炎症负荷指数对老年急性ST段抬高型心肌梗死患者经皮冠状动脉介入术后主要心血管不良事件的预测价值

To investigate the predictive value of inflammatory burden index for major adverse cardiovascular events in elderly patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention

摘要

目的 探讨炎症负荷指数 (IBI) 对老年急性ST段抬高型心肌梗死 (STEMI) 患者经皮冠状动脉介入 (PCI) 术后主要心血管不良事件 (MACE) 的预测价值。方法 选取2023年1月—2024年1月西北大学附属医院心血管内科收治的100例接受PCI治疗的老年STEMI患者作为研究对象, 依据术后6个月内是否发生MACE分为MACE组 (18例) 和非MACE组 (82例)。采用多因素logistic回归模型分析PCI术后发生MACE的独立影响因素, 采用ROC曲线分析IBI对MACE的预测价值。结果 MACE组病变血管数目≥2个的患者占比高于非MACE组 (P<0.05), MACE组术前N末端脑钠肽前体 (NT-proBNP)、超敏C反应蛋白 (hs-CRP)、心肌特异性肌钙蛋白I (cTnI)、IBI均高于非MACE组 (P<0.05)。以上指标作为自变量进行多因素logistic回归分析, 结果显示: 病变血管数目及术前NT-proBNP、hs-CRP、cTnI、IBI均为老年STEMI患者PCI术后发生MACE的独立危险因素 (P<0.05)。ROC曲线分析结果显示IBI预测MACE的曲线下面积为0.758 (95%CI: 0.654~0.862), 灵敏度为0.889, 特异度为0.610, 约登指数为0.499, 最大cut-off值为31.495。结论 IBI在老年STEMI患者PCI术后具有良好的预测MACE的能力, 其高值可能提示患者更高的发生风险。

Abstract

Objective To investigate the predictive value of inflammatory burden index (IBI) for major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in elderly patients with acute ST-segment elevation myocardial infarction (STEMI). Methods A total of 100 elderly patients with STEMI who underwent PCI from January 2023 to January 2024 in the Department of Cardiovascular Medicine, Northwestern University Affiliated Hospital were selected as the study subjects and divided into a MACE group (n=18) and a non-MACE group (n=82) according to whether MACE occurred within 6 months after operation. Multivariate logistic regression model was used to analyze the independent influencing factors of MACE after PCI, and a ROC curve was used to analyze the predictive value of IBI for MACE. Results The proportion of patients with ≥2 diseased vessels in the MACE group was higher than that in the non-MACE group (P<0.05). N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), cardiac specific troponin I (cTnI) and IBI in MACE group were higher than those in the non-MACE group (P<0.05). Multivariate logistic regression analysis was performed with the above indicators as independent variables, and the results showed that the number of diseased vessels, NT-proBNP, hs-CRP, cTnI, and IBI were all independent risk factors for MACE after PCI in elderly STEMI patients (P<0.05). ROC curve analysis showed that the area under the curve of IBI for predicting MACE was 0.758 (95% CI: 0.654 to 0.862), the sensitivity was 0.889, the specificity was 0.610, the Youden index was 0.499, and the maximum cut-off value was 31.495. Conclusion IBI has a good ability to predict MACE in elderly patients with STEMI after PCI, and its high value may indicate a higher risk of MACE.

关键词

ST段抬高型心肌梗死 / 经皮冠状动脉介入 / 炎症负荷指数 / 主要心血管不良事件

Key words

ST-segment elevation myocardial infarction / Percutaneous coronary intervention / Inflammatory burden index / Major adverse cardiovascular events

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基金资助

^*陕西省重点研发计划项目(2022SF-397)

西安市科技局医学研究项目: 一般研究(22YXYJ0046)