修正休克指数对急性ST段抬高型心肌梗死患者PCI后发生院内主要不良心血管事件的预测价值研究

Predictive Value of Modified Shock Index for Nosocomial Major Adverse Cardiovascular Events in Acute STEMI Patients after PCI

目的探讨修正休克指数(MSI)对急性ST段抬高型心肌梗死(STEMI)患者PCI后发生院内主要不良心血管事件(MACE)的预测价值。方法选取2017年1月至2020年6月就诊于河北省人民医院心血管内科并接受直接PCI的急性STEMI患者1137例为研究对象。根据急性STEMI患者PCI后是否发生院内MACE将其分为MACE组(n=115)和非MACE组(n=1022)。统计患者临床资料,采用多因素Logistic回归分析探讨急性STEMI患者PCI后发生院内MACE的独立影响因素,绘制ROC曲线以分析MSI对急性STEMI患者PCI后发生院内MACE的预测价值。结果多因素Logistic回归分析结果显示,年龄〔OR=1.033,95%CI(1.010,1.057)〕、收缩压〔OR=0.983,95%CI(0.967,0.999)〕、舒张压〔OR=1.030,95%CI(1.004,1.057)〕、MSI〔OR=26.410,95%CI(6.908,100.963)〕、心肌肌钙蛋白T(cTnT)〔OR=1.004,95%CI(1.004,1.005)〕、左心室射血分数(LVEF)〔OR=0.969,95%CI(0.943,0.995)〕是急性STEMI患者PCI后发生院内MACE的独立影响因素(P<0.05)。ROC曲线分析结果显示,MSI预测急性STEMI患者PCI后发生院内MACE的曲线下面积为0.736〔95%CI(0.692,0.781)〕,最佳截断值为0.728,灵敏度、特异度分别为90.4%、46.1%,约登指数为0.365。结论高龄及收缩压降低、舒张压升高、MSI升高、cTnT升高、LVEF降低是急性STEMI患者PCI后发生院内MACE的独立危险因素,MSI对急性STEMI患者PCI后发生院内MACE具有一定的预测价值,可用于评估患者早期预后。

Objective To investigate the predictive value of modified shock index(MSI)for nosocomial major adverse cardiovascular events(MACE)in acute ST-segment elevation myocardial infarction(STEMI)patients after PCI.Methods A total of 1137 patients with acute STEMI who underwent direct PCI in the Department of Cardiology of Hebei General Hospital from January 2017 to June 2020 were enrolled as the research objects.Patients were divided into MACE group(n=115)and non-MACE group(n=1022)according to the occurrence of nosocomial MACE in acute STEMI patients after PCI.The clinical data of the patients were collected,and the independent influencing factors of nosocomial MACE in acute STEMI patients after PCI were analyzed by multivariate Logistic regression analysis.ROC curve was used to analyze the predictive value of MSI for nosocomial MACE in acute STEMI patients after PCI.Results Multivariate Logistic regression analysis showed that age[OR=1.033,95%CI(1.010,1.057)],systolic blood pressure[OR=0.983,95%CI(0.967,0.999)],diastolic blood pressure[OR=1.030,95%CI(1.004,1.057)],MSI[OR=26.410,95%CI(6.908,100.963)],cardiac troponins T(cTnT)[OR=1.004,95%CI(1.004,1.005)]and left ventricular ejection fraction(LVEF)[OR=0.969,95%CI(0.943,0.995)]were independent influencing factors for the occurrence of nosocomial MACE in acute STEMI patients after PCI(P<0.05).ROC curve analysis results showed that the area under curve of MSI in predicting nosocomial MACE in acute STEMI patients after PCI was 0.736[95%CI(0.692,0.781)],the best cut-off value was 0.728,and the sensitivity and specificity were 90.4%and 46.1%,respectively,the Youden index was 0.365.Conclusion Old age,low systolic blood pressure,high diastolic blood pressure,high MSI,high cTnT and low LVEF are independent risk factors for nosocomial MACE in acute STEMI patients after PCI.MSI has predictive value for nosocomial MACE in acute STEMI patients after PCI,which can be used in clinic to evaluate the early prognosis of patients.