心电图联合血清氨基末端脑钠肽前体对急性心肌梗死患者择期经皮冠状动脉介入治疗后近期发生主要不良心血管事件的预测价值研究

背景目前,临床上仍缺乏急性心肌梗死(AMI)患者择期经皮冠状动脉介入治疗(PCI)后主要不良心血管事件(MACE)发生风险的预测指标。心电图和血清氨基末端脑钠肽前体(NT-proBNP)均可评价心功能,推测可用于预测AMI患者择期PCI后MACE发生风险。目的探讨心电图联合血清NT-proBNP对AMI患者择期PCI后近期发生MACE的预测价值。方法本研究为回顾性研究。选取2017年1月—2020年4月重庆市巴南区人民医院收治的169例AMI患者,均行择期PCI。统计AMI患者择期PCI后T波倒置、早期ST段回落<50%及近期MACE发生情况;比较发生与未发生MACE患者一般资料(包括性别、年龄、合并症、病变血管支数、罪犯血管、发病至择期PCI时间)及T波倒置发生率、早期ST段回落<50%发生率、血清NT-proBNP升高者所占比例;AMI患者择期PCI后近期发生MACE的影响因素分析采用多因素Logistic回归分析;以随访结果为"金标准",绘制四格表以评估T波倒置、早期ST段回落<50%、血清NT-proBNP升高及三者联合对AMI患者择期PCI后近期发生MACE的预测价值。结果本组患者择期PCI后24 h内T波倒置发生率为47.9%(81/169),择期PCI后1 h ST段回落<50%发生率为41.4%(70/169),随访期间MACE发生率为27.2%(46/169)。多因素Logistic回归分析结果显示,高血压OR=4.773,95%CI(1.750,13.020)]、2型糖尿病OR=5.452,95%CI(1.907,15.589)]、高脂血症OR=8.029,95%CI(2.689,23.967)]、T波倒置OR=9.728,95%CI(3.019,31.347)]、早期ST段回落<50%OR=12.013,95%CI(4.144,34.823)]及血清NT-proBNP升高OR=7.199,95%CI(2.598,19.949)]是AMI患者择期PCI后近期发生MACE的独立危险因素(P <0.05)。T波倒置预测AMI患者择期PCI后近期发生MACE的正确率为72.19%,早期ST段回落<50%预测AMI患者择期PCI后近期发生MACE的正确率为76.33%,血清NT-proBNP升高预测AMI患者择期PCI后近期发生MACE的正确率为75.74%,三者联合预测AMI患者择期PCI后近期发生MACE的正确率为94.08%。结论 AMI患者择期PCI后近期MACE发生风险较高,T波倒置、早期ST段回落<50%联合血清NT-proBNP升高对AMI患者择期PCI后近期发生MACE的预测价值较高。

Predictive Value of Electrocardiogram Combined with Serum NT-proBNP on Short-term Major Adverse Cardiovascular Events after Elective Percutaneous Coronary Intervention of Patients with Acute Myocardial Infarction

Background At present,there is a lack of clinical indicators to predict major adverse cardiovascular events(MACE)after elective percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI).ECG and serum N-terminal pro brain natriuretic peptide(NT-proBNP)can evaluate the changes of cardiac function,which can be used to predict the occurrence of MACE after elective PCI in AMI patients.Objective To investigate the predictive value of electrocardiogram combined with serum NT-proBNP on short-term MACE after elective PCI of patients with AMI.Methods This is a retrospective study.A total of 169 patients with AMI admitted to People’s Hospital of Chongqing Banan District from January 2017 to April 2020 were selected,and they were treated with elective PCI.The incidence of T wave inversion,early ST segment depression less than 50%and short-term MACE after elective PCI of patients with AMI were computed;the general information(including gender,age,complications,lesion blood vessel count,culprit artery,time from onset to elective PCI)and the incidence of T wave inversion and early ST segment depression<50%and the proportion of serum NT-proBNP elevation were compared in patients with and without MACE;multivariate Logistic regression analysis was used to analyze the influencing factors of short-term MACE after elective PCI in AMI patients;the follow up results were as the gold standard,and fourfold table was drawn to evaluate the predictive value of T-wave inversion,early ST segment depression<50%,serum NT-proBNP elevation and their combination on short-term MACE after elective PCI in AMI patients.Results The incidence of T wave inversion within 24 hours after elective PCI was 47.9%(81/169),the incidence of ST segment depression<50%within 1 hour after elective PCI was 41.4%(70/169),and the incidence of short-term MACE during follow up was 27.2%(46/169).Multivariate Logistic regression analysis showed that hypertensionOR=4.773,95%CI(1.750,13.020)],type 2 diabetesOR=5.452,95%CI(1.907,15.589)],hyperlipidemiaOR=8.029,95%CI(2.689,23.967)],T wave inversionOR=9.728,95%CI(3.019,31.347)],early ST segment depression<50%OR=12.013,95%CI(4.144,34.823)]and serum NT-proBNP elevationOR=7.199,95%CI(2.598,19.949)]were independent risk factors of short-term MACE after elective PCI in AMI patients(P<0.05).The diagnosticaccuracy rate of T wave inversion,early ST segment depression<50%,serum NT-proBNP elevation and their combination in predicting shortterm MACE after elective PCI in AMI patients was 72.19%,76.33%,75.74%,94.08%,respectively.Conclusion Patients with AMI have a high risk of short-term MACE after elective PCI.And T wave inversion,early ST segment depression<50%combined with serum NT-proBNP elevation have higher predictive value for short-term MACE after elective PCI in AMI patients.