Lang Yong, Ran Xun, Wang Lin, Li Wei
Department of Cardiology, Shangjin District of West China Hospital, Sichuan University, Chengdu 611743, China.
Department of Cardiology, Affiliated Hospital of Guizhou Medical University, Guizhou 550002, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2019 Dec;50(6):941-945.
To explore the risk factors of 12-month mortality in patients with acute ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI), and to evaluate the combined use of inflammatory factor complement Cq1/tumor necrosis factor-related protein-1 (CTRP-1) with global acute coronary event registration (GRACE) score in the patients with STEMI after PCI in terms of prognostic prediction for 12-month mortality risk.
326 acute STEMI patients were included retrospectively, with 33 patients in the death group and 293 patients in the survival group. Clinical data of patients and serum CTRP-1 concentration detected by enzyme-linked immunosorbent assay (ELISA) were collected, and all patients were evaluated by GRACE score. The cut-off point of CTRP-1 for predicting mortality was determined by receiver operating characteristic (ROC) curve. Cox regression model was used to analyze the risk factors of death. The predictive value of CTRP-1 combined with GRACE score was tested by Kaplan-Meier survival analysis.
Compared with the survival group, the average arterial pressure, left ventricular ejection fraction (LVEF) and left main lesion rate were lower, creatinine and troponin T were higher in the death group ( < 0.05). The mass concentration of CTRP-1 in the death group was higher than that in the survival group ( < 0.001). The proportion of patients in the high-risk group of GRACE score was 66.7% in the death group and 20.1% in the survival group. The area under the ROC curve of CTRP-1 was 0.874 ( < 0.001), and the sensitivity and specificity of predicting death were 92.5% and 73.6% respectively with the cut-off point of CTRP-1 187.9 ng/mL. Cox regression model showed that mean arterial pressure, LVEF, GRACE score and high CTRP-1 (>187.9 ng/mL) were independent risk factors for predicting death. Survival analysis showed that the cumulative survival rate of patients with high CTRP-1 level was lower than low CTRP-1 level in the high-risk group of GRACE score ( < 0.001).
Mean arterial pressure, LVEF value, GRACE score and CTRP-1 are risk factors for predicting mortality. Combined application of CTRP-1 with GRACE score has clinical value in prognostic evaluation of acute STEMI patients.
探讨急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）后12个月死亡率的危险因素，并评估炎症因子补体Cq1/肿瘤坏死因子相关蛋白-1（CTRP-1）与全球急性冠状动脉事件注册（GRACE）评分联合应用对PCI术后STEMI患者12个月死亡风险的预后预测价值。
回顾性纳入326例急性STEMI患者，其中死亡组33例，存活组293例。收集患者的临床资料及采用酶联免疫吸附测定（ELISA）法检测的血清CTRP-1浓度，所有患者均进行GRACE评分。通过受试者工作特征（ROC）曲线确定CTRP-1预测死亡率的截断点。采用Cox回归模型分析死亡的危险因素。通过Kaplan-Meier生存分析检验CTRP-1联合GRACE评分的预测价值。
与存活组比较，死亡组平均动脉压、左心室射血分数（LVEF）及左主干病变率较低，肌酐及肌钙蛋白T较高（均P<0.05）。死亡组CTRP-1的质量浓度高于存活组（P<0.001）。GRACE评分高危组患者比例在死亡组为66.7%，在存活组为20.1%。CTRP-1的ROC曲线下面积为0.874（P<0.001），CTRP-1预测死亡的敏感度和特异度分别为92.5%和73.6%，截断点为187.9 ng/mL。Cox回归模型显示平均动脉压、LVEF、GRACE评分及高CTRP-1（>187.9 ng/mL）是预测死亡的独立危险因素。生存分析显示，在GRACE评分高危组中，CTRP-1水平高的患者累积生存率低于CTRP-1水平低的患者（P<0.001）。
平均动脉压、LVEF值、GRACE评分及CTRP-1是预测死亡率的危险因素。CTRP-1与GRACE评分联合应用对急性STEMI患者的预后评估具有临床价值。
