作者：王家琦，吴路路，张飞飞，杨亚崇，李英肖，党懿，齐晓勇

单位：

1.075000河北省张家口市，河北北方学院研究生院 2.050051河北省石家庄市，河北省人民医院心血管内科 通信作者：齐晓勇，E-mail：hbghxiaoyong_q@126.com

单位（英文）：

1.Graduate School of Hebei North University, Zhangjiakou 075000, China 2.Department of Cardiology, Hebei General Hospital, Shijiazhuang 050051, China Corresponding author: QI Xiaoyong, E-mail: hbghxiaoyong_q@126.com

关键词：

ST段抬高型心肌梗死; 经皮冠状动脉介入治疗; 修正休克指数; 主要不良心血管事件;

关键词（英文）：

ST-segment elevation myocardial infarction; Percutaneous coronary intervention; Modified shock index;Major adverse cardiovascular events

中图分类号：

DOI：

10.12114/j.issn.1008-5971.2022.00.129

基金项目：

河北省自然科学基金资助项目（H2020307017）；河北省2019年度医学科学研究课题（20190237）

摘要：

目的 探讨修正休克指数（MSI）对急性ST段抬高型心肌梗死（STEMI）患者PCI后发生院内主要不良心血管事件（MACE）的预测价值。方法 选取2017年1月至2020年6月就诊于河北省人民医院心血管内科并接受直接PCI的急性STEMI患者1 137例为研究对象。根据急性STEMI患者PCI后是否发生院内MACE将其分为MACE组（n=115）和非MACE组（n=1 022）。统计患者临床资料，采用多因素Logistic回归分析探讨急性STEMI患者PCI后发生院内MACE的独立影响因素，绘制ROC曲线以分析MSI对急性STEMI患者PCI后发生院内MACE的预测价值。结果 多因素Logistic回归分析结果显示，年龄[OR=1.033,95%CI (1.010,1.057)]、收缩压[OR=0.983,95%CI(0.967,0.999)]、舒张压[OR=1.030,95%CI(1.004,1.057)]、MSI[OR=26.410,95%CI(6.908,100.963)]、心肌肌钙蛋白T(cTnT)[OR=1.004,95%CI(1.004,1.005)]、左心室射血分数（LVEF）[OR=0.969,95%CI(0.943,0.995)]是急性STEMI患者PCI后发生院内MACE的独立影响因素（P<0.05）。ROC曲线分析结果显示，MSI预测急性STEMI患者PCI后发生院内MACE的曲线下面积为0.736[95%CI(0.692,0.781)]，最佳截断值为0.728，灵敏度、特异度分别为90.4%、46.1%，约登指数为0.365。结论 高龄及收缩压降低、舒张压升高、MSI升高、cTnT升高、LVEF降低是急性STEMI患者PCI后发生院内MACE的独立危险因素，MSI对急性STEMI患者PCI后发生院内MACE具有一定的预测价值，可用于评估患者早期预后。

英文摘要：

【Abstract】 Objective To investigate the predictive value of modified shock index (MSI) for nosocomial major adversecardiovascular events (MACE) in acute ST-segment elevation myocardial infarction (STEMI) patients after PCI. Methods Atotal of 1 137 patients with acute STEMI who underwent direct PCI in the Department of Cardiology of Hebei General Hospitalfrom January 2017 to June 2020 were enrolled as the research objects. Patients were divided into MACE group (n=115) and nonMACE group (n=1 022) according to the occurrence of nosocomial MACE in acute STEMI patients after PCI. The clinical data ofthe patients were collected, and the independent influencing factors of nosocomial MACE in acute STEMI patients after PCI wereanalyzed by multivariate Logistic regression analysis. ROC curve was used to analyze the predictive value of MSI for nosocomialMACE in acute STEMI patients after PCI. Results Multivariate Logistic regression analysis showed that age [OR=1.033, 95%CI(1.010, 1.057) ] , systolic blood pressure [OR=0.983, 95%CI (0.967, 0.999) ] , diastolic blood pressure [OR=1.030, 95%CI (1.004,1.057) ] , MSI [OR=26.410, 95%CI (6.908, 100.963) ] , cardiac troponins T (cTnT) [OR=1.004, 95%CI (1.004, 1.005) ] and leftventricular ejection fraction (LVEF) [OR=0.969, 95%CI (0.943, 0.995) ] were independent influencing factors for the occurrenceof nosocomial MACE in acute STEMI patients after PCI (P < 0.05) . ROC curve analysis results showed that the area under curveof MSI in predicting nosocomial MACE in acute STEMI patients after PCI was 0.736 [95%CI (0.692, 0.781) ] , the best cut-offvalue was 0.728, and the sensitivity and specificity were 90.4% and 46.1%, respectively, the Youden index was 0.365. ConclusionOld age, low systolic blood pressure, high diastolic blood pressure, high MSI, high cTnT and low LVEF are independent riskfactors for nosocomial MACE in acute STEMI patients after PCI. MSI has predictive value for nosocomial MACE in acute STEMIpatients after PCI, which can be used in clinic to evaluate the early prognosis of patients.

参考文献：