24 h动态心电图参数联合心脏彩超及NT-proBNP对急性心肌梗死PCI术后远期MACE的预测价值

The predictive value of 24-hour dynamic ECG parameters combined with cardiac color ultrasound and NT-proBNP for long-term major adverse cardiovascular events after PCI for patients with acute myocardial infarction

目的 探究24 h动态心电图参数联合心脏彩超及N端B型脑钠肽前体(NT-proBNP)对急性心肌梗死(AMI)经皮冠状动脉介入术(PCI)后远期主要不良心血管事件(MACE)的预测价值。方法 回顾性随机选取淮安市第一人民医院2020年6月—2022年6月收治的162例行PCI术的AMI患者纳入研究,术后对患者进行为期12个月的随访,观察患者随访期间MACE发生情况,并将其分为MACE组和无MACE组。比较两组24 h动态心电图参数、心脏彩超参数、左心房内径(LAD)及NT-proBNP水平。收集两组患者临床相关资料并进行比较,多因素分析AMI患者PCI术后MACE的影响因素,采用受试者工作特征(ROC)曲线分析24 h动态心电图参数、心脏彩超参数及NT-proBNP水平联合检测对AMI患者PCI术后MACE的预测价值。结果 AMI患者PCI术后1年内MACE发生率为22.67%(34/150)。MACE组24 h NN间期标准差(24 h-SDNN)、左室射血分数(LVEF)水平低于无MACE组,左心室舒张末期内径(LVEDd)、NT-proBNP水平、合并糖尿病占比、Killip分级为Ⅲ~Ⅳ级占比、发病至PCI手术时间均高于无MACE组(P<0.05)。经二元Logistic回归分析,结果显示24 h-SDNN(OR=0.313,95%CI 0.116~0.840)、LVEF(OR=0.385,95%CI 0.164~0.899)是AMI患者PCI术后MACE的保护因素,LVEDd(OR=2.037,95%CI 1.368~3.032)、NT-proBNP(OR=5.103,95%CI 1.686~15.444)、Killip分级(OR=3.175,95%CI 1.337~7.535)是危险因素(P<0.05)。ROC曲线结果显示,24 h-SDNN、LVEF、LVEDd、NTproBNP水平检查及其联合检查预测AMI患者PCI术后MACE发生情况的曲线下面积(AUC)分别为0.787、0.775、0.810、0.793、0.918。结论 24 h-SDNN、LVEF是AMI患者PCI术后MACE的保护因素,LVEDd、NT-proBNP、Killip分级是危险因素;24 h-SDNN、LVEF、LVEDd、NT-proBNP水平联合检查可有效预测AMI患者PCI术后MACE发生情况。

Objective To explore the predictive value of 24 h dynamic electrocardiogram parameters combined with cardiac color Doppler ultrasonography and N-terminal pro-brain natriuretic peptide(NT-proBNP) for long-term major adverse cardiovascular events(MACE) after percutaneous coronary intervention(PCI) in patients with acute myocardial infarction(AMI).Methods A retrospectively analysis was conducted on the162 AMI patients who underwent PCI in Huai'an First Hospital from June 2020 to June 2022.All patients were followed up for 12 months after the operation.All patients were divided into MACE group and non-MACE group.The clinical data,the 24-hour dynamic electrocardiogram parameters,echocardiographic parameters and NT-proBNP levels were compared between the two groups.Multivariate analysis was used to analyze the factors of MACE in AMI patients after PCI.The receiver operating characteristic(ROC)curve was used to analyze the predictive value.Results The incidence of MACE in AMI patients within 12 months after PCI was 22.67%(34/150).The standard deviation of 24h NN interval(24 h-SDNN) and left ventricular ejection fraction(LVEF) in MACE group were lower than those in non-MACE group.The left ventricular end-diastolic diameter(LVEDd),NT-proBNP level,the proportion of patients with diabetes,the proportion of Killip classification Ⅲ-Ⅳ,and the time from onset to PCI operation were higher in the MACE group than those in the non-MACE group(P<0.05).Binary Logistic regression analysis showed that 24 h-SDNN(OR=0.313,95%CI 0.116-0.840) and LVEF(OR=0.385,95%CI 0.164-0.899) were protective factors for MACE in AMI patients after PCI,LVEDd(OR=2.037,95%CI 1.368-3.032),NT-proBNP(OR=5.103,95%CI 1.686-15.444) and Killip grade(OR=3.175,95%CI 1.337-7.535) were risk factors(P<0.05).ROC curve results showed that the area under the curve(AUC) of 24 h-SDNN,LVEF,LVEDd,NT-proBNP levels and their combination to predict the occurrence of MACE in AMI patients after PCI were 0.787,0.775,0.810,0.793 and 0.918,respectively.Conclusion 24 h-SDNN and LVEF are protective factors for MACE in AMI patients after PCI,and LVEDd,NT-proBNP and Killip classification are risk factors.The combined detection of 24 h-SDNN,LVEF,LVEDd and NTproBNP levels can effectively predict the occurrence of MACE in AMI patients after PCI.