STEMI患者血清胆红素水平与冠脉病变程度的相关性及预后评估

Association of serum bilirubin level with severity of coronary artery disease and prognosis in patients with STEMI

目的探讨ST段抬高型心肌梗死(STEMI)患者血清胆红素水平与SYNTAX积分的相关性,并进一步探讨其对STEMI患者经皮冠状动脉介入治疗(PCI)后住院期间主要不良心血管事件(MACE)的预测价值。方法前瞻性连续纳入上海市东方医院吉安医院2019年5月至2020年12月行直接PCI的STEMI患者。根据基线冠状动脉造影SYNTAX积分将STEMI患者分为SS低组(SYNTAX积分≤22分)和SS高组(SYNTAX积分>22分)。分别检测各组血清总胆红素(TBiL)、直接胆红素(DBiL)、间接胆红素(IBiL)水平。通过多元Logistic回归分析血清胆红素水平与SYNTAX积分相关性。结果共纳入942例STEMI患者,其中SS低组562例,SS高组380例。SS高组TBiL和IBiL水平较SS低组显著升高,差异有统计学意义(P<0.05)。TBiL与SYNTAX积分之间存在相关性(r^(2)=0.853 0,P<0.01)。结论 STEMI患者血清胆红素水平与SYNTAX积分相关,能辅助评估冠状动脉病变严重程度。

Objective To investigate the association of serum bilirubin level and SYNTAX score in patients with ST-segment elevation myocardial infarction(STEMI),and to further investigate its predictive value for major adverse cardiovascular events(MACE)after percutaneous coronary intervention(PCI)in STEMI patients during hospitalization.Methods STEMI patients who underwent direct PCI from May 2019 to December 2020 were prospectively and continuously enrolled in Shanghai East Hospital Ji'an Hospital from May 2019 to December 2020.Patients were divided into the SS low group(SYNTAX score≤22)and the SS high group(SYNTAX score>22)according to the baseline coronary angiographic SYNTAX score.Serum total bilirubin(TBiL),direct bilirubin(DBiL)and indirect bilirubin(IBiL)levels were detected in each group.The relation between serum bilirubin level and SYNTAX score was analyzed by multiple Logistic regression.Results A total of 942 STEMI patients were enrolled,including 562 patients in the SS low group and 380 patients in the SS high group.The levels of TBiL and IBiL in SS high group were significantly higher than those in SS low group,and the difference was statistically significant(P<0.05).There was correlation between TBiL and SYNTAX score(r^(2)=0.8530,P<0.01).Conclusion Serum bilirubin level is correlated with SYNTAX score in STEMI patients.It helps to evaluate the severity of coronary artery disease.