血浆致动脉粥样硬化指数对老年急性ST段抬高型心肌梗死患者预后的预测价值

Prognostic value of atherogenic index of plasma in elderly patients with acute ST-segment elevation myocardial infarction

目的 探讨血浆致动脉粥样硬化指数(atherogenic index of plasma, AIP)对老年急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)患者发生主要不良心血管事件(major adverse cardiovascular events, MACE)的预测价值。方法 回顾性选取2023年1月至5月于河北大学附属医院心血管内科就诊且行冠状动脉介入治疗的老年急性STEMI患者355例,电话回访到343患者。根据AIP四分位数水平分为A1组84例(<0.212)、A2组87例(0.212~0.339)、A3组86例(0.339~0.434)和A4组86例(≥0.434)。随访1年,观察心源性死亡、非致死性心肌梗死、缺血驱动的靶血管重建和心力衰竭再住院的发生率;构建Kaplan-Meier生存曲线比较4组MACE发生率;采用ROC曲线分析AIP的预测价值。结果 在1年随访期间,4组缺血驱动的靶血管血运重建、心力衰竭再住院、非致死性急性心肌梗死比例比较,差异有统计学意义(P<0.05,P<0.01)。4组累计生存率比较,差异有统计学意义(log rankχ^(2)=8.528,P=0.036)。多因素Cox比例风险回归分析显示,性别、高血压、心房颤动、多支血管病变、左主干病变、支架个数、SYNTAX评分、Killip分级、B型钠尿肽、糖化血红蛋白、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、AIP为老年急性STEMI患者发生MACE的独立预测因素。AIP对MACE预测的敏感性为66.7%,特异性为93.0%,曲线下面积为0.855(95%CI:0.776~0.933);联合预测的敏感性为100.0%,特异性为90.7%,曲线下面积为0.907(95%CI:0.954~0.987),联合预测的曲线下面积显著优于单独预测(P<0.05)。结论 AIP是一个强有力的生物标志物,可用于预测冠状动脉介入治疗的老年急性STEMI患者的预后,与Killip分级、SYNTAX评分、糖化血红蛋白、支架个数联合预测效能更好。

Objective To investigate the prognostic value of atherogenic index of plasma(AIP)for the occurrence of major adverse cardiovascular events(MACE)in elderly patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 355 elderly patients with acute STEMI who received coronary interventional therapy in Department of Cardiology,Affiliated Hospital of Hebei University from January to May 2023 were recruited retrospectively,and finally 343 of them with complete telephone follow-up data were included in this study.According to their AIP quartile level,they were divided into A1 group(<0.212,84 cases),A2 group(0.212-0.339,87 cases),A3 group(0.339-0.434,86 cases)and A4 group(≥0.434,86 cases).The incidences of cardiac death,nonfatal myocardial infarction,ischemia-driven target vessel remodeling and heart failure re-hospitalization were observed during 1-year follow-up.Kaplan-Meier survival curve was plotted to compare the incidence of MACE in the 4 groups.ROC curve analysis was employed to determine the predictive value of AIP.Results During 1-year follow-up,significant differences were observed in the proportions of ischemia-driven target vessel revascularization,heart failure re-hospitalization and non-fatal acute myocardial infarction among the 4 groups(P<0.05,P<0.01),and such difference was also seen in the cumulative survival rate among them(log rankχ^(2)=8.528,P=0.036).Multivariate Cox proportional hazards regression analysis showed that gender,hypertension,atrial fibrillation,multi-vessel disease,left main artery disease,number of stents,SYNTAX score,Killip grade,BNP,HbA1c,TC,LDL-C and HDL-C levels,and AIP were independent predictors of MACE.The AUC value of AIP in predicting MACE in elderly patients with acute STEMI was 0.855(95%CI:0.776-0.933),with a sensitivity of 66.7%and a specificity of 93.0%.When the above indicators combined together,the AUC value was 0.907(95%CI:0.954-0.987),and the sensitivity and specificity was 100.0%and 90.7%,respectively.The AUC value of combined prediction was significantly better than that of single indicator(P<0.05).Conclusion AIP is a powerful biomarker,and can be used to predict the prognosis of elderly acute STEMI after coronary interventional therapy,and it combined with Killip grade,SYNTAX score,HbA1c,and number of stents shows better predictive efficacy.