休克指数和心肌梗死溶栓危险指数对急性冠状动脉综合征合并心源性休克患者PCI术后死亡的预测价值

Predictive Value of Shock Index and Thrombolytic Risk Index in Myocardial Infarction for Death after PCI in Patients with Acute Coronary Syndrome Complicated with Cardiogenic Shock

目的分析休克指数(SI)和心肌梗死溶栓危险指数(TRI)对急性冠状动脉综合征(ACS)合并心源性休克患者经皮冠状动脉介入治疗(PCI)术后死亡的预测价值。方法选取2019年6—12月于张家口市第一医院行PCI手术且术后接受强化心脏治疗的97例ACS合并心源性休克患者为研究对象,依据患者预后情况分为生存组和死亡组。采用单因素和Logistic回归分析影响ACS合并心源性休克患者PCI术后死亡的危险因素,绘制受试者工作特征曲线(ROC曲线)评估SI、TRI对ACS合并心源性休克患者PCI术后死亡的预测价值。结果随访1年后,生存50例,死亡47例。单因素分析结果显示,死亡组年龄≥70岁比例、肌酸激酶同工酶MB(CK-MB)、心肌肌钙蛋白I(cTnI)、SI、TRI高于生存组[78.72%(37/47)比52.00%(26/50)、(168±20)mmol/L比(130±15)mmol/L、(50±7)μg/L比(41±6)μg/L、1.92±0.35比1.10±0.20、(33.2±2.2)%比(25.2±3.2)%](P<0.01)。Logistic回归分析结果显示,年龄≥70岁,CK-MB、cTnI水平高,SI、TRI高是影响ACS合并心源性休克患者死亡的危险因素(OR=2.190,95%CI 1.959~2.485;OR=2.251,95%CI 1.965~2.337;OR=2.154,95%CI 2.009~2.439;OR=2.166,95%CI 1.903~2.329;OR=2.058,95%CI 1.961~2.376)(P<0.05或P<0.01)。ROC曲线结果显示,SI与TRI联合预测ACS合并心源性休克患者PCI术后死亡的灵敏度、特异度、曲线下面积分别为92.27%、81.94%、0.962,均高于SI和TRI单独检测(78.20%、60.04%、0.774,78.55%、59.35%、0.770)。结论SI与TRI联合预测ACS合并心源性休克患者PCI术后死亡的准确性高于SI、TRI单独检测,临床可将SI、TRI作为预测ACS合并心源性休克PCI术后死亡的有效指标。

Objective To analyze the predictive value of shock index(SI)and thrombolytic risk index(TRI)in myocardial infarction for death after percutaneous coronary intervention(PCI)in patients with acute coronary syndrome(ACS)complicated with cardiogenic shock.Methods Ninety-seven patients with ACS combined with cardiogenic shock who underwent PCI and received intensive cardiac therapy after surgery in Zhangjiakou First Hospital from Jun.to Dec.2019 were included.According to the prognosis of the patients,they were divided into survival group and death group.Univariate and Logistic regression were used to analyze the risk factors affecting death after PCI in patients with ACS complicated with cardiogenic shock.Receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of SI and TRI for death after PCI in patients with ACS complicated with cardiogenic shock.Results After 1 year follow-up,50 cases survived and 47 cases died.The univariate analysis showed that the proportion of age≥70 years old,creatine kinase MB(CK-MB),cardiac troponin I(cTnI),SI and TRI in the death group were higher than those in the survival group[78.72%(37/47)vs 52.00%(26/50),(168±20)mmol/L vs(130±15)mmol/L,(50±7)μg/L vs(41±6)μg/L,(1.92±0.35)vs(1.10±0.20),(33.2±2.2)%vs(25.2±3.2)%](P<0.01).Logistic regression analysis showed that age≥70 years old,high CK-MB and cTnI levels,high SI and TRI were risk factors affecting the death of patients with ACS and cardiogenic shock(OR=2.190,95%CI 1.959-2.485;OR=2.251,95%CI 1.965-2.337;OR=2.154,95%CI 2.009-2.439;OR=2.166,95%CI 1.903-2.329;OR=2.058,95%CI 1.961-2.376)(P<0.05 or P<0.01).ROC curve results showed that the sensitivity,specificity and area under curve of SI and TRI combined to predict death after PCI in patients with ACS and cardiogenic shock were 92.27%,81.94%and 0.962,respectively,and all of them were higher than those predicted by single SI(78.20%,60.04%,0.774)and single TRI(78.55%,59.35%,0.770).Conclusion The accuracy of combined SI and TRI in predicting the death of patients with ACS and cardiogenic shock after PCI is higher than that of SI and TRI alone.In clinic,SI and TRI can be used as effective indicators to predict the death of patients with ACS and cardiogenic shock after PCI.