肌钙蛋白、SNYTAX积分、GRACE评分与老年冠心病PCI术后再次血运重建的关系

Relationship between Troponin,SNYTAX score,GRACE score and revascularization after PCI in elderly patients with coronary heart disease

目的探讨肌钙蛋白I(cTnI)、SNYTAX积分、全球急性冠状动脉疾病登记(GRACE)评分与老年冠心病PCI术后再次血运重建的关系。方法选取2016年1月-2021年1月中国人民解放军陆军第七十一集团军医院心血管内科收治PCI治疗老年冠心病患者300例,基于PCI术后冠状动脉造影检查结果是否需要再次血运重建分为再次血运重建组(A组)91例和非再次血运重建组(B组)209例。比较2组患者临床资料及cTnI、SNYTAX积分、GRACE评分,Logistic回归分析再次血运重建影响因素,受试者工作特征曲线(ROC)分析cTnI、SNYTAX积分、GRACE评分诊断再次血运重建的效能。结果A组cTnI水平、SNYTAX积分、GRACE评分高于B组(t=4.802、10.080、8.744,P均<0.001),cTnI高、SNYTAX积分高、GRACE评分高均是影响再次血运重建的危险因素[OR(95%CI)=7.581(1.655~9.558)、2.585(2.055~5.065)、1.832(1.234~4.276)];ROC曲线分析显示,高cTnI、SNYTAX积分、GRACE评分及三者联合检测的曲线下面积(AUC)分别为0.628、0.802、0.795、0.876,三者联合优于各自单独预测价值(Z=6.823、3.064、3.589,P均<0.001)。结论cTnI、SNYTAX积分、GRACE评分与老年冠心病PCI术后再次血运重建有关,上述指标联合检测可作为再次血运重建预测指标。

Objective To explore the relationship between Troponin I(cTnI),SNYTAX score,Global Registry of Acute Coronary artery disease(GRACE)score and revascularization after PCI in elderly patients with coronary heart disease.Methods From January 2016 to January 2021,300 elderly patients with coronary heart disease treated by PCI were selected from the Department of Cardiology of the Seventy First Army Hospital of the 71st Group Army.Based on the results of coronary angiography after PCI,they were divided into 91 patients in the revascularization group(Group A)and 209 patients in the non-revascularization group(Group B).Compare the clinical data,cTnI,SNYTAX scores,and GRACE scores of two groups of patients,conduct logistic regression analysis on the influencing factors of revascularization,and analyze the efficacy of cTnI,SNYTAX scores,and GRACE scores in diagnosing revascularization using receiver operating characteristic curve(ROC)analysis.Result The cTnI level,SNYTAX score,and GRACE score in Group A were higher than those in Group B(t=4.802,10.080,8.744,P<0.001).High cTnI,SNYTAX score,and GRACE score were all risk factors affecting revascularization[OR(95%CI)=7.581(1.655-9.558),2.585(2.055-5.065),1.832(1.234-4.276)];The Receiver operating characteristic analysis showed that the area under the curve(AUC)of high cTnI,SNYTAX score,GRACE score and joint detection of the three were 0.628,0.802,0.795 and 0.876,respectively,which were better than their individual predictive values(Z=6.823,3.064,3.589,P<0.001).Conclusion cTnI,SNYTAX score,and GRACE score are related to revascularization after PCI in elderly patients with coronary heart disease.Combined detection of these indicators can serve as predictive indicators for revascularization.