CKMB mass、D-D联合GRACE评分对STEMI患者预后的预测价值*

目的: 探讨肌酸激酶同工酶质量(CKMBmass)、D二聚体(D-D)检测联合全球急性冠状动脉综合征注册研究评分系统(GRACE)评分对急性ST段抬高心肌梗死(STEMI)患者预后的预测价值。方法: 选择2018年1月至2021年10月接诊的急性STEMI患者138例进行回顾性分析。患者入院完善相关检查后参照《中国经皮冠状动脉介入治疗指南(2016)》行PCI手术治疗,术后随访6个月。根据有无不良心血管事件(MACE)将患者分为两组。收集可能影响STEMI患者预后的因素,比较两组患者各影响因素,并采用Logistic回归分析获得急性STEMI患者预后独立性影响因素,以ROC法评估各指标单独检测与联合检测对STEMI患者预后的预测价值。结果: 138例患者中共有37例(26.81 %)术后出现MACE,单因素基础上行多因素Logistic回归分析,CKMBmass、D-D及GRACE评分为STEMI患者近期预后的独立性影响因素(P＜0.05)。ROC分析,CKMBmass、D-D、GRACE评分对STEMI患者预后的预测cut-off值分别为125.89 ng/mL、298.79 ng/mL、127.0分,AUC分别为0.856、0.850、0.789,三者联合诊断的AUC为0.958,其诊断效能高于各指标单独检测(P＜0.05)。结论: CKMB mass、D-D及GRACE评分均为急性STEMI患者预后影响因素,三者均可作为急性STEMI患者预后预测指标,联合检测可提高预测诊断效能。

Predictive value of CKMB mass,D-D combined with GRACE score in patients with ST-segment elevation myocardial infarction

Objective: To investigate the prognostic value of creatine kinase isozyme mass (CKMBmass) and D-Dimer (D-D) combined with the global acute coronary syndrome registration study score (GRACE) in patients with acute ST segment elevation myocardial infarction (STEMI). Methods: A retrospective analysis was performed on 138 acute STEMI patients admitted to our hospital from January 2018 to October 2021.The patients were admitted to the hospital and underwent PCI according to the "Guidelines for Percutaneous Coronary Intervention in China (2016)", and were followed up for 6 months.Patients were divided into 2 groups according to the presence or absence of adverse cardiovascular events (MACE). To collect factors that may affect the prognosis of STEMI patients. The influencing factors of patients in the two groups were compared, and the independent influencing factors for the prognosis of acute STEMI patients were obtained by Logistic regression analysis. The ROC method was used to evaluate the prognostic value of each index alone and combined detection in STEMI patients. Results: A total of 37 (26.81 %) of 138 patients developed MACE after surgery. The univariate basis and multivariate Logistic regression analysis showed that CKMBmass, D-D and GRACE scores were independent influencing factors for the short-term prognosis of STEMI patients (P＜0.05).The results of ROC analysis showed that the cut-off values of CKMBmass, D-D, and GRACE scores for predicting the prognosis of STEMI patients were 125.89 ng/mL、298.79 ng/mL、and 127.0 points, respectively, and the AUCs were 0.856,0.850,and 0.789, respectively. The AUC of the three combined diagnosis was0.958, and its diagnostic efficiency was higher than that of each index alone (P＜0.05). Conclusion: CKMB mass, D-D and GRACE scores are all prognostic factors in patients with acute STEMI, and all three can be used as prognostic indicators for patients with acute STEMI, and combined detection can improve the predictive diagnostic performance.