Gong Ming, Sasmita Bryan Richard, Zhu Yuansong, Chen Siyu, Wang Yaxin, Xiang Zhenxian, Jiang Yi, Luo Suxin, Huang Bi
Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, China.
Rev Cardiovasc Med. 2024 Jul 18;25(7):267. doi: 10.31083/j.rcm2507267. eCollection 2024 Jul.
Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) carries a high mortality risk. Inflammation and nutrition are involved in the pathogenesis and prognosis of both AMI and CS. The advanced lung cancer inflammation index ratio (ALI) combines the inflammatory and nutritional status. Our present study aimed to explore the prognostic value of ALI in patients with CS following AMI.
In total, 217 consecutive patients with AMI complicated by CS were divided into two groups based on the ALI admissions cut-off: 12.69 and 12.69. The primary endpoint of this study was 30-day all-cause mortality. The secondary endpoints were gastrointestinal hemorrhage and major adverse cardiovascular events (MACEs), including 30-day all-cause mortality, atrioventricular block, ventricular tachycardia/ventricular fibrillation, and nonfatal stroke. The association of ALI with the study endpoints was analyzed by Cox regression analysis.
During the 30-day follow-up period after admission, 104 (47.9%) patients died and 150 (69.1%) suffered MACEs. The Kaplan-Meier analysis revealed significantly higher cumulative mortality and lower MACE rates in the low-ALI group compared to the high-ALI group (both log-rank 0.001). The 30-day mortality rate was significantly higher in patients with ALI 12.69 compared to ALI 12.69 (72.1% vs. 22.6%; 0.001). Furthermore, the incidence of MACEs was higher in patients with ALI 12.69 (85.6% vs. 51.9%; 0.001). The receiver operating curve showed that ALI had a modest predictive value (area under the curve [AUC]: 0.789, 95% confidence interval [CI]: 0.729, 0.850). After multivariable adjustment, ALI 12.69 was an independent predictor for both 30-day all-cause mortality (hazard ratio [HR]: 3.327; 95% CI: 2.053, 5.389; 0.001) and 30-day MACEs (HR: 2.250; 95% CI 1.553, 3.260; 0.001). Furthermore, the addition of ALI to a base model containing clinical and laboratory data statistically improved the predictive value.
Assessing ALI levels upon admission can provide important information for the short-term prognostic assessment of patients with AMI complicated by CS. A lower ALI may serve as an independent predictor of increased 30-day all-cause mortality and MACEs.
急性心肌梗死（AMI）合并心源性休克（CS）具有较高的死亡风险。炎症和营养状况与AMI和CS的发病机制及预后均相关。晚期肺癌炎症指数比值（ALI）综合了炎症和营养状态。本研究旨在探讨ALI对AMI合并CS患者的预后价值。
总共217例连续的AMI合并CS患者根据入院时ALI的截断值12.69分为两组：ALI≤12.69和ALI＞12.69。本研究的主要终点是30天全因死亡率。次要终点是胃肠道出血和主要不良心血管事件（MACE），包括30天全因死亡率、房室传导阻滞、室性心动过速/心室颤动和非致死性卒中。通过Cox回归分析ALI与研究终点之间的关联。
入院后30天随访期间，104例（47.9%）患者死亡，150例（69.1%）发生MACE。Kaplan-Meier分析显示，与高ALI组相比，低ALI组的累积死亡率显著更高，MACE发生率更低（对数秩检验P均＜0.001）。ALI≤12.69的患者30天死亡率显著高于ALI＞12.69的患者（72.1%对22.6%；P＜0.001）。此外，ALI≤12.69的患者MACE发生率更高（85.6%对51.9%；P＜0.001）。受试者工作特征曲线显示ALI具有一定的预测价值（曲线下面积[AUC]：0.789，95%置信区间[CI]：0.729，0.850）。多变量调整后，ALI≤12.69是30天全因死亡率（风险比[HR]：3.327；95%CI：2.053，5.389；P＜0.001）和30天MACE（HR：2.250；95%CI 1.553，3.260；P＜0.001）的独立预测因素。此外，在包含临床和实验室数据的基础模型中加入ALI可在统计学上提高预测价值。
入院时评估ALI水平可为AMI合并CS患者的短期预后评估提供重要信息。较低的ALI可能是30天全因死亡率和MACE增加的独立预测因素。
