肾上腺素水平对STEMI患者行急诊PCI术后发生MACE的预测价值

The predictive value of epinephrine for MACE in patients with STEMI after emergency PCI

目的探讨肾上腺素(epinephrine,EPI)水平对急性ST段抬高型心肌梗死(ST segment elevation myocardial infarction,STEMI)行急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的患者术后发生主要不良心血管事件(major adverse cardiovascular events,MACE)的预测价值。方法选取2020年9月至2021年11月在江苏省苏北人民医院诊断为STEMI并行急诊PCI术的患者共107例,收集患者基线资料、生化检验资料和冠脉造影资料,应用酶联免疫法测定EPI水平。拟行下述分析:①根据研究对象是否发生MACE,将患者分为MACE组和非MACE组,比较两组各项指标;②根据受试者工作特征曲线(Receiver operating characteristic curve,ROC)分别计算出EPI水平预测发生MACE的最佳截点值,根据最佳截点值将患者分别分为高EPI水平组和低EPI水平组,分别比较组间MACE发生情况;③采用生存分析(Kaplan-Meier法和log-rank检验)探讨EPI水平与STEMI患者急诊PCI术后发生MACE的关系;④COX比例风险回归模型探讨STEMI患者急诊PCI术后发生MACE的危险因素。结果①107名患者中有19人发生了MACE,88人未发生MACE。与非MACE组相比,MACE组患者年龄更大,KillipⅡ级及以上比例、NT-proBNP和EPI水平更高,而FT3更低,差异有统计学意义(P<0.05),两组患者冠脉造影结果中,MACE组的Gensini评分显著高于非MACE组(P<0.01)。②根据ROC分析显示,EPI水平预测STEMI患者急诊PCI术后发生MACE的曲线下面积(Area under the curve,AUC)为0.699(95%CI:0.579~0.819,P=0.007),最佳截点值为528.54,灵敏度为78.9%,特异度为56.8%,根据EPI水平最佳截点值分组后,两组间比较发现,高EPI水平组的MACE发生率显著高于低EPI组(P=0.005);③Kaplan-Meier生存曲线提示EPI水平值越高,发生MACE的风险越高(log-rank检验为P=0.004)。④多因素COX回归分析,结果显示年龄(P=0.042)、FT3(P=0.000)、EPI水平(P=0.000)、Gensini评分(P=0.004)均为STEMI患者急诊PCI术后发生MACE的独立危险因素。结论①EPI水平与STEMI患者行急诊PCI术后发生MACE具有显著的相关性,对发生MACE有预测价值,EPI水平值越高,发生MACE的风险越高。②COX多因素回归分析结果显示:高EPI水平是STEMI患者急诊PCI术后发生MACE的独立危险因素。

Objective To explore the predictive value of Epinephrine(EPI)level for Major adverse cardiovascular events(MACE)in patients with ST segment elevation myocardial infarction(STEMI)after emergency Percutaneous coronary intervention(PCI).Methods A total of 107 patients with STEMI after emergency PCI in Northern Jiangsu People's Hospital of Jiangsu Province from September 2020 to November 2021 were selected.Baseline data,biochemical test data and coronary angiography data were collected.EPI level was measured by enzyme-linked immunosorbent assay.The following analysis was planned:①Patients were divided into MACE group and non-MACE group,and various indicators of the two groups were compared;②According to Receiver operating characteristic curve(ROC),the best cut-off values of EPI level which predict the occurrence of MACE were calculated respectively.Patients were respectively divided into high EPI level group and low EPI level group according to the best cut-off values,and the occurrence of MACE between the groups was compared respectively.③Survival analysis(Kaplan-Meier method and log-rank test)was used to investigate the relationship between EPI level and MACE in patients with STEMI after emergency PCI.④COX proportional hazard regression model was used to investigate the risk factors for MACE in patients with STEMI after emergency PCI.Results①According to the inclusion and exclusion criteria,107 patients with STEMI after emergency PCI were selected for the study,of which 19 patients had MACE and 88 patients did not have MACE.Compared with the non-MACE group,the patients in the MACE group were older,the proportion of KillipⅡand above,NT-proBNP and EPI were higher,while FT3 was lower,and the differences were statistically significant(P<0.05).The Gensini score of MACE group was significantly higher than that of non-MACE group(P<0.01).②According to ROC analysis,the Area under the curve(AUC)of EPI level for predicting MACE in patients with STEMI after emergency PCI was 0.699(95%CI:0.579-0.819,P=0.007),the best cut-off value of EPI level was 528.54,the sensitivity was 78.9%,and the specificity was 56.8%.The incidence of MACE in the high EPI level group was significantly higher than that in the low EPI group(P=0.005).③Kaplan-Meier survival curve showed that the higher the EPI level value,the higher the risk of MACE(log-rank test P=0.004).④Multivariate COX regression analysis showed that age(P=0.042),FT3(P=0.000),EPI level(P=0.000)and Gensini score(P=0.004)were independent risk factors for MACE.Conclusions①EPI level significantly correlates with the occurrence of MACE in patients with STEMI after emergency PCI.EPI level has predictive value for MACE in patients with STEMI after emergency PCI.The higher the EPI value,the higher the risk of MACE.②Multivariate COX regression analysis show that EPI level is independent risk factor for MACE in patients with STEMI after emergency PCI.