Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
BMJ Open. 2019 Aug 8;9(8):e025648. doi: 10.1136/bmjopen-2018-025648.
Alkaline phosphatase (ALP) can promote vascular calcification, but the association between ALP and in-hospital mortality in patients with acute coronary syndrome (ACS) is not well defined.
A prospective cohort study.
A total of 6368 patients with ACS undergoing percutaneous coronary intervention (PCI) from 1 January 2010 to 31 December 2017 were analysed.
In-hospital mortality was used in this study.
ALP was analysed both as a continuous variable and according to three categories. After multivariable adjustment, in-hospital mortality was significantly higher in Tertile 3 group (ALP＞85 U/L) (OR: 2.399, 95% CI 1.080 to 5.333, p=0.032), compared with other two groups (Tertile 1: ＜66 U/L; Tertile 2: 66-85 U/L). When ALP was evaluated as a continuous variable, after multivariable adjustment, the ALP level was associated with an increased risk of in-hospital mortality (OR: 1.011, 95% CI 1.002 to 1.020, p=0.014). C-statistic of ALP for predicting in-hospital mortality was 0.630 (95% CI 0.618 to 0.642, p=0.001). The cut-off value was 72 U/L with a sensitivity of 0.764 and a specificity of 0.468. However, ALP could not significantly improve the prognostic performance of Global Registry of Acute Coronary Events (GRACE) score (GRACE score+ALP vs GRACE score: C-statistic: z=0.485, p=0.628; integrated discrimination improvement: 0.014, p=0.056; net reclassification improvement: 0.020, p=0.630).
In patients with ACS undergoing PCI, ALP was an independent predictor of in-hospital mortality. But it could not improve the prognostic performance of GRACE score.
碱性磷酸酶（ALP）可促进血管钙化，但 ALP 与急性冠状动脉综合征（ACS）患者院内死亡率之间的关系尚不清楚。
前瞻性队列研究。
本研究共纳入 2010 年 1 月 1 日至 2017 年 12 月 31 日期间接受经皮冠状动脉介入治疗（PCI）的 6368 例 ACS 患者。
本研究采用院内死亡率。
ALP 连续变量和三分位值两种方式进行分析。多变量调整后，第三分位组（ALP＞85 U/L）（比值比：2.399，95%置信区间：1.080 至 5.333，p=0.032）的院内死亡率显著高于其他两组（第 1 分位组：＜66 U/L；第 2 分位组：66-85 U/L）。当 ALP 连续变量评估时，多变量调整后，ALP 水平与院内死亡率增加相关（比值比：1.011，95%置信区间：1.002 至 1.020，p=0.014）。ALP 预测院内死亡率的 C 统计量为 0.630（95%置信区间：0.618 至 0.642，p=0.001）。截断值为 72 U/L，敏感性为 0.764，特异性为 0.468。然而，ALP 并不能显著改善全球急性冠状动脉事件注册（GRACE）评分的预后性能（GRACE 评分+ALP 与 GRACE 评分：C 统计量：z=0.485，p=0.628；综合判别改善：0.014，p=0.056；净重新分类改善：0.020，p=0.630）。
在接受 PCI 的 ACS 患者中，ALP 是院内死亡率的独立预测因子。但它不能提高 GRACE 评分的预后性能。
