher than EF = 6.393).Conclusion:1.The serum miR-26 a level of STEMI patients decreased after admission;And the low value group is more obvious.The expression of miR-26 a is down regulated before cardiac insufficiency in patients with myocardial infarction,which may predict clinical cardiac insufficiency or left ventricular remodeling.2.Serum miR-26 a level is an independent risk factor for MACE in STEMI patients during perioperative period.Early miR-26 a level is in low value group,short-term prognosis is poor,and MACE events are more likely to occur.