行介入治疗急性心肌梗死患者溶栓危险指数与病变程度及预后相关性研究

Clinical study on correlation between thrombolysis in myocardial infarction risk index and disease severity and clinical prognosis of patients with acute myocardial infarction undergoing interventional therapy

目的:探讨行介入治疗急性心肌梗死(AMI)患者心肌梗死溶栓危险指数(TRI)与冠状动脉病变严重程度、临床预后相关性,为后续临床治疗及预后评价提供更多参考。方法:回顾性选取我院2010年1月至2016年5月,收治行介入治疗AMI患者共832例临床资料,采用ROC曲线分析TRI预测介入术后2年全因死亡最佳cut-off值;根据最佳cut-off值分组,即TRI≥24.10设为A组(233例)和TRI<24.10设为B组(599例),分析TRI与冠状动脉病变严重程度相关和介入术后临床预后相关影响因素。结果:A组患者SYNTAX评分、直接介入手术、IABP使用率及血管内超声使用率均显著高于B组(P<0.05);A组支架放置率和完全血运重建率均显著低于B组(P<0.05);A组阿司匹林、硝酸脂类药物及ACEI/ARB使用率均显著低于B组(P<0.05)。Pearson相关性分析显示,TRI与SYNTAX评分具有明显相关性(r=0.138,P=0.00);Logistic回归模型多因素分析显示,TRI是SYNTAX评分I≥33分影响因素(OR=1.31, 95%CI:1.12~1.25,P=0.00)。A组介入术后2年全因死亡率、心源性死亡率及支架内血栓形成率均显著高于B组(P<0.05)。采用ROC曲线分析TRI用于AMI患者介入术后2年全因死亡预测最佳cut-off值为为24.10,预测敏感度和特异度分别为81.59%,73.67%,AUC为0.816(95%CI:0.725~0.881,P=0.00);采用Cox回归模型多因素分析显示,TRI≥24.10是AMI患者介入术后2年全因死亡、心源性死亡及支架内血栓形成危险因素(P<0.05)。结论:TRI与SYNTAX评分密切相关;同时TRI高水平提示AMI患者介入术后2年预后不良。

Objective:To investigate the correlation between thrombolysis in myocardial infarction risk index(TRI)and disease severity and clinical prognosis of patients with acute myocardial infarction(AMI)undergoing interventional therapy.Methods:Clinical data of 832 patients with AMI undergoing interventional therapy were chosen in the period from January 2010 to May 2016.ROC curve were used to analyze TRI to predict the best cut-off value of all-cause death in 2 years after interventional therapy.According to the best cut-off value,All patients were divided into A group(233 cases)for TRI≥24.10 and B group(599 cases)for TRI<24.10.The correlation between TRI and severity of coronary artery disease and the related factors of clinical prognosis after interventional therapy were analyzed.Results:The SYNTAX score,direct interventional surgery,IABP usage and intravascular ultrasound usage of A group were significantly higher than B group(P<0.05).The stent placement rate and total revascularization rate of A group were significantly lower than B group(P<0.05).The usage rates of aspirin,nitrates and ACEI/ARB of A group were significantly lower than B group(P<0.05).Pearson correlation analysis showed that TRI was significantly correlated with SYNTAX score(r=0.138,P=0.00).Logistic regression model multivariate analysis showed that TRI was the independent influencing factor of SYNTAX score≥33 points(OR=1.31,95%CI:1.12-1.25,P=0.00).The allcause mortality,cardiogenic mortality and stent thrombosis rate in 2 year aftre intervention of A groupwere significantly higher than B group(P<0.05).ROC curve analysis showed that the best cut-off-off value of TRI for predicting allcause mortality was 24.10,the predictive sensitivity and specificity were separately 81.59%,73.67%,AUC=0.816.Multivariate Cox regression analysis showed that TRI≥24.10 was the independent risk factor for allcause death,cardiogenic death and stent thrombosis of AMI patients in 2 years after intervention(P<0.05).Conclusions:TRI should closely related to SYNTAX score,and the high levels of TRI suggests that the prognosis of AMI patients was poor 2 years after interventional therapy.