Analysis of predictive factors of intestinal obstruction in acute myocardial infraction patients afterprimary percutaneous coronary intervention / 中华急诊医学杂志

ABSTRACT

Objective to determine predictive factors of intestinal obstruction in acute myocardial infraction (AMI) patients after primary percutaneous coronary intervention (PCI) and to establish predictive model.Methods A total of 1220 AMI patients underwent primary PCI in Jiangxi provincial people's hospitalfrom June2004 toJune 2014were retrospectively analyzed.And 1025 cases of them whichall met the inclusion and exclusion criteriawere randomlydivided by using random number generated by SPSS 17.0 into two cohorts:model derivation cohort (MDC) and model validation cohort (MVC).MDC was divided into intestinal obstruction group and control group.predictive factors were identified using univariable andmultivariable logistic regression analysis in MDC.Interger point values were assigned to each predictor based upon their coefficient in multivariable logistic regression model to establish scoring model.The summed scores of each case in MVC were calculated to test predictive ability of the model by ROC cure.Results Total of 1 025 patients,103 patients were diagnosed with different types of intestinal obstruction and the incidence of intestinal obstruction was 10.0％.Low position intestinal obstruction,incomplete intestinal obstruction and simple intestinal obstructionwere main characteristics in these patients.logistic regression analysis identified ten risk factorscan predict the appearance of intestinal obstruction:age ＞ 65years old (OR =1.44,95％ CI:1.26-4.63,P =0.000),diabetes mellitus (OR =3.37,95％ CI:2.39-9.47,P =0.000),habitual constipation (OR =4.75,95 ％ CI:3.58-11.24,P =0.024),inferior and extensive anterior wall myocardial infarction (OR =2.16,95％ CI:1.94-4.79,P =0.017),cardiac functiongrade≥3 class (Killip classification) (OR=2.86,95％CI:1.98-5.67,P=0.002),femoral approach (OR=2.76,95％CI:1.38-6.12,P=0.002),K+ ＜3.5 mmol/L (OR=1.86,95％CI:1.11-5.47,P =0.005),taking laxative (OR =3.59,95％ CI:2.99-10.21,P =0.000),using morphine (OR =1.98,95％ CI:1.07-3.12,P =0.021) and estimated glomerular filtration rate (eGFR) ＜60 mL · min-1 · 1.73m-2 (OR =1.19,95％ CI:1.10-3.22,P =0.031).and areas under the ROC cure was 0.815 (95％ CI:0.802-0.883,P =0.000) and indicating the accuracy of predicting intestinal obstruction.Conclusions age ＞ 65 years old,diabetes mellitus,habitual constipation,inferior and extensive anterior parts of myocardial infarction,cardiac functiongrade ≥3class (Killip classification),femoral approach,K + ＜3.5mmol/L,taking laxative,using morphine and eGFR ＜ 60 ml.min-1.1.73m2 were important predictive factors for intestinal obstruction in AMI patients after underwent 0 and the scoring model can predict accurately intestinal obstruction in such patients.