多指标联合对急诊经皮冠脉介入治疗的急性ST段抬高型心肌梗死患者发生主要心血管不良事件的预测

Prediction of Major Cardiac Adverse Events in Patients with Acute ST Segment Elevation Myocardial Infarction after Emergency Percutaneous Coronary Intervention

目的探讨全球急性冠脉事件登记(GRACE)评分、应激高血糖和N末端脑钠肽前体(NT-pro-BNP)对急诊经皮冠脉介入(PCI)治疗的急性ST段抬高型心肌梗死(STEMI)患者发生主要心血管不良事件(MACEs)的预测价值,为STEMI患者临床诊疗中早期风险分层和预后判断寻找更好的方法,为患者制定最佳个体化治疗策略提供可靠的临床依据。方法本研究最终纳入342例急诊PCI的STEMI患者,在1年的随访中有88例患者出现MACEs。采用多因素Cox回归分析评估各危险因素对MACEs的预测价值。进一步用受试者操作特征(ROC)曲线计算曲线下的面积(AUC)。结果以性别、GRACE评分、入院随机血糖、NT-pro-BNP、吸烟、冠心病、高血压、糖尿病、脑卒中和冠状动脉血管病变(单支病变、双支病变、三支病变)、发病时间和用药情况作为协变量,MACEs作为状态变量,进行多因素Cox回归分析显示,GRACE评分、入院随机血糖、lgNT-pro-BNP是急诊PCI的STEMI患者发生MACEs的独立预测因子。根据AUC计算的入院随机血糖、GRACE评分、NT-pro-BNP及三指标联合对STEMI患者MACEs的预测值分别是0.694、0.758、0.732和0.813。结论GRACE评分、入院随机血糖、NT-pro-BNP对急诊PCI的STEMI患者1年后MACEs有独立的预测价值。联合GRACE评分、入院随机血糖、NT-proBNP可进一步提高对急诊PCI的STEMI患者MACEs的预测价值。

Objective The purpose of this study was to explore the predictive ability of global register of acute coronary event(GRACE)score,stress hyperglycemia and N-terminal pro-brain natriuretic peptide(NT-pro-BNP)concentration on major adverse cardiovascular events(MACEs)in patients with acute ST-segment elevation myocardial infarction(STEMI)treated by emergency percutaneous coronary intervention(PCI),to find a better method for early risk stratification and prognosis judgment in the clinical diagnosis and treatment of STEMI patients,and to provide reliable clinical basis for making the best individualized treatment strategies for patients.Methods The final analysis included 342 confirmed STEMI patients who had received acute PCI.88 patients with STEMI were included in the MACEs group,and the rest were included in the non-MACEs group.Multivariate Cox regression analysis was used to assess the relationship between the risk factors and MACEs.The receiver operator curves(ROC)were used to determine the area under the statistical curve(AUC).Results After adjustment for sex,current smoking,coronary heart disease,hypertension,diabetes mellitus,cerebral artery disease and coronary artery vessel lesion(single-vessel lesion,2-vessel lesion,3-vessel lesion),onset time and medication,the multivariate Cox’s regression analysis showed that the GRACE score,stress hyperglycemia and NT-pro-BNP were the independent predictors for MACEs in STEMI patients who received PCI.The AUC for level of admission blood sugar,GRACE score,NT-pro-BNP and their combination were 0.694,0.758,0.732 and 0.813,respectively.Conclusion In a one-year follow-up,GRACE score,level of admission blood sugar,NT-pro-BNP were valuable of prediction for MACEs in STEMI patients who received PCI.Additionally,the combination of GRACE score,level of admission blood sugar and NT-pro-BNP could enhance the prediction of 1-year MACEs in STEMI patients who received PCI.