Clinical Study Of H₂FPEF Score And Out-of-hospital Occurrence Of MACE After Pci In Patients With Acute STEMI

Object:To assess whether the H₂FPEF score[obesity（H）,hypertension（H）,atrial fibrillation（F）,pulmonary hypertension（P）,age>60 years（E）,E/e’>9（F）]can predict the occurrence of out-of-hospital major adverse cardiac events（MACE）after percutaneous coronary intervention（PCI）in patients with acute ST-segment elevation myocardial infarction and to screen for other independent risk factors affecting the occurrence of MACE in such patients as well.Methods:Two hundred and thirty-nine inpatients diagnosed with acute ST-segment elevation myocardial infarction with concomitant emergency PCI at the Cardiovascular Medicine Department of the Affiliated Hospital of Yan’an University from June 2019 to December 2020 were selected for the study.The clinical data of all study subjects were collected:（1）General data:including age,sex,height,weight,and information on history of smoking,hypertension,diabetes,atrial fibrillation,cerebrovascular disease and chronic lung disease.Record the heart rate,systolic blood pressure,diastolic blood pressure and medication use at the time of admission.（2）Laboratory data:record leukocytes,hemoglobin,erythrocyte ratio,platelets,D-dimer,UA,Na⁺,K⁺,creatinine,troponin,creatine kinase isoenzyme,NT-pro BNP,albumin,ALT,AST,direct bilirubin,indirect bilirubin,TC,TG,LDL-C,HDL-C.（3）Cardiac ultrasound data:include ejection fraction（3）Cardiac ultrasound data:including ejection fraction,left atrial internal diameter,left ventricular end-systolic internal diameter,left ventricular end-diastolic internal diameter,tricuspid regurgitant flow velocity,mitral early diastolic motion velocity（E peak）,peak mitral orifice ventricular late diastolic flow velocity（A peak）,tissue Doppler early diastolic motion velocity（e’）,calculation of E/A,E/e’and pulmonary artery systolic pressure.（4）Coronary angiographic data:collect offender vessels,whether multiple coronary lesions and the number of stents implanted.（5）Electrocardiogram:Standard 12-or 18-lead electrocardiogram was performed upon admission,and ambulatory electrocardiogram was completed during hospitalization.The H₂FPEF score was calculated from the clinical data and divided into 3 groups according to this score:low group（0-1）,medium group（2-5）,and high group（6-9）.All study subjects were followed up until December 31st,2022 and the specific cause and specific time of MACE,defined as a composite cardiovascular or cerebrovascular event during the follow-up time,including sudden cardiac death,recurrent myocardial infarction,hospitalization for heart failure failure,cerebrovascular accident,and other causes（including malignant arrhythmias and natural death）,were recorded.Patients who were lost during the follow-up period and who did not have MACE as of the date were defined as censored cases.Statistical analysis was performed using SPSS22.0 statistical software.Kaplan-Meier survival curves were produced,and COX regression analysis was performed to analyze the factors affecting the occurrence of MACE after PCI in patients with acute STEMI.Results:1.Analysis of general data:age and systolic blood pressure were greater in the medium and high subgroups than in the low subgroup（p<0.001）.In terms of gender composition,the differences between the medium subgroup and the low and high subgroups were statistically significant（p<0.001）.BMI was greater in the high subgroup than in the low and medium subgroups（p=0.002）.The incidence of hypertension and diabetes was significantly lower in the low subgroup than in the medium and high subgroups,while the incidence of atrial fibrillation was significantly higher in the high subgroup than in the low and high subgroups.There was no statistical difference between the three groups in terms of history of cerebrovascular disease,history of chronic lung disease,smoking history,admission heart rate,diastolic blood pressure,and medication use（p>0.05）.2.Analysis of laboratory data:WBC was greater in the low group and high group than in the medium group,and there was no statistically significant difference when comparing the two groups（p>0.05）.The HCT of the high subgroup was lower than that of the low and medium subgroups,but there was no statistically significant difference between the low and medium subgroups.Platelets and D-dimer were higher in the high subgroup than in the low and medium subgroups.LDL-C in the low subgroup was smaller than that in the medium and high subgroups,and HDL-C in the high subgroup was smaller than that in the other two groups.Na⁺and e GFR in the middle and high groups were lower than those in the low group.There was an overall difference in NT-pro BNP between the three groups,and the difference between the two groups was statistically significant after multiple comparisons（p<0.05）.There was no statistical difference in hemoglobin,albumin,direct bilirubin,indirect bilirubin,TG,TC,c Tn I,CK-MB,K⁺,and UA among the three groups（p>0.05）.3.Analysis of angiographic data:There was no statistical difference between the three groups in terms of offender vessels overall（p>0.05）,and the low and medium groups were smaller than the 6-9 groups in terms of the number of stents and the incidence of multiple coronary lesions（p<0.001）.4.Analysis of cardiac ultrasound data:E/e’and pulmonary artery systolic pressure were greater in the medium and high subgroups than in the low subgroup.The E peak and E/A were greater in the low subgroup than in the medium and high subgroups.There was an overall difference in left atrial internal diameter and a statistically significant difference between the two after multiple comparisons（p<0.05）.There were no statistically significant differences between the three groups in LVEF,LV end-systolic internal diameter,and LV end-diastolic internal diameter（all p>0.05）.5.The distribution and incidence of MACE were compared:7 cases occurred in the low group,29 cases in the middle group and 35 cases in the high group,and there was no statistical difference in the distribution of MACE among the three groups by chi-square analysis（p>0.05）.There was an overall difference in the incidence of hospitalization for heart failure,cerebrovascular accident and recurrent myocardial infarction among the three groups,with the high group>the medium group>the low group;among them,there was a statistically significant difference between the two comparisons of hospitalization for heart failure（p<0.05）.6.Survival rate:Analysis of three groups of patients with different score subgroups using Kaplan-Meier survival curves showed that the cumulative incidence of MACE was significantly higher in the high subgroup（score 6-9）than in the medium subgroup（score2-5）and low subgroup（score 0-1）（Log-Rank=142.428,P<0.001）.7.The results of multifactorial COX regression analysis showed that H2FPEF score（HR=1.810,95%CI=1.217,2.693;P=0.003）,LDL-C（HR=1.730,95%CI=1.244,2.406;P=0.001）,D-dimer（HR=1.282,95%CI=1.050.1.565;P=0.015）,and multiple coronary lesions（HR=4.682,95%CI=2.365,9.270;P<0.001）were independent predictors of the occurrence of MACE after PCI in patients with acute STEMI.Conclusions:1.The cumulative incidence of MACE was significantly higher in the high group（6-9 points）than in the medium group（2-5 points）and low group（0-1 points）.2.H₂FPEF score,D-dimer,LDL-C and multiple coronary lesions were independent predictors of the occurrence of MACE after PCI in patients with acute STEMI.H₂FPEF score can be used as an evaluation index to predict the occurrence of MACE after PCI in patients with acute STEMI.