PLR、D-二聚体联合CHA2DS2-VASc评分预测急性心肌梗死PCI后住院期间MACE的价值

Value of platelet to lymphocyte ratio and D-dimer combined with CHA2DS-VASc score in predicting major adverse cardiovascular events during hospitalization after percutaneous coronary intervention in acute myocardial infarction

目的探讨血小板与淋巴细胞比值(PLR)、D-二聚体(D-D)联合CHA2DS2-VASc评分预测急性心肌梗死经皮冠状动脉介入术(PCI)后住院期间主要心脏不良事件(MACE)的价值。方法选择2017年1月-2022年6月本院接受PCI术的89例急性心肌梗死患者,术前检测患者PLR,D-D,并计算CHA2DS2-VAsc评分,随访至出院,根据患者住院期间是否发生MACE分为发生组与未发生组。比较2组临床资料,分析急性心肌梗死PCI术后住院期间发生MACE的影响因素,以受试者工作特征(ROC)曲线下面积(AUC)评估术前PLR、D-D、CHA2DS2-VAsc评分及三者联合对急性心肌梗死PCI术后住院期间发生MACE的预测价值。结果随访至出院,89例急性心肌梗死PCI术后患者发生MACE 21例,MACE发生率为23.60%,其中心力衰竭13例、恶性心律失常1例、心源性死亡1例、靶血管再次血运重建3例、再发心肌梗死3例,剩余68例(76.40%)均未发生MACE。发生组年龄、心衰病史例数占比、术前冠脉病变Gensini评分、C反应蛋白(CRP)、PLR、D-D、CHA2DS2-VAsc评分高于未发生组(P<0.05)。Logistic多因素回归分析结果显示,年龄增加、术前PLR升高、D-D升高、CHA2DS2-VAsc评分升高为急性心肌梗死PCI术后住院期间发生MACE的影响因素(P<0.05)。ROC曲线结果显示,术前PLR、D-D、CHA2DS2-VAsc评分及三者联合预测急性心肌梗死PCI术后住院期间发生MACE的AUC值分别为0.708、0.660、0.658、0.805(P<0.05),且三者联合的AUC值均高于单一指标检测的AUC值(P<0.05)。结论PLR、D-D、CHA2DS2-VASc评分在预测急性心肌梗死PCI后住院期间是否发生MACE中具有重要价值,且三者联合具有更高的预测价值。

Objective To explore the value of platelet to lymphocyte ratio(PLR)and D-Dimer(D-D)combined with CHA2DS2-VASc score in predicting major adverse cardiovascular events(MACE)during hospitalization after percutaneous coronary intervention(PCI)in acute myocardial infarction.Methods 89 patients with acute myocardial infarction who underwent PCI in the 904th Hospital of Chinese People's Liberation Army Joint Logistic Support Force from January 2017 to June 2022 were selected.Preoperative PLR and D-D values of the patients were detected.And the CHA2DS2-VASc score was calculated.Follow-up was conducted until discharge.The patients were divided into the occurrence group and the non-occurrence group according to whether MACE occurred during hospitalization.The clinical data of two groups were compared,and the influencing factors of MACE during hospitalization after PCI in acute myocardial infarction were analyzed.The area under the receiver operating characteristic(ROC)curve(AUC)was used to evaluate the predictive value of preoperative PLR,D-D values,CHA2DS2-VASc scores and their combination in the occurrence of MACE during hospitalization after PCI in acute myocardial infarction.Results At the time of follow-up until discharge,21 cases of 89 patients with acute myocardial infarction after PCI developed MACE;And the MACE incidence rate was 23.60%,including 13 cases of heart failure,1 case of malignant arrhythmia,1 case of cardiogenic death,3 cases of revascularization of target vessels,and 3 cases of recurrent myocardial infarction;And the remaining 68 cases(76.40%)did not have MACE.The age,the proportion of patients with history of heart failure,the preoperative Gensini score of coronary artery disease,C-reactive protein(CRP)level,PLR,D-D value and CHA2DS2-VASc score in the occurrence group were higher than those in the non-occurrence group(P<0.05).Logistic multivariate regression analysis showed that increased age,increased preoperative PLR,increased D-D values,and increased CHA2DS2-VASc scores were the influencing factors for MACE during hospitalization after PCI in acute myocardial infarction(P<0.05).ROC curve results showed that AUC values of preoperative PLR,D-D values,CHA2DS2-VAsc scores and their combination to predict MACE during hospitalization after PCI in acute myocardial infarction were 0.708,0.660,0.658,and 0.805 respectively(P<0.05).The combined AUC values of the above three indicators were higher than the AUC values detected by a single indicator(P<0.05).Conclusion PLR,D-D values and CHA2DS2-VASc scores have important value in predicting whether MACE occurs during hospitalization after PCI in acute myocardial infarction,and the combination of the three indicators has higher predictive value.