摘要
目的探讨生物标志物复合评分法对接受经皮冠状动脉介入治疗(PCI)的急性冠状动脉综合征(ACS)患者发生缺血事件的预测价值。方法回顾性分析北部战区总医院心血管内科自2016年3月至2019年3月收治的6456例接受PCI的ACS患者的临床资料。根据患者住院期间生物标志物水平(高敏肌钙蛋白T≥0.1μg/L、N端B型利钠肽≥450.0 pg/ml、高敏C反应蛋白≥2.0 mg/L为升高,每个升高的生物标志物记为1分),将患者分入低风险组(0~1个生物标志物升高n=2450)、中风险组(2个生物标志物升高n=1704)、高风险组(3个生物标志物升高n=2302)。比较3组患者的一般资料、手术资料、出院后用药情况及结局事件,分析生物标志物评分与12个月内缺血事件的关系。结果3组患者年龄、性别、冠状动脉粥样硬化性心脏病类型、肾小球滤过率、左室射血分数、高敏肌钙蛋白T、N端B型利钠肽、高敏C反应蛋白,以及既往高血压、糖尿病、心肌梗死、卒中、PCI、吸烟比例比较,差异均有统计学意义(P<0.05)。3组患者支架个数、支架总长度、SYN-TAX评分,以及桡动脉入路、靶血管位置在左主干和左回旋支比例比较,差异均有统计学意义(P<0.05)。3组患者阿司匹林、P2Y12抑制剂、他汀类、血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体拮抗剂使用率比较,差异均有统计学意义(P<0.05)。3组患者12个月缺血事件、心原性死亡、全因死亡发生率比较,差异均有统计学意义(P<0.05)。在缺血事件中,中风险组比低风险组风险比为2.38(95%可信区间1.60~3.52,P<0.001),高风险组比低风险组风险比为2.55(95%可信区间1.76~3.70,P<0.001)。结论对于接受PCI的ACS患者,采用生物标志物复合评分法可以较准确地预测出院后12个月缺血事件的发生风险。
Objective To explore the value of biomarker composite score in predicting ischemic events in patients with acute coronary syndromes(ACS)receiving percutaneous coronary intervention(PCI).Methods The clinical data of 6456 patients with ACS who underwent PCI from March 2016 to March 2019 in the Department of Cardiology of General Hospital of Northern Theater Command were retrospectively analyzed.Biomarker levels(high sensitivity troponin-T≥0.1μg/L,N-terminal pro-B type natriuretic peptide≥450.0 pg/ml,high-sensitivity C-reactive protein≥2.0 mg/L)were elevated during hospitalization,and each elevated biomarker was marked as 1 point.Patients were divided into a low-risk group(0 to 1 biomarker elevated,n=2,450),a medium-risk group(2 biomar-kers elevated,n=1,704),and a high-risk group(3 biomarkers elevated,n=2,302).The general data,surgical data,post-discharge medication and outcome events of the 3 groups were compared,and the relationship between biomarker scores and ischemia events within 12 months was analyzed.Results There were significant differences in age,sex,type of coronary artery disease,glomerular fil-ter rate,left ventricular ejection fraction,high sensitivity troponin-T,N-terminal pro-B type natriuretic peptide,high-sensitivity C-reac-tive protein,and the proportion of previous hypertension,diabetes,myocardial infarction,stroke,PCI and smoking among 3 groups(P<0.05).There were statistically significant differences in the number of stents,total length of stents,SYNTAX score,proportion of radial artery approach and target vessel location in the left main and left circumflex branches among 3 groups(P<0.05).There was statisti-cal significance in the utilization rate of aspirin,P2Y12 inhibitor,statins,angiotensin-converting enzyme inhibitor/angiotensin-Ⅱrecep-tor antagonist among 3 groups(P<0.05).There were statistically significant differences in the incidence of 12-month ischemic e-vents,cardiac death and all-cause death among 3 groups(P<0.05).In ischemic events,the hazard ratio of the medium-risk grou
作者
曹伊楠
裘淼涵
严育东
惠曼
党丹
田浩甫
李颖颖
李丰怡
李毅
韩雅玲
CAO Yi-nan;QIU Miao-han;YAN Yu-dong;HUI Man;DANG Dan;TIAN Hao-fu;LI Ying-ying;LI Feng-yi;LI Yi;HAN Ya-ling(The Second Cadre Ward;Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,China;Jinzhou Medical University,Jinzhou 121001,China)
出处
《临床军医杂志》
CAS
2023年第10期1003-1007,共5页
Clinical Journal of Medical Officers
基金
国家重点研发计划项目(2022YFC2503500)
国家重点研发计划项目(2022YFC2503504)。
关键词
生物标志物
急性冠状动脉综合征
高敏C反应蛋白
高敏肌钙蛋白T
N端B型利钠肽
预后
经皮冠状动脉介入治疗
缺血事件
Biomarker
Acute coronary syndrome
High-sensitivity C-reactive protein
High sensitivity troponin-T
N-termi-nal pro-B type natriuretic peptide
Prognosis
Percutaneous coronary intervention
Ischemic events
