AMI伴心源性休克患者PCI前后休克指数与心肌梗死溶栓危险指数变化及对预后的预测价值

Changes of Shock Index and Thrombolysis Risk Index in Myocardial Infarction before and after PCI in Patients with AMI with Cardiogenic Shock and Their Predictive Value for Prognosis

目的分析急性心肌梗死(AMI)伴心源性休克(CS)患者经皮冠状动脉介入(PCI)前后休克指数(SI)与心肌梗死溶栓危险指数(TRI)的变化,并评估两者对其预后的预测价值。方法选取2017年1月至2023年1月于张家口市第一医院就诊的AMI伴CS患者120例,均行PCI治疗。术后随访1个月,统计患者预后情况,死亡患者纳入死亡组,存活患者纳入转归组。比较PCI前后SI、TRI,转归组、死亡组SI、TRI及临床资料差异;采用Logistic回归模型分析AMI伴CS患者预后的影响因素;绘制受试者工作特征(ROC)曲线评估SI、TRI单独及联合预测AMI伴CS患者预后的效能。结果PCI术后随访1个月,120例AMI伴CS患者死亡44例(36.67%);与PCI前比较,AMI伴CS患者PCI后SI、TRI均降低(P<0.01)。死亡组患者SI、TRI水平高于转归组(0.75±0.24比0.57±0.13、29±7比23±6)(P<0.01),吸烟、糖尿病、罪犯血管3支、心肌梗死溶栓试验(TIMI)血流分级0~1级的比例高于转归组[38.64%(17/44)比17.11%(13/76)、63.64%(28/44)比34.21%(26/76)、34.09%(15/44)比13.16%(10/76)、65.91%(29/44)比39.47%(30/76)](P<0.01)。Logistic回归分析结果显示,吸烟、糖尿病、罪犯血管3支、TIMI血流分级0~1级、SI、TRI均为AMI伴CS患者预后的影响因素(OR=7.267,95%CI 1.007~52.460;OR=4.314,95%CI 1.673~11.125;OR=7.829,95%CI 1.370~44.738;OR=1.800,95%CI 1.162~2.789;OR=2.198,95%CI 1.569~3.078;OR=3.554,95%CI 1.186~10.650)(P<0.05或P<0.01)。ROC曲线分析结果显示,SI预测AMI伴CS患者预后不良的最佳截断点为0.77,灵敏度、特异度、准确度分别为50.00%、96.05%、79.17%,曲线下面积(AUC)为0.706(95%CI 0.616~0.785);TRI最佳截断点为23.77,灵敏度、特异度、准确度分别为79.55%、63.16%、69.17%,AUC为0.763(95%CI 0.676~0.836);两者联合预测预后不良的灵敏度、特异度、准确度分别为50.00%、97.37%、80.00%,AUC为0.826(95%CI 0.746~0.889)。结论AMI伴CS患者PCI后SI、TRI均降低,两者联合预测患者预后的效能较高。

Objective To analyze the levels of shock index(SI)and thrombolysis risk index(TRI)in myocardial infarction before and after percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI)with cardiogenic shock(CS),and evaluate their predictive value for prognosis.Methods One hundred and twenty patients with AMI complicated by CS who underwent PCI treatment in Zhangjiakou First Hospital from Jan.2017 to Jan.2023 were included.The patients were followed up for 1 month after operation,and their prognosis was recorded.The patients who died were included in a death group,and the survivors were included in a conversion group.The SI and TRI before and after PCI were compared;the differences of SI,TRI and clinical data between the conversion group and the death group were compared.The influencing factors of prognosis in patients with AMI complicated by CS were analyzed by Logistic regression model;the efficacy of SI,TRI alone and combined prediction of prognosis in patients with AMI complicated by CS was evaluated by receiver operating characteristic(ROC)curve.Results One month after PCI,44(36.67%)of the 120 patients died;compared with before PCI,SI and TRI of the patients decreased after PCI(P<0.01).The SI,TRI levels,proportions of smoking,diabetes,3 culprit vessels,thrombolysis in myocardial infarction(TIMI)blood flow grade 0-1 in the death group were higher than those of the conversion group[0.75±0.24 vs 0.57±0.13,29±7 vs 23±6,38.64%(17/44)vs 17.11%(13/76),63.64%(28/44)vs 34.21%(26/76),34.09%(15/44)vs 13.16%(10/76),65.91%(29/44)vs 39.47%(30/76)](P<0.01).Logistic regression analysis showed that smoking,diabetes,3 culprit vessels,TIMI blood flow grade 0-1,SI and TRI were all risk factors for prognosis in patients with AMI complicated by CS(OR=7.267,95%CI 1.007-52.460;OR=4.314,95%CI 1.673-11.125;OR=7.829,95%CI 1.370-44.738;OR=1.800,95%CI 1.162-2.789;OR=2.198,95%CI 1.569-3.078;OR=3.554,95%CI 1.186-10.650)(P<0.05 or P<0.01).ROC curve showed that the best cut-off point of SI for predicting poor prognosis in patients with AMI complicated by CS was 0.77,with the sensitivity of 50.00%,specificity of 96.05%and accuracy of 79.17%,respectively,and the area under curve(AUC)of 0.706(95%CI 0.616-0.785);the best cut-off point of TRI was 23.77,with the sensitivity,specificity and accuracy of 79.55%,63.16%and 69.17%,respectively,and the AUC of 0.763(95%CI 0.676-0.836);the sensitivity was 50.00%,specificity was 97.37%and accuracy was 80.00%of combined prediction for the poor prognosis,and the AUC was 0.826(95%CI 0.746-0.889).Conclusion SI and TRI decrease after PCI in patients with AMI complicated by CS,and the combined prediction the two for the prediction of prognosis has higher efficacy.