全身免疫炎症指数对急性心肌梗死患者直接经皮冠状动脉介入治疗术后院内主要不良心血管事件的预测价值

The value of systemic immune inflammation index in predicting in-hospital major adverse cardiovascular events after direct percutaneous coronary intervention in patients with acute myocardial infarction

目的:探讨全身免疫炎症指数(SII)对接受直接经皮冠状动脉介入治疗(PCI)的急性心肌梗死(AMI)患者发生院内主要不良心血管事件(MACE)的预测价值。方法:连续纳入2019年9月-2020年4月就诊于徐州医科大学附属医院急诊科,并接受直接PCI治疗的AMI患者,共计298例,回顾性分析患者的一般资料、临床表现、实验室数据、心电图及影像学资料等,由入室的血常规计算SII、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)数值,根据住院期间是否发生MACE分为MACE组(n=58)与非MACE组(n=240),比较2组的临床资料,行单因素及多因素回归分析,分析MACE的危险因素,探讨SII与MACE的相关性,并绘制受试者工作特征(ROC)曲线,评估SII、NLR、PLR对AMI患者院内MACE的预测价值,根据最大约登指数确定SII的最佳临界值,并将SII联合急性冠脉事件全球注册(GRACE)评分,评价是否能增加GRACE评分预测AMI患者院内MACE的效能。结果:与非MACE组相比,MACE组SII、NLR及PLR显著升高(P<0.05);多因素回归分析显示,SII是AMI后发生MACE的独立危险因素;ROC曲线表明,3种炎症指标对患者院内MACE的发生均有一定的预测价值,其中SII曲线下面积(AUC)为0.829(P<0.05,95%CI 0.776-0.882),显著高于NLR及PLR,表明SII预测效能最大,将SII联合GRACE评分后,AUC由原来的0.870(P<0.05,95%CI 0.803-0.882)增加至0.906(P<0.05,95%CI 0.851-0.936)。结论:入室SII与AMI患者的预后相关,能够更高效地识别高危患者,联合GRACE评分后,能够提升GRACE评分对AMI患者发生MACE的预测价值。

Objective:To investigate the relationship between systemic immune inflammation index(SII)and in-hospital major adverse cardiovascular events(MACE)in patients with acute myocardial infarction(AMI)who received direct percutaneous coronary intervention(PCI).Methods:A total of 298 patients with acute myocardial infarction were enrolled in the Emergency Department of the affiliated Hospital of Xuzhou Medical University from September 2019 to April 2020 and received direct PCI treatment.The general data,clinical manifestations,laboratory data,electrocardiogram and imaging data of the patients were analyzed retrospectively.The values of SII,neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)were calculated from the blood routine examination.According to the adverse events occurred during hospitalization,the patients were divided into two groups:MACE group(n=58)and non-MACE group(n=240).The clinical data of the two groups were compared and analyzed by univariate and multivariate regression analysis to analyze the risk factors of adverse events,to explore the correlation between SII and adverse events,and to draw the receiver operating characteristic(ROC)curve to evaluate the predictive value of SII,NLR and PLR in hospital MACE in patients with myocardial infarction.The best critical value of SII was determined according to the most approximate index,and SII was combined with Global Registration of Acute Coronary events(GRACE)score to evaluate whether the efficiency to predict the in hospital MACE in patients with acute myocardial infarction can be increased.Results:SII.NLR and PLR in MACE group were significantly higher than those in non MACE group.Multivariate regression analysis showed that SII was an independent risk factor for adverse events after myocardial infarction.ROC curve showed that the three inflammatory indexes had certain predictive value for the occurrence of MACE in hospital,of which the area under SII curve(area under curve,AUC)was 0.829(P<0.05,95%CI 0.776-0.882).which was sig-nificantly higher than that of NLR and PLR.It shows that the prediction efficiency of SII was the best.After the SII combined with GRACE score,the AUC is increased from 0.870(P<0.05,95%CI 0.803-0.882)to 0.906(P<0.05,95%CI 0.851-0.936).Conclusion;Admission SII is related to the prognosis of patients with AMI,and can more efficiently identify high risk patients.When SII was combined with GRACE score,the predictive val-ue of GRACE score for MACE in patients with AMI was improved.