Li Sheng-Yu, Liu Lei, Wang Ding-Kun, Ding Xiao-Song, Li Wei-Ping, Li Hong-Wei
Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, People's Republic of China.
J Inflamm Res. 2023 Mar 22;16:1255-1266. doi: 10.2147/JIR.S393703. eCollection 2023.
So far, ST-segment elevation myocardial infarction (STEMI) is still the main cause of morbidity and mortality of cardiovascular diseases worldwide. Recent studies showed that pentraxin-3 (PTX3) was related to the early diagnosis and prognosis of coronary heart disease. This study aimed to investigate the dynamical change of PTX3 after primary percutaneous coronary intervention (pPCI) in STEMI patients and its prognostic value.
In this prospective cohort study, a total of 350 patients were enrolled. The plasma level of PTX3 was measured at admission, 24-hour and 5-day after pPCI. The primary endpoint was the incidence of major adverse cardiac cerebral events (MACCEs) during 1-year follow-up.
Compared with the admission, PTX3 levels were significantly increased at 24 hours, and decreased at 5 days after pPCI in the whole cohort. PTX3 levels at these three time points were not significantly different between the patients with and without MACCEs. Notably, the change in PTX3 from admission to post-pPCI 24-hour (ΔPTX3) was higher in patients with MACCEs (112.83 vs 17.94 ng/dl, P = 0.001). The ROC curves showed that the cut-off value was 29.22 ng/dl and the area under curves was 0.622 (95% CI: 0.554-0.690, p = 0.001). Multivariable cox regression models revealed that the high ΔPTX3 group was an independent predictor of MACCEs (adjusted HR = 2.010, 95% CI = 1.280-3.186, p = 0.003). The higher ΔPTX3 group had significantly higher incidences of revascularization (HR = 2.094, 95% CI: 1.056-4.150, p = 0.034) and composite MACCEs (HR = 2.219, 95% CI: 1.425-3.454, p < 0.001). However, the change of PTX3 level from admission to post-pPCI 5-day had no independently predictive value.
The higher increase of PTX3 level 24-hour after pPCI appeared to have a potential value in independently predicting the incidence of 1-year MACCEs in STEMI patients, especially for coronary revascularization.
迄今为止，ST段抬高型心肌梗死（STEMI）仍是全球心血管疾病发病和死亡的主要原因。最近的研究表明，五聚体-3（PTX3）与冠心病的早期诊断和预后有关。本研究旨在探讨STEMI患者经皮冠状动脉介入治疗（pPCI）后PTX3的动态变化及其预后价值。
在这项前瞻性队列研究中，共纳入350例患者。在入院时、pPCI后24小时和5天时测量PTX3的血浆水平。主要终点是1年随访期间主要不良心脑血管事件（MACCEs）的发生率。
与入院时相比，整个队列中PTX3水平在pPCI后24小时显著升高，在5天时降低。发生和未发生MACCEs的患者在这三个时间点的PTX3水平无显著差异。值得注意的是，发生MACCEs的患者从入院到pPCI后24小时PTX3的变化（ΔPTX3）更高（112.83对17.94 ng/dl，P = 0.001）。ROC曲线显示，临界值为29.22 ng/dl，曲线下面积为0.622（95%CI：0.554 - 0.690，p = 0.001）。多变量cox回归模型显示，高ΔPTX3组是MACCEs的独立预测因子（校正HR = 2.010，95%CI = 1.280 - 3.186，p = 0.003）。较高的ΔPTX3组的血运重建发生率（HR = 2.094，95%CI：1.056 - 4.150，p = 0.034）和复合MACCEs发生率（HR = 2.219，95%CI：1.425 - 3.454，p < 0.001）显著更高。然而，从入院到pPCI后5天PTX3水平的变化没有独立预测价值。
pPCI后24小时PTX3水平的较高升高似乎在独立预测STEMI患者1年MACCEs的发生率方面具有潜在价值，尤其是对于冠状动脉血运重建。
