急性ST段抬高型心肌梗死患者PCI术后1年心血管事件的危险因素分析

Risk factors of cardiovascular events in patients with acute ST-segment elevation myocardial infarction one year after PCI

目的探讨急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后1年发生心血管事件的危险因素。方法回顾性分析2019年1月至2020年1月中国人民解放军联勤保障部队第九〇三医院行PCI的STEMI患者110例,根据PCI术后1年是否发生心血管事件分为预后不良组(29例)和预后良好组(81例)。检测miR-150、miR-20a、氨基末端脑钠肽前体(NT-proBNP)水平。采用ROC曲线分析miR-150、miR-20a、NT-proBNP预测STEMI患者PCI术后1年发生心血管事件的效能;采用多因素logistic回归分析STEMI患者PCI术后1年发生心血管事件的危险因素。结果预后不良组年龄≥60岁、糖尿病、高血压、当前吸烟、多支病变患者占比高于预后良好组,miR-150、miR-20a水平低于预后良好组,NT-proBNP水平高于预后良好组,差异均有统计学意义(均P<0.05);ROC曲线分析显示,miR-150(AUC 0.713,灵敏度0.667,特异度0.793)、miR-20a(AUC 0.792,灵敏度0.556,特异度0.897)、NT-proBNP(AUC 0.769,灵敏度0.621,特异度0.988)预测STEMI患者PCI术后1年发生心血管事件的最佳截断值分别为0.425、0.975、1202.500 ng/L(均P<0.01);多因素logistic回归分析显示,年龄≥60岁、糖尿病、高血压、当前吸烟、多支病变、miR-150≤0.425、miR-20a≤0.975、NT-proBNP≥1202.500 ng/L均是STEMI患者PCI术后1年发生心血管事件的危险因素(均P<0.01)。结论对STEMI患者的年龄、糖尿病、高血压、吸烟情况、多支病变、miR-150、miR-20a、NT-proBNP等因素应加以关注,以减少PCI术后心血管事件的发生。

Objective To investigate the risk factors of cardiovascular events in patients with acute ST-segment elevation myocardial infarction(STEMI)one year after percutaneous coronary intervention(PCI).Methods The clinical data of 110 STEMI patients who underwent PCI in 903rd Hospital of PLA from January 2019 to January 2020 were retrospectively analyzed.The cardiovascular events occurred 1 year after PCI in 29 cases,and did not occur in 81 cases.The risk factors for cardiovascular events 1 year after PCI in STEMI patients were determined by unconditional logistic stepwise regression analysis.Results The proportion of patients with poor prognosis≥60 years old,diabetes,hypertension,current smoking,and multi vessel disease were higher than that of patients with good prognosis,the levels of miR-150 and miR-20a were lower than those of patients with good prognosis,and the level of NT-proBNP was higher than that of patients with good prognosis(all P<0.05).ROC curve analysis showed that the optimal cutoff values for predicting cardiovascular events in STEMI patients 1 year after PCI were 0.425,0.975,and 1202.500 ng/L for miR-150(AUC 0.713,sensitivity 0.667,specificity 0.793),miR-20a(AUC 0.792,sensitivity 0.556,specificity 0.897),and NT-proBNP(AUC 0.769,sensitivity 0.621,specificity 0.988)(all P<0.01).Logistic regression analysis showed that≥60 years old,diabetes,hypertension,current smoking,multi vessel disease,miR-150≤0.425,miR-20a≤0.975,NT-proBNP≥1202.500 ng/L were all risk factors for cardiovascular events in STEMI patients 1 year after PCI(all P<0.01).Conclusion The occurrence of cardiovascular events after PCI in STEMI patients is associated with age,diabetes,hypertension,smoking status,multi-vessel lesions,miR-150,miR-20a,and NT-probNP levels.