营养相关参数对老年急性心肌梗死患者PCI术后发生MACE的预测价值

The predictive value of nutritional parameters for MACE after PCI in elderly patients with acute myocardial infarction

目的探讨营养相关参数与老年急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后发生主要不良心血管事件(MACE)风险的关系。方法选取2021年12月至2022年12月收治于东南大学附属中大医院行PCI的老年AMI患者596例,术后随访6个月根据有无发生MACE将患者分为MACE组(114例)和NMACE组(482例)。使用单因素和多因素Logistic回归对患者发生MACE相关因素进行分析,受试者工作特征曲线(ROC)评估不同参数对AMI患者PCI术后发生MACE的预测价值。结果MACE组患者糖尿病史、冠状动脉粥样硬化性心脏病(冠心病)史、合并心力衰竭、Killip分级、左主干病变、射血分数(EF)值、空腹血糖(FBG)、营养风险筛查NRS-2002均高于NMACE组(P<0.05),总胆固醇(TC)、白蛋白(ALB)、低密度脂蛋白(LDL)、血红蛋白(Hb)、淋巴细胞比率、老年营养风险指数(GNRI)均低于NMACE组(P<0.05),GNRI、TC、EF值、ALB均为发生MACE保护因素,NRS-2002、Killip分级、FBG均为发生MACE的危险因素,ROC曲线显示GNRI联合NRS-2002、ALB预测MACE的AUC为0.872(95%CI:0.845~0.900),敏感度为91.0%,特异度为81.3%。结论GNRI、NRS-2002、ALB与老年心肌梗死患者PCI术后MACE的发生密切相关,提高营养水平或有利于减少的MACE发生。

Objective To explore the relationship between nutritional parameters and the risk of major adverse cardiovascular events(MACE)after PCI in elderly patients with acute myocardial infarction.Method A total of 596 elderly patients with acute myocardial infarction who underwent PCI at the Affiliated Hospital of Southeast University from December 2021 to December 2022 were selected.After 6 months of follow-up,the patients were divided into the MACE group(114 cases)and the NMACE group(482 cases)based on the presence or absence of MACE.Single factor and multivariate logistic regression were used to analyze the factors related to MACE occurrence in patients,and the receiver operating characteristic curve(ROC)was used to evaluate the predictive value of different parameters for MACE occurrence in patients with acute myocardial infarction after PCI.Results The history of diabetes,coronary heart disease,combined heart failure,Killip grade,left main artery disease,EF value,fasting blood glucose,NRS-2002 in the MACE group were higher than those in the NMACE group(P<0.05),and total cholesterol,albumin,low-density lipoprotein,hemoglobin,lymphocyte ratio,GNRI were lower than those in the NMACE group(P<0.05).GNRI,total cholesterol,EF value,albumin were protective factors for MACE.NRS-2002,Killip grade Fasting blood glucose is a risk factor for MACE.The ROC curve shows that the AUC of GNRI combined with NRS-2002 and albumin for predicting MACE is 0.872(95%CI:0.845~0.900),sensitivity is 91.0%,and specificity is 81.3%.Conclusion GNRI,NRS-2002,albumin are closely related to the occurrence of MACE after PCI in elderly myocardial infarction patients,and improving nutritional levels may be beneficial for reducing the occurrence of MACE.