摘要
目的:探究术前可溶性生长刺激表达基因2(soluble growth stimulation expressed gene 2,sST2)蛋白对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)患者经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)术后新发心房颤动(new onset atrial fibrillation, NOAF)的预测价值。方法:连续纳入2021年1月—2021年10月就诊于徐州医科大学附属医院心内科,并于发病12 h内行直接PCI术治疗的STEMI患者,根据术后患者住院期间多次床边心电图及心电监护结果将患者分为NOAF组(35例)和非NOAF组(302例)。回顾性分析2组STEMI患者的一般临床基线资料、介入治疗相关资料,并采用二元多因素logistic回归分析筛选PCI术后NOAF的独立危险因素,采用受试者工作特征(ROC)曲线评价入院sST2水平预测PCI术后NOAF的价值,并对所有正常出院的患者进行为期1年的随访,采用Kaplan-Meier方法,绘制风险曲线,进行log-rank检验,比较NOAF组与非NOAF组患者出院后主要不良心血管事件(major adverse cardiovascular event, MACE)的发生情况。结果:2组患者在入院心室率、中性粒细胞计数、血小板计数、入院sST2、hs-CRP、VLDL-C、左室射血分数、左房内径、术后血流TIMI分级方面差异有统计学意义(P<0.05)。二元多因素logistic回归分析显示入院sST2升高、入院心室率加快、血小板计数升高、左室射血分数降低、术后复流情况较差是导致PCI术后NOAF的独立危险因素。绘制入院sST2预测STEMI患者急诊PCI术后NOAF的ROC曲线,ROC曲线下面积为0.698(95%CI:0.610~0.786,P<0.001),通过约登指数计算最佳截断值为46.11 ng/mL,当sST2为46.11 ng/mL时,灵敏度71.4%,特异度63.2%。并绘制风险曲线,NOAF组MACE发生率显著高于非NOAF组,行log-rank检验,P=0.014。结论:sST2是预测STEMI患者PCI术后发生NOAF的独立危险因子,当sST2≥46.11 ng/mL时,患者出现NOAF的概率较大,且NOAF组患者出院后MACE发生率高于非NOAF组。
Objective To explore the predictive value of the preoperative soluble growth stimulation expressed gene 2(sST2)protein in predicting new-onset atrial fibrillation(NOAF)after percutaneous coronary intervention(PCI)in patients with ST-segment elevation myocardial infarction(STEMI).Methods STEMI patients who were admitted to the Cardiology Department of the Affiliated Hospital of Xuzhou Medical University from January 2021 to October 2021 and received primary percutaneous coronary intervention within12 hours of the onset were divided into NOAF group(n=35)and non-NOAF group(n=302)according to the results of bedside ECG and ECG monitoring during hospitalization.The general clinical baseline data and interventional therapy-related data of the two groups of STEMI patients were retrospectively analyzed,and binary multivariate logistic regression was used to screen the independent risk factors of NOAF after PCI.The value of predicting NOAF after PCI was evaluated by the receiver operating characteristic(ROC)curve.All normallydischarged patients were followed for one year,and the risk curve was drawn by the Kaplan-Meier method.Log-rank test was performed to compare the incidence of major adverse cardiovascular events(MACE)after discharge between the NOAF group and the non-NOAF group.Results There were significant differences in heart rate,neutrophil count,platelet count,sST2,hs-CRP,VLDL-C,left ventricular ejection fraction,left atrial diameter,and postoperative blood flow TIMI grade between the two groups.Multivariate logistic regression analysis showed that increased sST2,increased heart rate,increased platelet count,decreased left ventricular ejection fraction and poor postoperative reflow were independent risk factors for new-onset atrial fibrillation after PCI.The ROC curve of admission sST2 was drawn to predict NOAF after PPCI in STEMI patients.The area under the ROC curve is 0.698(95%CI:0.610-0.786,P<0.001).The best cut-off value calculated by Youden's index is 46.11 ng/mL.When the sST2 is 46.11ng/mL,the sensitivity is 71.4%and the specificity is 63.2%.The risk curve was also drawn.The incidence of MACE in the NOAF groupwas significantly higher than that in the non-NOAF group.Log-rank test was performed(P=0.014).Conclusion Serum soluble sST2 is an independent risk factor for predicting the occurrence of NOAF after PCI in STEMI patients.When sST2≥46.11 ng/mL,STEMI patients after PCI are more likely to get NOAF,and the incidence of MACE after discharge in the NOAF group is higher than that in the non-NOAF group.
作者
徐杰
杨一鸣
赵燕茹
刘春蕊
潘思雨
李芳芳
纵静
钱文浩
XU Jie;YANG Yiming;ZHAO Yanru;LIU Chunrui;PAN Siyu;LI Fangfang;ZONG Jing;QIAN Wenhao(Department of Cardiology,Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu,221000,China)
出处
《临床心血管病杂志》
CAS
北大核心
2023年第5期388-393,共6页
Journal of Clinical Cardiology
基金
国家自然科学基金项目(No:81900216)。
关键词
可溶性生长刺激表达基因2
心房颤动
ST段抬高型心肌梗死
经皮冠状动脉介入治疗
soluble growth stimulation expressed gene 2
atrial fibrillation
ST-segment elevation myocardial infarction
percutaneous coronary intervention
