术前LVEDP、CK-MB及UA水平对STEMI患者经皮冠状动脉介入术后死亡的预测价值

Preoperative LVEDP,CK-MB,and UA levels in predicting the mortality of STEMI patients after percutaneous coronary intervention

目的:探究左心室舒张末期压力(LVEDP)、肌酸激酶同工酶(CK-MB)及尿酸(UA)水平对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)后死亡的预测价值。方法:连续性入选2017年2月—2019年3月在我院行PCI的STEMI患者,按照术后1年内生存状况分为死亡组(24例)和存活组(98例)。比较两组患者临床特点、生化指标、冠状动脉病变程度、心功能情况、Gensini积分以及LVEDP、CK-MB、UA水平,有统计意义者纳入Cox回归分析预后相关因素;并采用ROC曲线分析LVEDP、CK-MB及UA水平对STEMI患者介入术后死亡的预测价值。结果:与存活组比较,死亡组前壁心肌梗死比例更多,收缩压、舒张压、左心室射血分数(LVEF)水平较低,Gensini积分、LVEDP、CK-MB及UA水平明显升高(均P<0.05)。Logistic回归分析显示,收缩压、舒张压、LVEF为PCI后患者死亡的保护因素(OR=0.965、0.979、0.879,均P<0.05),Gensini积分、LVEDP、CK-MB及UA均为患者PCI后死亡的独立危险因素(OR=1.078、3.359、1.019、1.009,均P<0.05)。ROC曲线分析显示,LVEDP、CK-MB、UA单独预测介入术后死亡的曲线下面积(AUC)分别为0.973、0.819、0.625,敏感性分别为95.8%、83.3%、45.8%,特异性分别为94.4%、79.6%、91.7%。LVEDP、CK-MB、UA联合预测介入术后死亡的AUC为0.985,敏感性、特异性分别为99.1%、100.0%。结论:入院时收缩压、舒张压、LVEF为PCI后患者死亡的保护因素,Gensini积分、LVEDP、CK-MB及UA均为患者PCI后死亡的独立危险因素。LVEDP、CK-MB及UA联合检测对STEMI患者介入术后死亡的预测价值较高。

Objective:To explore the predictive value of left ventricular end diastolic pressure(LVEDP),creatine kinase isoenzyme(CK-MB),and uric acid(UA)levels for the mortality of patients with acute ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Method:From February 2017 to March 2019,STEMI patients who underwent PCI in our hospital were selected as the study objects.According to the survival status within one year after PCI,they were divided into the death group(n=24)and survival group(n=98).The clinical characteristics,biochemical indexes,degree of coronary artery disease,cardiac function,Gensini score,LVEDP,CK-MB,and UA levels between the two groups were compared.Those with statistical significance were included in Cox regression analysis to analyze the prognostic factors.The ROC curve was used to analyze the predictive value of LVEDP,CK-MB,and UA levels for the mortality of STEMI patients after intervention.Result:Compared with the survival group,the death group had higher proportion of anterior myocardial infarction,lower levels of systolic blood pressure,diastolic blood pressure,left ventricular ejection fraction(LVEF),and significantly higher Gensini score,levels of LVEDP,CK-MB,and UA(all P<0.05).Logistic regression analysis showed that systolic blood pressure,diastolic blood pressure,and LVEF were protective factors of death after PCI(OR=0.965,0.979,0.879,all P<0.05),Gensini score,LVEDP,CK-MB,and UA were all independent risk factors of death after PCI(OR=1.078,3.359,1.019,1.009,all P<0.05).ROC curve analysis showed that the area under the curve(AUC)of LVEDP,CK-MB,and UA in predicting postoperative death were 0.973,0.819,and 0.625,the sensitivity were 95.8%,83.3%,and 45.8%,the specificity was 94.4%,79.6%,and 91.7%,respectively;the AUC of combination of LVEDP,CK-MB,and UA in predicting postoperative death was 0.985,the sensitivity and specificity were 99.1%and 100.0%,respectively.Conclusion:Systolic blood pressure,diastolic blood pressure and LVEF are protective factors of death after PCI,Gensini score,LVEDP,CK-MB and UA are independent risk factors of mortality after PCI.The combined detection of LVEDP,CK-MB and UA has a high predictive value for the death of STEMI patients after PCI.