休克指数和TIMI危险评分与急性冠状动脉综合征合并心源性休克患者PCI术后预后的相关性

Correlation of Shock Index and TIMI Risk Score with Prognosis after PCI in Patients with Acute Coronary Syndrome Combined with Cardiogenic Shock

目的分析休克指数(SI)和心肌梗死溶栓试验(TIMI)危险评分与急性冠状动脉综合征(ACS)合并心源性休克(CS)患者经皮冠状动脉介入治疗(PCI)术后预后的相关性。方法回顾性分析2019年10月至2021年10月在张家口市第一医院行PCI的126例ACS合并CS患者的病历资料,根据入院28 d转归将患者分为生存组(98例)和死亡组(28例)。单因素分析性别、年龄、实验室指标[收缩压、舒张压、心率、平均动脉压、动脉血氧饱和度(SaO 2)、心脏指数(CI)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血红蛋白、血肌酐、估算的肾小球滤过率(eGFR)、肌酸激酶同工酶MB(CK-MB)、心肌肌钙蛋白T(cTnT)]、入院时SI和TIMI危险评分等可能影响ACS合并CS患者PCI术后预后的危险因素,多因素Logistic回归分析明确影响ACS合并CS患者PCI术后预后的危险因素,绘制受试者工作特征曲线(ROC曲线)评估SI、TIMI危险评分对ACS合并CS患者PCI术后预后的预测价值。结果死亡组糖尿病比例、CK-MB、cTnT、入院时SI和TIMI危险评分均高于生存组[67.86%(19/28)比38.78%(38/98)、(109±10)mmol/L比(90±10)mmol/L、(29±8)μg/L比(17±7)μg/L、1.55±0.16比1.45±0.15、(4.23±0.22)分比(3.12±0.15)分],CI低于生存组[(1.3±0.3)L/(min·m 2)比(1.7±0.4)L/(min·m 2)](均P<0.01)。Logistic回归分析显示,CK-MB、cTnT、入院时SI、入院时TIMI危险评分升高是影响ACS合并CS患者PCI术后预后不良的独立危险因素(P<0.01)。ROC曲线分析显示,SI、TIMI危险评分预测ACS合并CS患者PCI术后预后的最佳截断点分别为1.47、3.25分,曲线下面积分别为0.814、0.908,灵敏度分别为75.00%、92.86%,特异度分别为73.47%、72.45%,TIMI危险评分对ACS合并CS患者PCI术后预后的预测价值高于SI(P<0.01)。结论SI、TIMI危险评分是影响ACS合并CS患者PCI术后预后的独立危险因素,对该类患者预后均具有一定预测价值。

Objective To analyze the correlation between the shock index(SI)and the thrombolysis in myocardial infarction(TIMI)risk score and the prognosis after percutaneous coronary intervention(PCI)in patients with acute coronary syndrome(ACS)combined with cardiogenic shock(CS).Methods The medical records of 126 patients with ACS combined with CS who underwent PCI at Zhangjiakou First Hospital from Oct.2019 to Oct.2021 were retrospectively analyzed,and the patients were divided into a survival group(98 patients)and a death group(28 patients)according to the outcomes of 28 d after admission.Univariate analysis of gender,age,laboratory parameters[systolic blood pressure,diastolic blood pressure,heart rate,mean arterial pressure,arterial oxygen saturation(SaO 2),cardiac index(CI),triacylglycerol(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),hemoglobin,blood creatinine,estimated glomerular filtration rate(eGFR),creatine kinase-MB(CK-MB),cardiac troponin T(cTnT)],SI and TIMI risk scores at admission,and other risk factors that may affect the prognosis of ACS combined with CS patients after PCI was done,and the multivariate Logistic regression analysis to clarify the risk factors that affect the prognosis of ACS combined with CS patients after PCI.The predictive value of SI and TIMI risk scores on the prognosis of ACS combined with CS patients after PCI was assessed by plotting the receiver operating characteristic curve(ROC curve).Results The proportion of diabetes,CK-MB,cTnT,SI and TIMI risk scores at admission were higher in the death group than in the survival group[67.86%(19/28)vs 38.78%(38/98),(109±10)mmol/L vs(90±10)mmol/L,(29±8)μg/L vs(17±7)μg/L,1.55±0.16 vs 1.45±0.15,(4.23±0.22)vs(3.12±0.15)],and CI was lower than in the survival group[(1.3±0.3)L/(min·m 2)vs(1.7±0.4)L/(min·m 2)](all P<0.01).Logistic regression analysis showed that CK-MB,cTnT,SI at admission,and elevated TIMI risk score at admission were all independent risk factors for poor prognosis after PCI in patients with ACS combined with CS(P<0.01).ROC curve analysis showed that the best cut-off points of SI and TIMI risk score for predicting the prognosis after PCI in patients with ACS combined with CS were 1.47 and 3.25,respectively,and the area under curve was 0.814 and 0.908,with sensitivity of 75.00%and 92.86%and specificity of 73.47%and 72.45%,respectively.The predictive value of TIMI risk score for prognosis after PCI in patients with ACS combined with CS was higher than that of SI(P<0.01).Conclusion Both SI and TIMI risk scores are independent risk factors affecting the prognosis of patients with ACS and CS after PCI,and they have certain predictive value for the prognosis of the patients.