PAR对急性ST段抬高型心肌梗死患者急诊PCI术后冠脉无复流的预测价值

The Value of Platelet-to-Albumin Ratio to Predict No-Reflow in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

目的评估血小板与白蛋白比值(PAR)对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入(PCI)术治疗后冠脉无复流的预测价值。方法回顾性分析2017年1月至2019年10月于该院心血管内科确诊为STEMI并在12 h内急诊行PCI术的641例患者临床资料。将患者按术后是否发生冠脉无复流分为无复流组(104例)和完全灌注组(537例),比较两组患者基线资料及各项检验结果,采用多因素Logistic回归模型筛选冠脉无复流的影响因素,绘制ROC曲线评价PAR对冠脉无复流的预测价值。结果无复流组吸烟史比例、入院收缩压、舒张压、血红蛋白、白蛋白水平均低于完全灌注组,而入院心率、总缺血时间、血肌酐、血糖、血小板计数及PAR水平均高于完全灌注组(P均<0.05)。多元Logistic回归结果显示,PAR水平及入院血糖为冠脉无复流的独立影响因素。ROC曲线显示,PAR预测冠状动脉无复流的曲线下面积为0.706,截断值为3.42,截断值对应的灵敏度为70.2%,特异度为66.0%,具有预测价值(95%CI:0.652~0.761,P<0.05)。结论术前PAR是STEMI患者PCI术后冠脉无复流的影响因素,并对冠脉无复流具有一定的预测价值。

Objective To explore the predictive value of platelet-to-albumin(PAR)for no-reflow of coronary artery after emergency percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods The clinical data of 641 patients who were diagnosed with STEMI and treated with emergency PCI within 12 hours in our hospital from January 2017 to October 2019 were retrospectively analyzed.The patients were divided into no reflow of coronary artery group(n=104)and the complete perfusion group(n=537)according to whether there was reflow of coronary artery after PCI.The clinical baseline data and medical laboratory results were compared between the two groups.Multivariate Logistic regression analysis was used to screen the influencing factors of no-reflow coronary artery Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of PAR for no-reflow of coronary artery.Results No-reflow group smoking history scale,systolic pressure,diastolic pressure and hemoglobin and albumin levels were lower than the complete perfusion group,while the heart rate,total ischemia time,blood glucose,serum creatinine,platelet counts and platelet-to-albumin ratio were higher than the complete perfusion group(P all<0.05).Multivariate Logistic regression analysis showed that the platelet-to-albumin and blood glucose were predictors of no-reflow of coronary artery.The ROC curve showed that the area under the curve of PAR in predicting no-reflow of coronary artery was 0.706,and the cut off value was 3.42.The sensitivity and specificity of the predictive threshold were 70.2%and 66.0%,respectively,which had diagnostic value on no-reflow of coronary artery in patients with acute STEMI(95%CI:0.652~0.761,P<0.05).Conclusion PAR is the influencing factor of no-reflow coronary artery in STEMI patients after PCI,and it has certain value in the prediction of no-reflow coronary artery.