循环中苯乙酰谷氨酰胺与ST段抬高型心肌梗死多支冠状动脉疾病严重程度及预后的关联
Association of Circulating Phenylacetylglutamine With Multi-Vessel Coronary Disease Severity and Outcomes in ST-Segment-Elevation Myocardial Infarction.
作者信息
Zhao Peng, Dong Nana, Wang Yan, Zhao Suhong, Tian Yanan, Qin Zhifeng, Ban Xiaofang, Han Feiyuan, Meng Li, Yang Fan, Wang Yidan, Wu Yunfei, Yu Zhongzhi, Xu Qinglu, Li Xinyue, Li Shuo, Liu Huibin, Fang Shaohong, Xie Wanqing, Yu Bo, Liu Xinxin, Tian Jinwei
机构信息
Department of Cardiology The Second Affiliated Hospital of Harbin Medical University Harbin Province Heilongjiang China.
Key Laboratory of Myocardial Ischemia Ministry of Education Harbin Province Heilongjiang China.
出版信息
J Am Heart Assoc. 2025 Feb 18;14(4):e038175. doi: 10.1161/JAHA.124.038175. Epub 2025 Jan 23.
BACKGROUND
There is a lack of evidence regarding the association between plasma phenylacetylglutamine levels and lesion severity and clinical prognosis in patients with ST-segment elevation myocardial infarction (STEMI) with multivessel coronary disease (MVCD). This study aims to investigate the potential of phenylacetylglutamine as a biomarker for major adverse cardiovascular events (MACEs) of patients with STEMI and MVCD.
METHODS AND RESULTS
Clinical data and blood samples were collected from 631 patients with STEMI and MVCD, who underwent primary percutaneous coronary intervention. Quantitative coronary angiography analysis was performed using the QAngio XA 7.3 system. Plasma phenylacetylglutamine concentrations were measured by rapid resolution liquid chromatography quadrupole time-of-flight mass spectrometry. Among a total of 631 patients, median plasma phenylacetylglutamine level was 3.8 (2.1-6.8) μmol/L and the cumulative MACE rate at follow-up was 12%. Plasma phenylacetylglutamine levels of patients with MACE were significantly higher than patients without MACE. We employed restricted cubic spline, Kaplan-Meier curves, and Cox proportional hazard models to explore the association between plasma phenylacetylglutamine and prognosis of patients with STEMI and MVCD. Per SD, an increment in phenylacetylglutamine was associated with a 24% higher risk of complexity lesion. Higher phenylacetylglutamine level was an independent predictor of MACEs (hazard ratio [HR], 2.76 [95% CI, 1.62-4.72]). A novel prognostic scoring system was established by combining phenylacetylglutamine levels with the synergy between percutaneous coronary intervention with Taxus and cardiac surgery score, with higher scores significantly increasing the risk of MACEs (HR, 4.01 [95% CI, 2.04-7.89]).
CONCLUSIONS
Phenylacetylglutamine levels were associated with lesion complexity and prognosis, may serve as a novel biomarker in patients with STEMI and MVCD.
背景
关于ST段抬高型心肌梗死（STEMI）合并多支冠状动脉疾病（MVCD）患者血浆苯乙酰谷氨酰胺水平与病变严重程度及临床预后之间的关联，目前缺乏证据。本研究旨在探讨苯乙酰谷氨酰胺作为STEMI合并MVCD患者主要不良心血管事件（MACE）生物标志物的潜力。
方法与结果
收集了631例接受直接经皮冠状动脉介入治疗的STEMI合并MVCD患者的临床资料和血样。使用QAngio XA 7.3系统进行定量冠状动脉造影分析。采用快速液相色谱四极杆飞行时间质谱法测定血浆苯乙酰谷氨酰胺浓度。在总共631例患者中，血浆苯乙酰谷氨酰胺水平中位数为3.8（2.1 - 6.8）μmol/L，随访期间累积MACE发生率为12%。发生MACE的患者血浆苯乙酰谷氨酰胺水平显著高于未发生MACE的患者。我们采用限制立方样条、Kaplan - Meier曲线和Cox比例风险模型来探讨血浆苯乙酰谷氨酰胺与STEMI合并MVCD患者预后之间的关联。每标准差增加，苯乙酰谷氨酰胺水平升高与复杂病变风险增加24%相关。较高的苯乙酰谷氨酰胺水平是MACE的独立预测因子（风险比[HR]，2.76[95%置信区间，1.62 - 4.72]）。通过将苯乙酰谷氨酰胺水平与紫杉醇药物涂层支架经皮冠状动脉介入治疗与心脏手术评分之间的协同作用相结合，建立了一种新的预后评分系统，评分越高，MACE风险显著增加（HR，4.01[95%置信区间，2.04 - 7.89]）。
结论
苯乙酰谷氨酰胺水平与病变复杂性及预后相关，可能是STEMI合并MVCD患者的一种新型生物标志物。
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