Analysis of risk factors for occurrence of ventricular fibrillation in patients with acute inferior myocardial infarction undergoing emergency percutaneous coronary intervention / 中国中西医结合急救杂志

ABSTRACT

Objective To investigate the preoperative risk factors of occurrence of intra-operative ventricular fibrillation (VF) in patients with acute inferior myocardial infarction undergoing emergency percutaneous coronary intervention(PCI). Methods A retrospective approach was conducted, 572 patients with acute inferior myocardial infarction admitted to Cangzhou City People's Hospital from May 2016 to May 2018 were enrolled, and they were divided into VF group (50 cases) and non-VF group (520 cases) according to whether the intra-operative complication of VF occurred. The clinical data of the two groups of patients were collected, and the related risk factors were analyzed by univariate and multivariate analyses to explore the preoperative risk factors related to VF intra-operative occurrence in patients with acute inferior myocardial infarction undergoing emergency PCI; the receiver operating characteristic (ROC) curve was drawn to evaluate the test efficiencies of all kinds of risk factors. Results The univariate analysis showed that the ratio of Killip > Ⅰ grade, infarct area size/blood potassium concentration (IS/[K]) and symptom onset to balloon dilatation time (SOTBT) in the VF group were significantly higher than those in the non-VF group [Killip > Ⅰ grade36.5% (19/52) vs. 24.0% (125/520), IS/[K] 3.2±0.3 vs. 2.5±0.8, SOTBT (hours) 6.3 (2.1, 8.0) vs. 4.6 (1.8, 6.5)], the differences were statistically significant (all P < 0.05); the T wave peak to T end interval/QT interval (Tp-e/QT) and blood potassium level of the VF group were significantly lower than those of the non-VF group [Tp-e/QT 0.3±0.1 vs. 0.4±0.1; blood potassium (mmol/L) 2.8±0.5 vs. 4.1±1.2, both P < 0.05]. Multivariate logistic regression analysis showed that the SOTBT > 6 hours [odds ratio (OR) = 8.337], Killip >Ⅰ grade (OR = 1.721), hypokalemia (OR = 1.031) and high IS/[K] (OR = 9.167) were independent risk factors for intra-operative occurrence of VF in patients with acute inferior myocardial infarction during emergency PCI (all P < 0.05). ROC curve analysis showed that the area under the ROC curve (AUC) of serum potassium, IS/[K], SOTBT > 6 hours and Killip > Ⅰ grade for predicting the intra-operative occurrence of VF during emergency PCI for patients with acute inferior myocardial infarction had certain values, their AUC were 0.633, 0.837, 0.821, 0.682, respectively, suggesting that IS/[K] and SOTBT > 6 hours had moderate predictive values, and serum potassium, Killip > Ⅰ grade had relatively low predicative values; when the optimal cut-off value of IS/[K] was 2.8, the sensitivity was 85.5% and the specificity was 80.0%. Conclusion SOTBT > 6 hours, Killip > Ⅰ grade, hypokalemia, and high IS/[K] are independent risk factors of intra-operative occurrence of VF in patients with acute inferior myocardial infarction undergoing emergency PCI.