糖化血红蛋白与行急诊PCI的AMI患者冠脉病变的相关性及其对术后MACE的预测作用

Correlation between HbA1c and Coronary Artery Lesions in Patients of AMI with Emergency PCI and Its Predictive Effect on Postoperative MACE

目的:探讨糖化血红蛋白(glycosylated hemoglobin,HbA1c)与行急诊经皮冠状动脉介入治疗术(percutaneous coronary intervention,PCI)的急性心肌梗死(acute myocardial infarction,AMI)患者冠脉病变的相关性及其对术后心脏主要不良事件(major adverse cardiac events,MACE)的预测价值。方法:序贯选取2016年1月-2017年12月在本院诊断为AMI并行急诊PCI治疗的患者371例,根据入院时HbA1c水平分为A组(HbA1c<5.7%,n=152)、B组(HbA1c 5.7%~6.4%,n=113)和C组(HbA1c≥6.5%,n=106)。比较各组研究对象冠状动脉病变情况、分析HbA1c与冠脉Gensini评分的相关性、进行为期2年的随访并比较各组MACE的发生情况。结果:C组三支病变及弥漫性病变比例高于A、B两组,B组高于A组,差异有统计学意义(P<0.05);三组分叉病变所占比例差异无统计学意义(P>0.05)。C组Gensini评分高于A、B两组,B组高于A组,差异有统计学意义(P<0.05)。相关分析显示HbA1c和冠脉Gensini评分呈正相关关系(r=0.886,P=0.000)。B、C组血运重建及MACE发生率高于A组,差异有统计学意义(P<0.05)。经Kaplan-Meier生存分析显示A、B、C三组随访24个月时无MACE生存率分别为85.5%、72.6%、63.2%,差异有统计学意义(P<0.05)。结论:HbA1c水平与AMI患者冠脉病变范围和程度具有相关性,能够预测行急诊PCI治疗患者MACE事件的发生,为患者个体化治疗方案的制定提供参考。

Objective:To investigate the correlation between glycosylated hemoglobin(HbA1c)and coronary artery lesions in patients with emergency percutaneous coronary intervention(PCI)and its predictive value on postoperative major adverse cardiac events(MACE).Method:A total of 371 patients with acute myocardial infarction,who underwent emergency PCI from January 2016 to December 2017 in our hospital were selected.According to the HbA1c levels,all patients were divided into the group A(HbA1c<5.7%,n=152),the group B(HbA1c 5.7%-6.4%,n=113),the group C(HbA1cM6.5%,n=106).Coronary artery lesion of each group and the correlation between HbA1c and coronary Gensini score were analyzed.The three groups were followed up for 2 years and the occurrence of MACE in each group was studied.Result:The proportions of three-vessel and diffuse lesions in the group C were higher than those in the group A and B,the proportions of three-vessel and diffuse lesions in the group B were higher than those in the group A,the differences were statistically significant(P<0.05).The proportion of bifurcation lesions in the three groups was not statistically significant(P>0.05).The Gensini score in the group C was higher than that in the group A and B,the Gensini score in the group B was higher than that in the group A,the differences were statistically significant(P<0.05).Correlation analysis showed a positive correlation between HbA1c and coronary Gensini score(r=0.886,P=0.000).The incidences of revascularization and MACE in the group B and C were higher than those in the group A,the differences were statistically significant(P<0.05).Kaplan-Meier survival analysis showed that the no MACE survival rates in the group A,B,C were 85.5%,72.6%and 63.2%after a follow-up of 24 months,the difference was statistically significant(P<0.05).Conclusion:HbA1c was correlated with the scope and extent of coronary artery lesion in patients with AMI who underwent emergency PCI,and can predict the occurrence of MACE of AMI patients undergoing emergency PCI,which can provide reference for the formulation of individual treatment plan for patients.