T12水平竖脊肌横截面积与老年急性冠脉综合征患者预后相关性的研究

Association between the transverse area of vertical spinal muscle at T12 level and prognosis in elderly patients with acute coronary syndrome

目的分析第十二胸椎(T12)水平竖脊肌横截面积与老年急性冠脉综合征(acute coronary syndrome,ACS)住院患者预后的相关性。方法采用前瞻性队列研究。收集2019年1月至2022年6月北京博爱医院经急诊收入心血管内科监护病房或急诊监护病房的老年ACS患者的临床资料;入院后24 h内检测血常规、生化指标;完成超声心动图检查;24 h内进行胸部CT检查,计算T12水平左、右侧竖脊肌横截面积后求和;进行心肌梗死溶栓治疗临床试验(thrombolysis in myocardial infraction,TIMI)评分。随访患者12个月内主要不良心脑血管事件(major adverse cardiovascular and cerebrovascular event,MACCE)的发生情况。比较MACCE组与无MACCE组间临床资料及实验室指标的差异;采用多因素Logistic回归模型分析T12水平竖脊肌横截面积与ACS后12个月内发生MACCE的相关性。结果共406例患者纳入本研究,12个月内MACCE的发生率为22.2%。MACCE组T12水平竖脊肌横截面积[(20.43±3.51)cm2 vs.(24.36±3.66)cm2,Z=4.412,P<0.001]低于无MACCE组。Logistic回归分析显示,调整性别、年龄、身体质量指数、TIMI评分、是否血运重建5个因素后,T12水平竖脊肌横截面积(OR=0.883,95%CI:0.803~0.971,P=0.010)与ACS后12个月内发生MACCE呈独立相关。结论T12水平竖脊肌横截面积可作为老年ACS患者12个月内发生MACCE的独立预测因子。

Objective To analyze the association between the transverse area of erector spine muscle at T12 level and prognosis in elderly patients with acute coronary syndrome(ACS).Methods This was a prospective cohort study.Clinical data of elderly patients with ACS admitted to the coronary care unit or the emergency intensive care unit in Beijing Bo'Ai Hospital from January 2019 to June 2022.Blood routine and biochemical indicators were detected and echocardiography was performed within 24 hours after admission,chest CT examination was completed and the cross-sectional areas of the left and right vertical spinalis muscles were calculated at T12 level,thrombolysis in myocardial infarction(TIMI)was performed within 24 hours after admission.The occurrence of major adverse cardiovascular and cerebral events(MACCE)within 12 months was followed up.The differences of clinical data and laboratory indexes between the MACCE group and the non-MACCE group were compared.Multivariable logistic regression model was used to analyze the association between the cross-sectional area of vertical spinal muscle at T12 level and the occurrence of MACCE within 12 months after ACS.Results A total of 406 patients were enrolled in the study,the incidence of MACCE within 12 months was 22.2%.The cross-sectional area of erector spine muscle at T12 level[(20.43±3.51)cm2 vs.(24.36±3.66)cm2,(Z=4.412,P<0.001)]in the MACCE group was lower than that in the non-MACCE group.Logistic regression analysis showed that after adjusting for sex,age,body mass index(BMI),TIMI score and revascularization,the cross-sectional area of erector spine muscle at T12 level(OR=0.883,95%CI:0.803-0.971,P=0.010)was independently associated with MACCE within 12 months after ACS.Conclusion The transverse area of vertical spinal muscle at T12 level can be used as an independent predictor of MACCE within 12 months in elderly patients with ACS.