氨基末端脑钠肽前体联合CAMI-STEMI评分对急性心肌梗死患者PCI治疗后预后的评估

Prognosis evaluation in patients with acute myocardial infarction after percutaneous coronary intervention by N-terminal pro-brain natriuretic peptide combined with CAMI-STEMI score

目的探讨氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)联合中国心肌梗死注册登记研究-ST段抬高型心肌梗死(China Acute Myocardial Infarction for ST-segment elevation myocardial infarction,CAMI-STEMI)评分对急性心肌梗死(acute myocardial infarction,AMI)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后预后的评估价值。方法选取宝鸡市中医医院2016年4月至2018年4月收治的AMI患者130例作为研究对象(AMI组),另选取同期体检健康者135名作为对照组,比较两组NT-proBNP浓度与CAMI-STEMI评分。采用回顾性分析法分析患者的临床资料,根据疾病预后情况将患者分为主要不良心血管事件(major adverse cardiovascular event,MACE)组46例和无MACE组84例,比较两组NT-proBNP浓度与CAMI-STEMI评分。采用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析NT-proBNP浓度与CAMI-STEMI评分对AMI患者预后的预测价值。结果(1)AMI组患者NT-proBNP浓度、CAMI-STEMI评分均高于对照组,差异有统计学意义(P<0.05)。(2)对AMI患者随访6个月后,有46例发生MACE,84例未发生MACE;MACE组患者NT-proBNP浓度、CAMI-STEMI评分均高于无MACE组,差异有统计学意义(P<0.05)。(3)经ROC分析,NT-proBNP浓度预测MACE的最佳界值为741μg/L,灵敏度为91.12%,特异度是73.57%;CAMI-STEMI评分预测MACE的最佳界值为4分,灵敏度为90.02%,特异度是72.23%。(4)NT-proBNP浓度、CAMI-STEMI评分在MACE患者的鉴别能力及预后预测能力方面比较,差异无统计学意义(P>0.05)。结论NT-proBNP浓度联合CAMI-STEMI评分对AMI患者PCI治疗后住院期间及随访期6个月的MACE发生率有较高的预测价值,值得临床推广应用。

Objectives To investigate the prognostic value of N-terminal pro-brain natriuretic peptide(NT-proBNP)combined with China Acute Myocardial Infarction for ST-segment elevation myocardial infarction(CAMI-STEMI)score in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods Totally 130 patients with AMI(AMI group)and 135 cases of healthy individuals(control group)treated in Baoji Traditional Chinese Medicine Hospital from April 2016 to April 2018 were selected.The clinical data were analyzed retrospectively.Concentrations of NT-proBNP and CAMI-STEMI score were compared between AMI group and control group.According to the prognosis,the patients were divided into major adverse cardiovascular event(MACE)group(n=46)and non-MACE group(n=84).Concentrations of NT-proBNP and CAMI-STEMI score were compared between MACE group and non-MACE group.Then the prognostic value of NT-proBNP and CAMI-STEMI scores in patients with AMI was analyzed by receiver operating characteristic curve(ROC).Results(1)The concentration of NT-proBNP and CAMI-STEMI score in AMI group were significantly higher than those in control group(P<0.05).(2)After 6 months follow-up,among the AMI patients,there were 46 cases with MACE and 84 cases without MACE.Concentrations of NT-proBNP and CAMI-STEMI score in MACE group were significantly higher than those in nonMACE group(P<0.05).(3)ROC analysis showed that the optimal cut-off value,sensitivity and specificity were 741 ug/L,91.12%and 73.57%for NT-proBNP in predicting MACE,and were 4 points,90.02%and 72.23%for CAMI-STEMI score in predicting MACE.(4)The prognostic and identification value of NT-proBNP and CAMI-STEMI scores for AMI patients had no difference(P>0.05).Conclusions Concentrations of NT-proBNP combined with CAMI-STEMI score has a high predictive value for the incidence of MACE during hospitalization and follow-up after PCI in patients with AMI,which is worthy of clinical application.