【摘要】：目的:本研究旨在探討修正休克指數(shù)對急性ST段抬高型心肌梗死(acute ST-segment elevation myocardial infarction,STEMI)患者直接經(jīng)皮冠狀動脈支架置入(percutaneous coronary intervention,PCI)術(shù)后短期主要不良心血管事件(major adverse cardiovascular events,MACE)危險的預(yù)測價值。方法:共納入2013年09月至2015年02月于南昌大學(xué)第二附屬醫(yī)院心血管內(nèi)科行直接PCI術(shù)的STEMI患者263例,記錄其臨床基本資料,計算休克指數(shù)(shock index,SI)、修正休克指數(shù)(modified shock index,MSI)和心肌梗死溶栓治療臨床試驗(thrombolysis in myocardial infarction,TIMI)危險評分值。根據(jù)受試者操作特征曲線((receiver operator characteristic curve,ROC)曲線下面積(area under the curve,AUC)對比3種評分系統(tǒng)對STEMI患者7天內(nèi)全因死亡、致命性心律失常、心源性休克、再發(fā)心肌梗死等MACE發(fā)生的預(yù)測能力,并根據(jù)MSI的診斷界值將患者分為高MSI組及低MSI組,比較兩組間7天及30天MACE發(fā)生情況。根據(jù)多因素logistic回歸分析篩選出STEMI患者7天MACE發(fā)生的獨立危險因素。結(jié)果:1、本研究共納入了263例行直接PCI的STEMI患者,年齡為37-88歲,其中男性220例。STEMI患者7天MACE發(fā)生組中TIMI、SI及MSI分值均高于無MACE生存組(P0.05)。3種評分預(yù)測STEMI患者7天MACE發(fā)生的AUC均0.7,且分辨準確度無顯著差異(P0.05)。2、由ROC曲線分析得出MSI預(yù)測STEMI患者7天MACE發(fā)生的診斷界值是1.3(AUC=0.718,95%CI為0.638-0.797,P0.01)。根據(jù)界值分為低MSI組(174例)和高MSI組(89例),其中高MSI組年齡更大(63.1±12.8 vs 68.7±13.5,P0.01),余指標未見差異。7天隨訪過程中MACE發(fā)生48例,其中高MSI組MACE發(fā)生率更高(37.1%vs 7.6%,P0.5)。30天隨訪過程中MACE發(fā)生59例,高MSI組MACE發(fā)生率更高(37.1%vs 7.6%,P0.5)。3、7天內(nèi)無MACE發(fā)生組與MACE組之間具有統(tǒng)計學(xué)差異的因素分別為年齡(62.8±12.8 vs 74.8±10.7,P0.01)、高血壓史(40.3%vs 56.8%,P0.05)、收縮壓(120.7±25.2 vs 111.7±19.2,P0.05)、舒張壓(74.5±14.8 vs 70.2±14.5,P0.05)、心率(80.2±16.4 vs 93.1±23.9,P0.01)、Killip分級≥II級(8.7%vs41.7%,P0.05)、MSI分值(1.07±0.24 vs 1.36±0.26,P0.01)。4、多因素logistic回歸分析結(jié)果顯示:STEMI患者7天MACE發(fā)生的獨立危險因素為年齡(OR值=1.07,95%CI為1.032-1.121,P0.01)、血糖(OR值=1.217,95%CI為1.081-1.370,P0.05)、MSI得分(OR值=3.615,95%CI為1.213-10.667,P0.05)。并且MSI得分與年齡呈弱相關(guān)(r=0.223,P0.01),與血糖無明顯相關(guān)(P0.05)。結(jié)論:TIMI、SI及MSI評分系統(tǒng)對預(yù)測STEMI患者直接PCI術(shù)后短期MACE發(fā)生都有較高的價值,而MSI評分可以更簡單可靠地預(yù)測STEMI患者的短期預(yù)后。
[Abstract]:Objective: to evaluate the value of modified shock index in predicting the risk of short-term major adverse cardiovascular events (major adverse cardiovascular events,MACE) in patients with acute ST segment elevation myocardial infarction (acute ST-segment elevation myocardial infarction,STEMI) after direct percutaneous coronary artery stent implantation (percutaneous coronary intervention,PCI). Methods: from September 2013 to February 2015, 263 patients with STEMI underwent direct PCI operation in the Department of Cardiovascular Medicine, the second affiliated Hospital of Nanchang University. The basic clinical data were recorded. The shock index (shock index,SI), modified shock index (modified shock index,MSI) and clinical trial (thrombolysis in myocardial infarction,TIMI of myocardial infarction were calculated. According to the area under the operating characteristic curve (receiver operator characteristic curve,ROC (area under the curve,AUC), the predictive ability of the three scoring systems for the occurrence of MACE in STEMI patients within 7 days was compared. According to the diagnostic threshold of MSI, the patients were divided into high MSI group and low MSI group, and the occurrence of MACE in 7 and 30 days between the two groups was compared. According to multivariate logistic regression analysis, the independent risk factors of MACE in STEMI patients at 7 days were selected. Results: 1. A total of 263 STEMI patients with direct PCI were enrolled in this study, of whom 220 were males. The scores of TIMI,SI and MSI in the 7-day MACE group were higher than those in the non-MACE survival group (P 0.05). All the three scores predicted the AUC occurrence of MACE in STEMI patients on the 7th day, and there was no significant difference in the resolution accuracy (P 0.05). According to ROC curve analysis, the diagnostic threshold of MSI in predicting the occurrence of MACE in STEMI patients on the 7th day was 1.3 (AUC=0.718,95%CI was 0.638 鹵0.797, P01). According to the boundary value, the patients were divided into low MSI group (n = 174) and high MSI group (n = 89). The age of high MSI group was 63.1 鹵12.8 vs 68.7 鹵13.5, and there was no difference in the rest indexes. 48 cases of MACE occurred during 7 days follow-up, among which the incidence of MACE in high MSI group was higher (37.1%vs 7.6%, P0.5). 59 cases of MACE occurred during 30 days follow-up, and the incidence of MACE in high MSI group was higher (37.1%vs 7.6%). P0.5). 3The factors of age (62.8 鹵12.8 vs 74.8 鹵10.7, P 0.01), hypertension history (40.3%vs 56.8%, P 0.05), systolic blood pressure (120.7 鹵25.2 vs 111.7 鹵19.2, P 0.05), diastolic blood pressure (74.5 鹵14.8 vs 70.2 鹵14.5, P 0.05), heart rate (80.2 鹵16.4 vs 93.1 鹵23.9, P 0.05), diastolic blood pressure (74.5 鹵14.8 vs 70.2 鹵14.5), heart rate (80.2 鹵16.4 vs 93.1 鹵23.9, P < 0.05), diastolic blood pressure (74.5 鹵14.8 vs 70.2 鹵14.5, P 0.05), heart rate (80.2 鹵16.4 vs 93.1 鹵23.9, respectively) P01), Killip grade 鈮，

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