血浆致动脉粥样硬化指数对急性心肌梗死患者PCI术后主要心血管不良事件的预测价值

The predictive value of plasma atherosclerotic index for major adverse cardiovascular events after PCI in patients with acute myocardial infarction

摘要

目的 探究血浆致动脉粥样硬化指数(AIP)对急性心肌梗死(AMI)患者行经皮冠脉介入术(PCI)后出现主要不良心血管事件(MACE)风险的预测价值。方法 采用回顾性研究方法,选取在淮南东方医院集团总院2020年1月至2023年12月采取PCI治疗,且随访24个月内发生MACE事件的患者45例作为MACE组,选取同期PCI治疗的AMI患者但24个月内未发生MACE事件的45例患者作为对照组。对比两组PCI后出院时AIP等实验室指标、病历资料、个人病史资料等并构建多因素模型及列线图预测模型,采用受试者工作特征曲线(ROC)分析AIP值单独预测MACE的价值,以及列线图预测模型预测MACE发生的价值。结果 MACE组与对照组在合并房颤(24.44% vs 6.67%,χ²=5.414,P=0.020)、合并脑血管病史(15.56% vs 2.22%,χ²=4.939,P=0.026)、血尿酸[(394.5±33.7)μmol/L vs (372.8±31.6)μmol/L,t=3.151,P=0.002]、ApoA1[(1.19±0.23)g/L vs (1.32±0.24)g/L,t=-2.623,P=0.010]、斑块总面积[(136.9±9.5)mm² vs (122.6±9.3)mm²,t=7.216,P<0.001]、斑块负荷[(51.37±5.84)% vs (43.08±6.17)%,t=6.546,P<0.001]以及AIP[(0.18±0.05) vs (0.14±0.05),t=3.795,P<0.001]方面的差异具有统计学意义。合并房颤(OR=1.846)、既往脑血管病史(OR=1.565)、斑块负荷越大(OR=1.829)、AIP值越大(OR=5.099)是AMI患者PCI后MACE发生的危险因素(P<0.05),血清ApoA1水平越高(OR=0.448)可降低AMI患者PCI后MACE发生的风险(P<0.05)。AIP值预测AMI患者PCI后MACE发生的ROC曲线下面积AUC=0.715(95%CI:0.667~0.782);列线图模型预测AMI患者PCI后MACE发生的ROC曲线下面积AUC=0.842(95%CI:0.810~0.896)。结论 AIP与AMI患者PCI后MACE的发生具有密切关系,AIP结合病史及实验室指标构建预测模型对于预测MACE的发生具有较高价值。

Abstract

Objective To investigate the predictive value of the atherogenic index of plasma (AIP) for the risk of major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods This retrospective study selected 45 patients who underwent PCI in the Huainan Eastern Hospital Group Main Hospital between January 2020 and December 2023 and experienced major adverse cardiovascular events (MACE) within 24 months of follow-up including as the MACE group. A control group of 45 AMI patients who received PCI during the same period but did not experience MACE within 24 months was also selected. Laboratory indices including the AIP at discharge, clinical data, and medical history, were compared between the two groups. A multivariate logistic regression model and a nomogram prediction model were constructed. The value of AIP alone in predicting MACE was analyzed using ROC curves, as was that of the nomogram model for MACE occurrence. Results There were statistically significant differences between the MACE group and the control group in atrial fibrillation (24.44% vs 6.67%, χ²=5.414, P=0.020), the rate of cerebrovascular disease history (15.56% vs 2.22%, χ²=4.939, P=0.026), blood uric acid (394.5±33.7 μmol/L vs 372.8±31.6 μmol/L, t=3.151, P=0.002), ApoA1 (1.19±0.23 g/L vs 1.32±0.24 g/L, t=-2.623, P=0.010), total plaque area (136.9±9.5 mm ² vs 122.6±9.3 mm², t=7.216, P<0.001), plaque burden (51.37%±5.84% vs 43.08%±6.17%, t=6.546, P<0.001), and AIP (0.18±0.05 vs 0.14±0.05, t=3.795, P<0.001). Atrial fibrillation (OR=1.846), a previous history of cerebrovascular disease (OR=1.565), larger plaque burden (OR=1.829), and larger AIP value (OR=5.099) were risk factors for MACE occurrence after PCI in AMI patients (P<0.05). Higher serum ApoA1 level (OR=0.448) could reduce the risk of MACE occurrence after PCI in AMI patients (P<0.05). The area under the ROC curve of AIP value for predicting MACE occurrence after PCI in AMI patients was AUC=0.715 (95%CI: 0.667~0.782); the area under the ROC curve of the nomogram model for predicting MACE occurrence after PCI in AMI patients was AUC=0.842 (95%CI: 0.810~0.896). Conclusion AIP is significantly associated with the occurrence of MACE in AMI patients after PCI. Constructing a predictive model by combining AIP with medical history and laboratory indicators has high value in predicting the occurrence of MACE.

关键词

急性心肌梗死 / 血浆致动脉粥样硬化指数 / 经皮冠脉介入术 / 预测 / 不良心血管事件

Key words

Acute myocardial infarction / Atherosclerosis index of plasma / Percutaneous coronary intervention / Prediction / Major adverse cardiovascular events

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基金资助

2024年度淮南联合大学安徽省级科学研究项目(自然科学)(2024AH051717)

淮南联合大学2024年度校级质量工程项目(XSZSFK2403)

淮南联合大学2024年度校级质量工程项目(XJXTD2402)