Zhang Lin, Wang Zijian, Lu Xia, Gan Feng
Department of Cardiology, Beijing Aerospace General Hospital, Beijing, China.
Department of Nuclear Medicine, Beijing Anzhen Hospital, Beijing, China.
Ann Transl Med. 2023 Mar 15;11(5):214. doi: 10.21037/atm-23-1079.
Percutaneous coronary intervention (PCI) is currently the main treatment of acute ST-segment elevated myocardial infarction (STEMI), whereafter various postoperative adverse events often occur. Central arterial pressure (CAP) is closely related to the pathophysiological process of cardiovascular disease, and its relationship with outcomes after PCI in STEMI patients remains unclear. The aim of this study was to observe the relationship between pre-PCI CAP and in-hospital outcomes in STEMI patients which might be helpful to evaluate prognosis.
A total of 512 STEMI patients who underwent emergency PCI were included. Baseline data and CAP information before PCI and in-hospital outcomes were collected. Multivariate logistic regression was used to adjust for confounding factors. Potential non-linear relationships between CAP and in-hospital outcomes were described using a restricted cubic bar plot. The area under the receiver operating characteristic (ROC) curve (AUC), net reclassification index, and composite discriminant improvement index were used to analyze the correlation between CAP and outcomes during hospitalization.
Among the 512 patients, 116 experienced at least 1 in-hospital major adverse cardiovascular events (MACEs), with an incidence rate of 22.60%. Among CAP indicators, higher [>137.5 mmHg, OR =2.70, 95% confidence interval (CI): 1.20-6.06] or lower (<102 mmHg, OR =7.55, 95% CI: 3.45-16.52) central systolic pressure (CSP), lower (<61 mmHg, OR =2.78, 95% CI: 1.36-5.67) central diastolic pressure (CDP), higher (>55 mmHg, OR =2.09, 95% CI: 1.01-4.31) or lower (<29 mmHg, OR =3.28, 95% CI: 1.54-7.00) central pulse pressure (CPP), and higher (>101 mmHg, OR =2.07, 95% CI: 1.01-4.61) or lower (<76 mmHg, OR =4.91, 95% CI: 2.31-10.44) central mean pressure (CMP) were independent risk factors for MACEs. The relationship between CSP and CMP and in-hospital outcomes showed a "J"-shaped relationship, CDP and in-hospital outcomes showed an "L"-shaped relationship, and CPP and in-hospital outcomes showed a "U"-shaped relationship. There was no statistical difference in the prediction ability of in-hospital outcomes detected between CSP, CDP, and CMP (P>0.05), but the comparison of the 3 with CPP was statistically significant (P<0.05).
CSP, CDP, and CMP have certain predictive ability for postoperative in-hospital outcomes in STEMI patients and can be used during percutaneous intervention.
经皮冠状动脉介入治疗（PCI）是目前急性ST段抬高型心肌梗死（STEMI）的主要治疗方法，术后常发生各种不良事件。中心动脉压（CAP）与心血管疾病的病理生理过程密切相关，其与STEMI患者PCI术后结局的关系尚不清楚。本研究旨在观察STEMI患者PCI术前CAP与院内结局的关系，这可能有助于评估预后。
共纳入512例行急诊PCI的STEMI患者。收集PCI术前的基线数据、CAP信息及院内结局。采用多因素逻辑回归调整混杂因素。使用受限立方条图描述CAP与院内结局之间的潜在非线性关系。采用受试者工作特征（ROC）曲线下面积（AUC）、净重新分类指数和综合判别改善指数分析CAP与住院期间结局的相关性。
512例患者中，116例发生至少1次院内主要不良心血管事件（MACE），发生率为22.60%。在CAP指标中，较高[>137.5 mmHg，比值比（OR）=2.70，95%置信区间（CI）：1.20-6.06]或较低（<102 mmHg，OR =7.55，95%CI：3.45-16.52）的中心收缩压（CSP）、较低（<61 mmHg，OR =2.78，95%CI：1.36-5.67）的中心舒张压（CDP）、较高（>55 mmHg，OR =2.09，95%CI：1.01-4.31）或较低（<29 mmHg，OR =3.28，95%CI：1.54-7.00）的中心脉压（CPP）以及较高（>101 mmHg，OR =2.07，95%CI：1.01-4.61）或较低（<76 mmHg，OR =4.91，95%CI：2.31-10.44）的中心平均压（CMP）是MACE的独立危险因素。CSP和CMP与院内结局的关系呈“J”形，CDP与院内结局的关系呈“L”形，CPP与院内结局的关系呈“U”形。CSP、CDP和CMP对院内结局的预测能力差异无统计学意义（P>0.05），但这三者与CPP比较差异有统计学意义（P<0.05）。
CSP、CDP和CMP对STEMI患者术后院内结局具有一定的预测能力，可在经皮介入治疗期间使用。
