Chen Y, Song Y, Xu J J, Tang X F, Wang H H, Jiang P, Jiang L, Liu R, Zhao X Y, Gao L J, Song L, Zhang Y, Chen J, Gao Z, Qiao S B, Yang Y J, Gao R L, Xu B, Yuan J Q
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2018 Nov 24;46(11):874-881. doi: 10.3760/cma.j.issn.0253-3758.2018.11.011.
To investigate the relationship between thrombolysis in myocardial infarction risk index(TRI) and the severity of coronary artery lesions and long-term outcome in acute myocardial infarction(AMI) patients undergoing percutaneous coronary intervention(PCI). A total of 1 663 consecutive AMI patients undergoing PCI between January and December 2013 in Fuwai hospital were prospectively included in this study. The severity of coronary artery lesions was evaluated using the SYNTAX score. Receiver operating characteristic(ROC) curve was used to analyze the optimal cut-off value of TRI on predicting all-cause mortality at 2 years after PCI.The patients were divided into 2 groups based on the optimal cut-off value of TRI:high TRI group (TRI ≥ 23.05, 465 cases) and low TRI group(TRI<23.05, 1 198 cases). Multivariate logistic regression analyses were used for determining the relationship between TRI and SYNTAX scores≥33. A multivariate Cox regression analyses was used to identify the influence factors of long-term outcome after PCI. SYNTAX score was higher in high TRI group than in low TRI group (13.00(7.00, 20.50) vs.10.25(7.00, 17.00), 0.001). TRI was independently associated with SYNTAX score ≥ 33 (1.09,95% 1.03-1.16, 0.004). After the 2 years follow-up, rates of all-cause death (4.1% (19/465) vs. 0.3% (4/1 198) , 0.001), cardiac death (2.6% (12/465) vs. 0.2% (2/1 198) , 0.001) and stent thrombosis (1.7% (8/465) vs. 0.5% (6/1 198) , 0.015) were all significantly higher in high TRI group than in low TRI group. Multivariate Cox regression analyses showed that TRI≥ 23.05 was an independent risk factor of all-cause death (=5.22, 95% 1.63-16.72, 0.005), cardiac death (=8.48, 95% 1.75-41.07, 0.008) and stent thrombosis(=3.87, 95% 1.32-11.41, 0.014) at 2 years after PCI in AMI patients, but which was not the independent risk factor of major adverse cardiovascular and cerebrovascular events (=0.96, 95% 0.69-1.36, 0.834) .The area under ROC curve of TRI ≥ 23.05 on predicting 2 years all-cause mortality in AMI patients undergoing PCI was 0.803(95% 0.711-0.894, 0.001). TRI is independently associated with SYNTAX score ≥ 33. TRI is also an independent risk factor of 2 years all-cause death, cardiac death and stent thrombosis in AMI patients undergoing PCI.
探讨心肌梗死溶栓风险指数（TRI）与接受经皮冠状动脉介入治疗（PCI）的急性心肌梗死（AMI）患者冠状动脉病变严重程度及长期预后的关系。前瞻性纳入2013年1月至12月在阜外医院连续接受PCI的1663例AMI患者。采用SYNTAX评分评估冠状动脉病变的严重程度。采用受试者操作特征（ROC）曲线分析TRI预测PCI术后2年全因死亡率的最佳截断值。根据TRI的最佳截断值将患者分为两组：高TRI组（TRI≥23.05，465例）和低TRI组（TRI<23.05，1198例）。采用多因素logistic回归分析确定TRI与SYNTAX评分≥33之间的关系。采用多因素Cox回归分析确定PCI术后长期预后的影响因素。高TRI组的SYNTAX评分高于低TRI组（13.00（7.00，20.50）对10.25（7.00，17.00），P=0.001）。TRI与SYNTAX评分≥33独立相关（比值比1.09，95%可信区间1.03-1.16，P=0.004）。随访2年后，高TRI组的全因死亡率（4.1%（19/465）对0.3%（4/1198），P=0.001）、心源性死亡率（2.6%（12/465）对0.2%（2/1198），P=0.001）和支架血栓形成率（1.7%（8/465）对0.5%（6/1198），P=0.015）均显著高于低TRI组。多因素Cox回归分析显示，TRI≥23.05是AMI患者PCI术后2年全因死亡（风险比5.22，95%可信区间1.63-16.72，P=0.005）、心源性死亡（风险比8.48，95%可信区间1.75-41.07，P=0.008）和支架血栓形成（风险比3.87，95%可信区间1.32-11.41，P=0.014）的独立危险因素，但不是主要不良心血管和脑血管事件的独立危险因素（风险比0.96，95%可信区间0.69-1.36，P=0.834）。TRI≥23.05预测接受PCI的AMI患者2年全因死亡率的ROC曲线下面积为0.803（95%可信区间0.711-0.894，P=0.001）。TRI与SYNTAX评分≥33独立相关。TRI也是接受PCI的AMI患者2年全因死亡、心源性死亡和支架血栓形成的独立危险因素。
