STEMI患者PCI术后MACE的预测研究

Study on prediction of MACE in STEMI patients after PCI by electrocardiogram fQRS combined with serum NT-proBNP and Tei index

目的:探讨心电图碎裂QRS波(fQRS)联合血清氨基末端脑钠肽前体(NT-proBNP)、Tei指数对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)后主要不良心血管事件(MACE)的预测价值。方法:回顾性分析2016年5月~2020年6月本院收治的采取急诊PCI术治疗的120例STEMI患者的临床资料,均于术前行心电图、超声心动图检查及血清NT-proBNP水平监测。术后随访6个月,根据MACE发生情况,将其分为发生组与未发生组,对比此两组术前心电图fQRS、血清NT-proBNP及Tei指数,并采用Logistic回归性分析法分析术前心电图fQRS、血清NT-proBNP、Tei指数与STEMI患者PCI术后MACE发生的关系,另采用受试者工作特征(ROC)曲线评估术前心电图fQRS联合血清NT-proBNP、Tei指数对STEMI患者PCI术后MACE发生的预测价值。结果:120例STEMI患者PCI术后的MACE发生率为18.33%,发生组术前存在fQRS波占比及术前NT-proBNP水平、Tei指数均高于未发生组(P<0.05);经多因素Logistic回归分析,术前fQRS、术前NT-proBNP水平及Tei指数均是STEMI患者PCI术后发生MACE的危险因素(OR=4.802、3.579、3.313,P<0.05);根据ROC曲线,术前fQRS波、血清NT-proBNP水平、Tei指数单项及联合预测STEMI患者PCI术后MACE发生的灵敏度分别为95.45%、81.82%、77.27%、77.27%,特异度分别为57.14%、81.63%、82.65%、93.88%,曲线下面积(AUC)分别为0.856、0.904、0.862、0.942。结论:心电图fQRS、血清NT-proBNP水平、Tei指数均与STEMI患者PCI术后MACE的发生存在一定的关系,均对术后MACE的发生具有较好的预测价值,但联合检测的预测效能更佳。

Objective:To investigate the predictive value of electrocardiogram fragmented QRS complex(fQRS)combined with serum N-terminal pro brain natriuretic peptide(NT-proBNP)and Tei index for major adverse cardiovascular events(MACE)in patients with acute ST segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods:The clinical data of 120 STEMI patients treated with emergency PCI in our hospital from May 2016 to June 2020 were retrospectively analyzed,and the electrocardiogram,echocardiography and serum NT-proBNP levels of them were detected before operation.The patients were followed up for 6 months and divided into occurrence group and non-occurrence group according to the occurrence of MACE,and the pre-operative electrocardiogram fQRS,serum NT-proBNP and Tei index were compared between the two groups,and the relationships between pre-operative electrocardiogram fQRS,serum NT-proBNP,Tei index and MACE in STEMI patients after PCI were analyzed by Logistic regression analysis method,then the predictive values of pre-operative electrocardiogram fQRS combined with serum NT-proBNP and Tei index for MACE in STEMI patients after PCI were analyzed by Receiver operating characteristic(ROC)curve.Results:The incidence of MACE in 120 STEMI patients after PCI was 18.33%,and the ratio of fQRS and NT-proBNP level and Tei index before operation in the occurrence group were higher than those in the non-occurrence group(P<0.05).Multivariate logistic regression analysis showed that pre-operative fQRS,pre-operative NT-proBNP level and Tei index were risk factors for MACE after PCI in STEMI patients(OR=4.802,3.579,3.313,P<0.05).According to ROC curve,the sensitivity of fQRS wave,serum NT-proBNP level and Tei index in single and combined predicting MACE of STEMI patients after PCI were 95.45%,81.82%,77.27%and 77.27%respectively,and the specificity were 57.14%,81.63%,82.65%and 93.88%,respectively and the area under the curve(AUC)were 0.856,0.904,0.862 and 0.942 respectively.Conclusion:Electrocardiogram fQRS,serum NT-proBNP level and Tei index have certain relationship with the occurrence of MACE after PCI in STEMI patients,which have good predictive value for the occurrence of MACE after PCI,but the combined detection of them has better predictive effect.