摘要
目的探讨全球急性冠状动脉事件注册(GRACE)评分联合血浆氧化三甲胺(TMAO)水平与急性ST段抬高型心肌梗死(STEMI)患者接受直接经皮冠状动脉介入(PCI)治疗后院内主要心血管不良事件(MACE)的关系及预测价值。方法连续入组2020年6~11月直接PCI治疗的急性STEMI患者105例作为研究对象,收集患者临床基线及冠脉手术资料,记录院内MACE(心力衰竭、恶性心律失常、靶血管再次血运重建和心源性死亡)发生情况。根据患者院内是否发生MACE分为MACE组和非MACE组,应用二元Logistic回归分析院内MACE的独立预测因子,绘制ROC曲线以评估GRACE评分、TMAO及两者联合对院内MACE的预测价值。结果共纳入105例患者,院内MACE发生率为15.2%。调整混杂因素后,二元Logistic回归分析显示GRACE评分(OR=1.043,95%CI 1.008~1.079,P=0.016),TMAO(OR=1.010,95%CI 1.000~1.019,P=0.044)是STEMI患者直接PCI术后院内MACE的独立预测因子。在院内MACE预测中,GRACE评分在ROC曲线下面积0.831(95%CI 0.685~0.977,P<0.01),189.5作为GRACE评分最佳临界值,灵敏度为75%,特异度为89.9%。TMAO在ROC曲线下面积0.759(95%CI 0.647~0.871,P=0.001),80.92作为TMAO评分最佳临界值,灵敏度为93.8%,特异度为48.3%。GRACE评分联合TMAO(联合预测因子)在ROC曲线下面积0.843(95%CI 0.703~0.983,P<0.01),972.25作为联合预测因子最佳临界值,灵敏度75%,特异度94.4%。联合预测因子与单一GRACE评分和单一TMAO的预测能力比较差异均无统计学意义(P>0.05)。结论GRACE评分、TMAO均是院内MACE的独立预测因子,GRACE评分联合TMAO可以预测STEMI患者PCI治疗后院内MACE的发生,但未体现出优于单一使用GRACE评分或TMAO的预测价值。
Objective To investigate the application value of global registry of acute coronary events risk(GRACE)score combined with plasma trimethylamine oxide(TMAO)in predicting the occurrence of inhospital major adverse cardiovascular events(MACE)in patients with acute ST segment elevation myocardial infarction(STEMI)after primary percutaneous coronary intervention(PCI).Methods A total of 105 patients with acute STEMI who were treated by PCI in our hospital from June 2020 to November 2020 were enrolled in the study.The clinical baseline and coronary operation data were collected,and the incidence rates of MACE(heart failure,malignant arrhythmia,target vessel revascularization and cardiogenic death)were recorded.According to whether the pateints had MACE,the patients were divided into MACE group and the non-MACE group.Binary logistic regression model was used to analyze the independent predictors of MACE.And ROC curves were used to evaluate the predictive value of GRACE score,and TMAO as well as combination detection of the two factors in predicting in-hospital MACE.Results Of the 105 patients,the incidence of inhospital MACE was 15.2%.After adjusting the confounding factors,binary logistic regression analysis showed GRACE score,TMAO were independent predictors of inhospital MACE after primary PCI in patients with STEMI(P<0.01),and the area under curve(AUC)of GRACE score was 0.831(P<0.01),and the optimal cut-off value was 189.5,with sensitivity being 75%and specificity being 89.9%.The AUC of TMAO was 0.759(P<0.01),and the optimal cut-off value was 80.92,with sensitivity being 93.8%and specificity being 48.3%.The AUC of GRACE score combined with TMAO was 0.843(P<0.01),and the optimal cut-off value was 972.25,with sensitivity being 75%and specificity being 94.4%.There was no significant difference in predictive power among the combined predictor,GRACE score only or TMAO only(P>0.05).Conclusion GRACE score and TMAO are independent predictors of inhospital MACE,and GRACE score combined with TMAO can predict the occurrence of
作者
马静红
高曼
杨倩
张飞飞
党懿
MA Jinghong;GAO Man;YANG Qian(Graduate School of Hebei North University,Hebei,Zhangjiakou 075000,China)
出处
《河北医药》
CAS
2022年第19期2911-2915,共5页
Hebei Medical Journal
