急性心肌梗死患者PCI治疗后一年内发生不良心血管事件的危险因素及其预测效能

Risk factors for adverse cardiovascular events within one year after PCI treatment in patients with acute myocardial infarction and their predictive efficacy

目的 探讨急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后一年内发生不良心血管事件(MACE)的危险因素及其预测效能。方法 AMI患者100例,均行PCI,根据治疗后一年内是否发生MACE分为MACE(+)组(14例)和MACE(-)组(86例),采用单因素分析法、多因素Cox回归分析法分析AMI患者行PCI后一年内发生MACE的影响因素和危险因素,并通过ROC曲线和Kaplan-Meier生存曲线评估危险因素的预测效能。结果 单因素分析显示,两组非经典型单核细胞亚群(NCM)比例、Genisi评分、SYNTAX评分、LVESD比较,P均<0.05。多因素分析显示,NCM比例、Genisi评分是AMI患者行PCI后一年内发生MACE的独立危险因素(P均<0.05)。ROC曲线显示,当NCM比例为9.090%时,约等指数为0.756,其预测AMI患者行PCI后一年内发生MACE的灵敏度为100%,特异度为76.5%,ROC曲线下面积为0.880,95%CI为0.812~0.947,P<0.05;Kaplan-Meier生存曲线显示,以NCM比例的最佳截断值9.090%对AMI患者进行危险分层,NCM比例≥9.090%为低危患者,NCM比例<9.090%为高危患者。结论 AMI患者行经PCI后一年内发生MACE的危险因素是NCM比例,检测此指标有助于AMI患者术后MACE事件发生的预测。

Objective To explore the risk factors for major cardiovascular adverse events(MACE)within one year after percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI)and their predictive effi-cacy.Methods Totally 100 AMI patients underwent PCI,and were divided into the MACE(+)group(14 cases)and MACE(-)group(86 cases)based on the occurrence of MACE within one year after treatment.Univariate analysis and multivariate Cox regression analysis were used to analyze the influencing factors and risk factors for MACE in AMI patients after PCI,and the predictive ability of risk factors was evaluated through receiver operating characteristic(ROC)curve and Kaplan-Meier survival curve.Results Univariate analysis showed that significant differences were found in the pro-portion of two non-classical monocyte subpopulations(NCM),Genisi score,SYNTAX score,and LVESD between these two groups(all P<0.05).Multivariate analysis showed that the proportion of NCM and Genisi score were independent risk factors for MACE in AMI patients after PCI(both P<0.05).The ROC curve showed that when the proportion of NCM was 9.090%,the approximate index was 0.756,with a sensitivity of 100%and a specificity of 76.5%in predicting MACE of AMI patients after PCI.The area under the ROC curve was 0.880,95%CI was 0.812 to 0.947,and P<0.05.The Ka-plan-Meier survival curve showed that AMI patients were stratified into the low-risk patients(NCM proportion≥9.090%)and high-risk patients(NCM proportion<9.090%)based on the optimal cut-off value of NCM proportion at 9.090%.Conclusion The risk factor for MACE in AMI patients after PCI within one year is the proportion of NCM,and detecting this indicator helps predict postoperative MACE in AMI patients.