Wang Ji-Xiang, Gao Jing, Xiao Jian-Yong, Gao Ming-Dong, Zhang Nan, Lu Peng-Ju, Liu Yin
Cardiology Institute, Tianjin Chest Hospital, Tianjin 300222, China.
Institute of Cardiovascular Diseases, Tianjin Chest Hospital, Tianjin 300222, China.
Appl Bionics Biomech. 2022 Apr 29;2022:7614619. doi: 10.1155/2022/7614619. eCollection 2022.
To investigate the relevance between interventional time and clinical outcomes in non-ST-elevation myocardial infarction (NSTEMI) patients of different risk stratifications, which were divided into different groups according to GRACE scores and the time from admission to percutaneous coronary intervention (PCI).
Patients were grouped according to the GRACE score and the time from admission to intervention therapy. The Cox multivariate risk regression model was used to analyze the correlation between the GRACE score and the time from admission to intervention therapy with major adverse cardiovascular events (MACEs). Cox interactive item regression was also used to investigate the correlation between the time of intervention therapy and GRACE risk stratification with clinical outcomes and to evaluate the efficacy of intervention therapy in different risk stratifications of patients with NSTEMI.
Interactive item Cox regression analysis and subgroup analysis show that high-risk NSTEMI patients with a GRACE score > 140 points and the time from admission to intervention < 24 h ( = 0.0004) and 24-72 h ( = 0.0143) have interactive effects on the impact of the MACE event with the reference of intervention time > 72 h and GRACE score < 108 points. The time from admission to intervention < 24 h is an independent protective factor for the occurrence of MACE events (HR = 0.166, 95% CI 0.052-0.532, = 0.0025). Middle-risk patients with NSTEMI with a GRACE score of 109-140 points and the time from admission to intervention < 24 h ( = 0.0370) and 24-72 h ( = 0.0471) have an interactive effect on the impact of MACE. The time from admission to intervention > 72 h is an independent protective factor for the occurrence of MACE (HR = 0.201, 95% CI 0.045-0.897, = 0.0355).
The time from admission to intervention < 24 h could effectively reduce the risk of MACE events within 1 year in high-risk patients with NSTEMI (GRACE score > 140 points); the time from admission to intervention > 72 h can reduce the risk of MACE events within 1 year in low-risk patients with NSTEMI (GRACE score ≤ 108 points).
探讨不同危险分层的非ST段抬高型心肌梗死（NSTEMI）患者介入时间与临床结局之间的相关性，这些患者根据全球急性冠状动脉事件注册（GRACE）评分以及从入院到经皮冠状动脉介入治疗（PCI）的时间分为不同组。
根据GRACE评分和从入院到介入治疗的时间对患者进行分组。采用Cox多因素风险回归模型分析GRACE评分和从入院到介入治疗的时间与主要不良心血管事件（MACE）之间的相关性。还采用Cox交互项回归分析介入治疗时间与GRACE危险分层与临床结局之间的相关性，并评估介入治疗在不同危险分层的NSTEMI患者中的疗效。
交互项Cox回归分析和亚组分析显示，GRACE评分>140分且从入院到介入时间<24小时（P = 0.0004）和24 - 72小时（P = 0.0143）的高危NSTEMI患者，以介入时间>72小时且GRACE评分<108分为参照，对MACE事件的影响存在交互作用。从入院到介入时间<24小时是MACE事件发生的独立保护因素（HR = 0.166，95%CI 0.052 - 0.532，P = 0.0025）。GRACE评分为109 - 140分且从入院到介入时间<24小时（P = 0.0370）和24 - 72小时（P = 0.0471）的中危NSTEMI患者对MACE的影响存在交互作用。从入院到介入时间>72小时是MACE发生的独立保护因素（HR = 0.201，95%CI 0.045 - 0.897，P = 0.0355）。
从入院到介入时间<24小时可有效降低高危NSTEMI患者（GRACE评分>140分）1年内发生MACE事件的风险；从入院到介入时间>72小时可降低低危NSTEMI患者（GRACE评分≤108分）1年内发生MACE事件的风险。
