Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Urumqi, China.
BMJ Open. 2020 Feb 18;10(2):e031227. doi: 10.1136/bmjopen-2019-031227.
A combined equation based on white cell count (WCC) and total bilirubin (TB) was assessed for its ability to predict adverse clinical outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PCI).
A single-centre, prospective cohort study.
The First Affiliated Hospital of Xinjiang Medical University.
A total of 615 patients with STEMI postprimary PCI were enrolled. WCC and TB were collected at admission. Logistic regression was used to determine the combined equation. The primary endpoints were in-hospital mortality and major adverse cardiovascular events (MACE), which composed of cardiac death, cardiac shock, malignant arrhythmia (ventricular tachycardia, ventricular fibrillation), severe cardiac insufficiency, non-fatal myocardial infarction, angina pectoris readmission, severe cardiac insufficiency (cardiac III-IV level), stent restenosis and target vessels revascularisation during the hospitalisation and 36 months follow-up period.
77 patients occurred in MACE during the hospitalisation (17 in-hospital mortality). WCC and TB were taken as an independent variables to make a category of logistic regression analysis of in-hospital MACE, the logistic regression model was: logit (P)=-8.00+0.265 WCC+0.077 TB, the combination of WCC and TB was more valuable on evaluating the in-hospital mortality (area under the curve 0.804, 95% CI 0.678 to 0.929, p<0.001). Multivariate logistic regression analysis showed that combined detection was an independent risk factor for in-hospital MACE (OR 5.85, 95% CI 3.425 to 9.990, p=0.032). During the follow-up period, 172 patients (29.5%) developed MACE. But the combined detection did not predict the long-term clinical outcome.
The combination of WCC and TB is an independent predictor for in-hospital outcomes in patients with STEMI than single detection.
评估基于白细胞计数（WCC）和总胆红素（TB）的联合方程在接受直接经皮冠状动脉介入治疗（PCI）的急性 ST 段抬高型心肌梗死（STEMI）患者中预测不良临床结局的能力。
单中心前瞻性队列研究。
新疆医科大学第一附属医院。
共纳入 615 例直接 PCI 后 STEMI 患者。入院时采集 WCC 和 TB。使用逻辑回归确定联合方程。主要终点为住院期间和 36 个月随访期间的院内死亡率和主要不良心血管事件（MACE），MACE 由心脏死亡、心源性休克、恶性心律失常（室性心动过速、心室颤动）、严重心功能不全、非致死性心肌梗死、心绞痛再入院、严重心功能不全（心功能 III-IV 级）、支架再狭窄和靶血管血运重建组成。
住院期间 77 例发生 MACE（17 例院内死亡）。WCC 和 TB 作为自变量进行住院 MACE 的逻辑回归分类分析，逻辑回归模型为：logit（P）=-8.00+0.265 WCC+0.077 TB，WCC 和 TB 的联合对评估院内死亡率更有价值（曲线下面积 0.804，95%CI 0.678 至 0.929，p<0.001）。多变量逻辑回归分析显示，联合检测是住院 MACE 的独立危险因素（OR 5.85，95%CI 3.425 至 9.990，p=0.032）。随访期间，172 例（29.5%）患者发生 MACE，但联合检测不能预测长期临床结局。
与单一检测相比，WCC 和 TB 的联合检测是 STEMI 患者住院期间结局的独立预测指标。
