Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
Medicine (Baltimore). 2022 Nov 11;101(45):e31738. doi: 10.1097/MD.0000000000031738.
A significant proportion of patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI) have a totally occluded culprit artery (OCA). If these patients do not meet very high-risk criteria, they may be deprived of an immediate invasive strategy. Therefore, there is a need for markers that can predict OCA in patients with NSTEMI. A total of 357 consecutive patients with NSTEMI but without very high-risk criteria were included in this retrospective study. Two groups were formed: NSTEMI with OCA (n = 106) and NSTEMI with patent culprit artery (PCA) (n = 251). Complete blood count (CBC) and serum biochemical parameters obtained immediately at admission were compared between the groups. Receiver operating characteristic (ROC) analysis to predict the presence of OCA was performed for the parameters that were significantly different between the groups, and an area under the curve (AUC) > 0.7 was considered to suggest acceptable discrimination. Neutrophil count [8.13 (2.82-27.88) × 103/µL vs 5.59 (1.85-19.71) × 103/µL, P < .001] and aspartate aminotransferase (AST) level [45 (12-405) U/L vs 25 (5-143) U/L, P < .001] were significantly higher in patients with OCA. The AUC was 0.750 for neutrophil count and 0.731 for AST level. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of elevated neutrophil and/or AST levels for the presence of OCA were 77.4%, 70.1%, 52.2%, and 88.0%, respectively. More strikingly, the specificity was 95.2% in the presence of both neutrophil and AST elevation. Elevated neutrophil and/or AST levels at admission were strongly associated with the presence of OCA in patients with NSTEMI.
连续 357 例非 ST 段抬高型心肌梗死（NSTEMI）但不具备极高危标准的患者被纳入本回顾性研究。将这些患者分为两组：罪犯血管完全闭塞（OCA）的 NSTEMI 患者（n=106）和罪犯血管未完全闭塞（PCA）的 NSTEMI 患者（n=251）。比较两组入院时即刻的全血细胞计数（CBC）和血清生化参数。对两组间有显著差异的参数进行接受者操作特征（ROC）分析，以预测 OCA 的存在，曲线下面积（AUC）>0.7 被认为具有可接受的鉴别力。OCA 组的中性粒细胞计数[8.13（2.82-27.88）×103/μL 比 5.59（1.85-19.71）×103/μL，P<0.001]和天冬氨酸转氨酶（AST）水平[45（12-405）U/L 比 25（5-143）U/L，P<0.001]明显更高。中性粒细胞计数和 AST 水平的 AUC 分别为 0.750 和 0.731。中性粒细胞和/或 AST 水平升高对 OCA 存在的敏感性、特异性、阳性预测值和阴性预测值（NPV）分别为 77.4%、70.1%、52.2%和 88.0%。更引人注目的是，当同时存在中性粒细胞和 AST 升高时，特异性为 95.2%。入院时升高的中性粒细胞和/或 AST 水平与 NSTEMI 患者 OCA 的存在密切相关。
