衰弱、血清C-末端聚集蛋白与老年急性冠脉综合征患者预后的相关性研究

Association of frailty and serum C-terminal agrin fragment with the prognosis in elderly patients with acute coronary syndrome

目的探索衰弱、血清C-末端聚集蛋白(CAF)与老年急性冠脉综合征(ACS)患者预后的相关性。方法前瞻性队列,连续收集2020年1月至2022年5月北京博爱医院经急诊收入老年ACS患者207例的临床资料;入组后24 h内留取血清标本检测CAF水平;进行心肌梗死溶栓治疗临床试验(TIMI)评分、衰弱筛查问卷(FSQ)评分;随访患者90 d内发生主要不良心脑血管事件(MACCE)的情况。采用多因素Logistic回归方程分析MACCE的影响因素;采用受试者工作特征(ROC)曲线评价FSQ评分、血清CAF及二者联合对MACCE的预测能力。根据90 d生存情况分为存活组(176例)和死亡组(31例),采用Cox比例风险回归模型进行生存分析。结果发生MACCE组FSQ评分(Z=4.412,P<0.001)、血清CAF(Z=6.702,P<0.001)均高于未发生MACCE组;Logistic回归分析显示,调整年龄、性别、TIMI评分、完全血运重建4个因素后,FSQ定义的衰弱(OR=1.714;95%CI:1.059~2.775;P=0.028)、血清CAF升高(OR=1.230;95%CI:1.122~1.350;P<0.05)均是ACS后发生MACCE的独立危险因素。FSQ评分预测MACCE的ROC曲线下面积(AUC)为0.797(95%CI:0.735~0.850;P<0.001),预测切点为>2分,约登指数(YI)=0.419,敏感度0.708,特异度0.711;CAF预测MACCE的AUC为0.766(95%CI:0.701~0.822;P<0.001),预测切点为>6.01μg/L,YI=0.460,敏感度0.750,特异度0.710;二者联合的预测效能高于单独应用FSQ评分(Z=2.294,P=0.022)或CAF(Z=2.545,P=0.011)。Cox回归分析显示,FSQ定义的衰弱(HR=3.487;95%CI:1.329~9.153;P=0.011)与ACS发生90 d全因死亡独立相关。结论开展衰弱筛查、检测血清CAF水平可能改善老年ACS患者的危险分层。

Objective To explore the association of frailty and serum C-terminal agrin fragment(CAF)with the prognosis of elderly patients with acute coronary syndrome(ACS).MethodsIn this prospective cohort study,clinical data of 207 older patients with ACS between January 2020 and May 2022 were collected.Serum samples were obtained within 24 hours after enrollment to detect CAF levels.Meanwhile,the thrombolysis in myocardial infarction(TIMI)and frailty screening questionnaire(FSQ)scores were assessed on admission.Patients were followed up for major adverse cardiovascular and cerebrovascular events(MACCE)for 90 days.Multivariate logistic regression was used to analyze the influencing factors of MACCE.The receiver operating characteristic(ROC)curve was performed to evaluate the predictive ability of the FSQ score,serum CAF and their combination for MACCE.According to 90-day mortality,patients were divided into a survival group(n=176)and a death group(n=31).The Cox proportional hazards regression model was used for survival analysis.ResultsThe FSQ score(Z=4.412,P<0.001)and serum CAF(Z=6.702,P<0.001)in the MACCE group were higher than those in the non-MACCE group.Logistic regression analysis showed that after adjusting for age,sex,TIMI score and complete revascularization,frailty defined by FSQ(OR=1.714;95%CI:1.059-2.775;P=0.028)and high serum CAF(OR=1.230;95%CI:1.122-1.350;P<0.05)were independent risk factors for MACCE.The area under the ROC curve(AUC)of the FSQ score for predicting MACCE was 0.797(95%CI:0.735-0.850;P<0.001),the predictive cut-off point was an FSQ score>2,and the Youden index(YI)was 0.419,yielding a sensitivity of 0.708 and a specificity of 0.711.In addition,the AUC of serum CAF for predicting MACCE was 0.766(95%CI:0.701-0.822;P<0.001),the predictive cut-off point was>6.01μg/L,and YI was 0.460,yielding a sensitivity of 0.750 and a specificity of 0.710.The predictive ability of FSQ combined with CAF for MACCE was higher than FSQ(Z=2.294,P=0.022)or CAF(Z=2.545,P=0.011)alone.Cox regression analysis showed that frailty defined by FSQ(HR=3.487;95%CI:1.329-9.153;P=0.011)was independently associated with all-cause mortality within 90 days after ACS.ConclusionsFrailty assessment and serum CAF detection can improve the risk stratification of elderly patients with ACS.