非ST段抬高急性冠状动脉综合征患者妊娠相关血浆蛋白A水平与冠状动脉介入治疗预后的关系

目的探讨非ST段抬高急性冠状动脉(冠脉)综合征患者循环妊娠相关血浆蛋白A(PAPP-A)水平与经皮冠脉介入治疗(PCI)术预后的关系。方法检测86例单支冠脉病变的非ST段抬高急性冠脉综合征患者(不稳定型心绞痛58例,非ST段抬高急性心肌梗死28例)PCI术前PAPP-A和高敏C反应蛋白(hs-CRP)水平,考察其冠脉病变形态和术前术后罪犯血管供血区域的TIMI心肌灌注分级(TMPG),分析它们与术后随访1年内的主要心血管事件联合终点之间的关系。结果与无心血管事件患者比较,有心血管事件的患者术前hs-CRP水平较高(P=0.016),PAPP-A水平也明显升高(28.55±20.21)mIU/L比(19.37±15.24)mIU/L,P=0.007],男性患者、高脂血症患者和有复杂病变的患者也较多。随访(9.7±3.0)个月期间,19例(22%)患者发生心血管事件;低PAPP-A的患者无心血管终点事件生存率较高(log rank=7.881,P=0.049),而PAPP-A≥15.41 mIU/L是强的联合终点事件预测因子(OR=2.23,95%CI:1.27～5.33,P=0.021)。结论 PAPP-A水平对单支血管病变的非ST段抬高急性冠脉综合征患者PCI术后的中期预后有预测作用。

Relationship between outcome of patients with non-ST-elevation acute coronary syndrome underwent percutaneous coronary intervention and pregnancy-associated plasma protein A

Objective To investigate the relationship between circulating pregnancy-associated plasma protein A （PAPP-A） level and short-term outcome of patients with non-ST-elevation acute coronary syndrome （NSTEACS） underwent percutaneous coronary intervention （ PCI）. Methods The levels of circulating PAPP-A and high-sensitivlty C-reactive protein （hs-CRP） were measured in 86 patients with NSTEACS and 1-vessel disease（58 with unstable angina and 28 with non-ST-elevation acute myocardial infarction ） betore PCI. The morphology of coronary lesions, and TIMI myocardial perfusion grade in the area related to culprit vessel before and after PCI were analyzed. The patients were followed up for 1 to 14 months （9. 7±3.0）. The endpoints （ cardiac events ） included cardiac death, non-fatal myocardial infarction, target vessel revaseularization and rehospitalization owing to angina. Results During （9. 7 ± 3.0）months follow-up, 19 patients （22%） developed cardiac events. Patients with cardiac events had higher levels of hs-CRP （P = 0. 016） and PAPP-A （28.55 ±20. 21 ） mIU/L vs. （ 19. 37 ± 15.24） mIU/L, P = 0. 007 ] before PCI, more patients with hyperlipidemia and complex lesions, and more males than those without events. Patients with lower PAPP-A levels had higher event-free survival rates （log rank = 7. 881, P = 0. 049） , and PAPP-A ≥ 15.41 mlU/L was a strong predictor of combined endpoint （OR = 2. 23, 95% CI： 1.27 -5.33, P = 0. 021 ）. Conclusions The PAPP-A levels can predict the short-term outcome of patients with NSTEACS and single vessel stenosis underwent PCI.