急性ST段抬高型心肌梗死患者血清可溶性肿瘤坏死因子样凋亡弱诱导因子对急诊介入术后院内心血管不良事件的预测价值

目的研究急性ST段抬高型心肌梗死(STEMI)患者血清可溶性肿瘤坏死因子样凋亡弱诱导因子(sTWEAK)对急诊经皮冠状动脉介入术(PCI)后院内心血管不良事件的预测价值。方法选择2017年5月至2019年5月期间在我院诊断为急性STEMI并接受急诊PCI治疗的患者进行回顾性研究。评价患者PCI术后院内心血管不良事件,包括死亡、心肌梗死、室性心律失常、脑血管意外的情况。分析PCI术后院内心血管不良事件的影响因素及血清sTWEAK的预测价值。结果入组的100例患者中,PCI术后发生心血管不良事件14例,发生率为14%。单因素分析显示,与PCI术后未发生心血管不良事件患者比较,PCI术后发生心血管不良事件患者的糖尿病率、白细胞计数、血糖、高敏C反应蛋白、磷酸肌酸激酶同工酶(CK-MB)峰值、多支血管病变比例、sTWEAK含量均增加,发病至PCI时间延长,使用替罗非班比例、血栓抽吸比例、治疗后TIMI分级均降低。Logistic回归分析显示,糖尿病、CK-MB峰值、sTWEAK、使用替罗非班、血栓抽吸是PCI术后心血管不良事件的影响因素。入院时血清sTWEAK预测PCI术后院内心血管不良事件的最佳截点为68.5 ng/L,灵敏度、特异性分别为62.35%、71.43%。结论急性STEMI患者入院时血清sTWEAK增高对PCI术后院内心血管不良事件具有预测价值。

The predictive value of serum soluble tumor necrosis factor-like weak inducer of apoptosis for cardiovascular adverse events after emergency intervention in patients with acute ST-segment elevation myocardial infarction

Aim To study the predictive value of serum soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) for cardiovascular adverse events after percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods The patients diagnosed as acute STEMI receiving emergency PCI in our hospital from May 2017 to May 2019 were selected for retrospective study. Cardiovascular adverse events including death, myocardial infarction, ventricular arrhythmia and cerebrovascular accident were evaluated after PCI.Then the influencing factors for cardiovascular adverse events and the predictive value of serum sTWEAK were analyzed after PCI. Results Among the 100 patients, 14 patients had cardiovascular adverse events after PCI, and the incidence was 14%. Univariate analysis showed that compared with the patients without cardiovascular adverse events after PCI, the incidence of diabetes, white blood cell count, blood glucose, hypersensitive C-reactive protein, creatine kinase-MB (CK-MB) peak value, the proportion of multi vessel lesions and the content of sTWEAK increased, the time from the onset to PCI prolonged, the proportion of tirofiban use, the proportion of thrombus aspiration and TIMI grade after treatment decreased, in the patients with cardiovascular adverse events after PCI. Logistic regression analysis showed that diabetes mellitus, CK-MB peak value, sTWEAK, tirofiban use and thrombus aspiration were the influencing factors of cardiovascular adverse events after PCI. The best cut-off point of serum sTWEAK in predicting cardiovascular adverse events after PCI was 68.5 ng/L, and the sensitivity and specificity were 62.35% and 71.43% respectively. Conclusion The increase of serum sTWEAK in patients with acute STEMI at admission has a predictive value for cardiovascular adverse events in the hospital after PCI.