冠状动脉旁路多支移植术后发生院内不良心血管结局事件的预测研究

Prediction of in-hospital adverse cardiovascular outcomes after coronary artery bypass multi-vessel grafting

目的:探究联合检测NLR、cTnⅠ及NT-proBNP水平预测冠状动脉3支病变患者行冠状动脉旁路移植(coronary artery bypass grafting,CABG)术后发生院内主要心血管不良事件(major adverse cardiovascular events,MACE)风险的价值。方法:回顾性分析2019年1月至2019年7月,于首都医科大学附属北京安贞医院心脏外科中心行CABG术的冠心病(3支冠状动脉狭窄)患者574例,根据医院记录和电话访谈记录其院内MACE包括新发心室颤动、低心输出量综合征(low cardiac output syndrome,LCOS)、主动脉内球囊反搏(intra-aortic ballon pump,IABP)的使用和全因死亡,分为MACE组(n=55)和非MACE组(n=519),收集患者的基本临床资料和入院24 h内NLR、cTnI及NT-proBNP检查结果,进行组间比较,分析上述指标单独及联合检测对冠状动脉多支病变患者行CABG术后发生院内MACE风险的预测效能。结果:院内发生MACE患者NLR、cTnI及NT-proBNP水平均显著高于院内未发生MACE(非MACE)组,差异有统计学意义(P<0.05)。在单独预测冠状动脉多支病变患者行CABG术后发生院内MACE风险方面,NT-proBNP的曲线下面积最大,为0.848(P<0.001),NT-proBNP的敏感性最高,为83.6%。与单独预测相比,各指标联合预测的曲线下面积提高为0.92(P<0.001),敏感性提高为92.7%。结论:联合检测NLR、cTnI及NT-proBNP水平对预测冠状动脉三支病变患者行CABG术后院内MACE风险具有一定的价值,值得在临床上推广。

Objective:To investigate the value of NT-proBNP levels in predicting the risk of in-hospital major adverse cardiovascular events(MACE)in patients with three-vessel coronary artery disease(TVD)undergoing coronary artery bypass grafting(CABG).Methods:A total of 574 patients with coronary heart disease(three-vessel coronary artery stenosis)who underwent CABG in the Cardiac Surgery Center of Beijing Anzhen Hospital,Capital Medical University from January 2019 to July 2019 were retrospectively analyzed.In-hospital MACE including new-onset ventricular fibrillation,Low cardiac output syndrome(LCOS),use of intra-aortic balloon pump(IABP)and all-cause death were recorded according to hospital records and telephone interviews.The patients were divided into MACE group(n=55)and non-MACE group(n=519).The basic clinical data and the results of NLR,cTnI and NT-proBNP within 24 hours after admission were collected and compared between the two groups.The predictive efficacy of the above indicators alone and in combination on the risk of in-hospital MACE after CABG in patients with multi-vessel coronary artery disease was analyzed.Results:NLR,cTnI and NT-proBNP levels in patients with MACE during hospitalization were significantly higher than those in patients without MACE(non-MACE)during hospitalization,and the difference was statistically significant(P<0.05).NT-proBNP had the largest area under the curve(AUC)of 0.848(P<0.001)and the highest sensitivity in predicting the risk of in-hospital MACE after CABG in patients with multi-vessel coronary artery disease.And 83.6%.Compared with individual prediction,the area under the curve of combined prediction was increased by 0.92(P<0.001),and the sensitivity was increased by 92.7%.Conclusions:Combined detection of NLR,cTnI and NT-proBNP levels has certain value in predicting the risk of in-hospital MACE in patients with three-vessel coronary artery disease after CABG,which is worthy of clinical promotion.