血清Gas6水平联合CHA2DS2-VASc评分对STEMI患者PCI术后短期发生MACE的预测价值

Predictive value of serum Gas6 levels combined with CHA2DS2-VASc scores for short-term development of MACE in STEMI patients after PCI

摘要:

目的 探讨血清生长停滞特异性蛋白6（Gas6）水平联合CHA₂DS₂-VASc评分对ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入术（PCI）后短期发生主要不良心血管事件（MACE）的预测价值。方法 选取2020年7月—2022年6月新乡医学院第一附属医院收治的220例接受PCI的STEMI患者为STEMI组，根据PCI术后3个月是否发生MACE将STEMI组患者分为MACE组和非MACE组。另选取同期68例健康体检志愿者为对照组。收集STEMI患者的临床资料，检测血清Gas6水平，计算CHA₂DS₂-VASc评分。采用多因素Logistic回归分析STEMI患者PCI术后3个月发生MACE的影响因素，采用受试者工作特征（ROC）曲线分析血清Gas6水平和CHA₂DS₂-VASc评分对STEMI患者PCI术后3个月发生MACE的预测价值。结果 STEMI组血清Gas6水平低于对照组（P <0.05）。随访3个月，220例STEMI患者PCI术后MACE发生率为18.64%（41/220）。MACE组的年龄、多支病变占比、KILLIP分级≥Ⅱ级占比、低密度脂蛋白胆固醇、肌酐、CHA₂DS₂-VASc评分高于非MACE组，单支病变占比、左心室射血分数（LVEF）、血红蛋白、Gas6低于非MACE组（P <0.05）。多因素Logistic回归分析结果显示，年龄［O^R=1.227（95% CI：1.020，1.476）］、多支病变［O^R=2.475（95% CI：1.327，4.616）］、KILLIP分级≥Ⅱ级［O^R=4.050（95% CI：1.327，12.355）］、CHA₂DS₂-VASc评分［O^R=1.849（95% CI：1.385，2.468）］为STEMI患者PCI术后3个月发生MACE的独立危险因素，LVEF［O^R=0.878（95% CI：0.796，0.968）］和Gas6［O^R=0.547（95% CI：0.378，0.793）］为其独立保护因素（P <0.05）。ROC曲线分析结果显示，Gas6联合CHA₂DS₂-VASc评分预测STEMI患者PCI术后3个月短期发生MACE的曲线下面积最大，为0.854（95% CI：0.800，0.898），敏感性为78.05%（95% CI：0.624，0.894），特异性为84.92%（95% CI：0.788，0.898）。结论 血清Gas6水平和CHA₂DS₂-VASc评分与STEMI患者PCI术后短期发生MACE的关系密切，两者联合预测STEMI患者PCI术后短期发生MACE的价值较高。

Abstract:

Objective To investigate the predictive value of serum growth arrest specific 6 (Gas6) levels combined with CHA₂DS₂-VASc score on the short-term occurrence of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in patients with ST segment elevation myocardial infarction (STEMI).Methods Two hundred and twenty patients with STEMI treated with PCI admitted to the First Affiliated Hospital of Xinxiang Medical College from July 2020 to June 2022 were selected as the STEMI group, and STEMI patients were divided into MACE and non-MACE groups according to whether MACE occurred 3 months after PCI, and 68 healthy physical examination volunteers were selected as the control group during the same period. Clinical data of STEMI patients were collected, serum Gas6 levels were measured, and CHA₂DS₂-VASc scores were calculated. Multi-factor logistic regression was used to analyze the factors influencing the short-term occurrence of MACE after PCI in STEMI patients, and receiver operating characteristic (ROC) curves were used to analyze the predictive value of serum Gas6 levels and CHA₂DS₂-VASc scores on the short-term occurrence of MACE after PCI in STEMI patients.Results The level of serum Gas6 in STEMI group was lower than that in control group (P < 0.05). Following up for 3 months, the incidence of MACE in 220 STEMI patients after PCI was 18.64% (41/220). The age, proportion of multi-vessel lesions, proportion of KILLIP grade ≥ grade Ⅱ, low density lipoprotein cholesterol, creatinine, and CHA₂DS₂-VASc scores in the MACE group were higher than those in the non-MACE group, while the proportion of single-vessel lesions, left ventricular ejection fraction (LVEF), hemoglobin, and Gas6 were lower than those in the non-MACE group (P < 0.05). Multivariate logistic regression analysis showed that the age [O^R = 1.227 (95% CI: 1.020, 1.476)], multi-vessel lesions [O^R = 2.475 (95% CI: 1.327, 4.616) ], KILLIP grade ≥ grade Ⅱ [O^R = 4.050 (95% CI: 1.327, 12.355) ], and the CHA₂DS₂-VASc score [O^R = 1.849 (95% CI: 1.385, 2.468) ] were independent risk factors for MACE after PCI in STEMI patients, The LVEF [O^R = 0.878 (95% CI: 0.796, 0.968) ] and Gas6 [O^R = 0.547 (95% CI: 0.378, 0.793) ] were independent protective factors (P < 0.05). The ROC curve analysis showed that the area under the curve of Gas6 combined with CHA₂DS₂-VASc score for predicting MACE in STEMI patients after PCI was the highest, which was 0.854 (95% CI: 0.800, 0.898), and sensitivity was 78.05% (95% CI: 0.624, 0.894), the specificity was 84.92% (95% CI: 0.788, 0.898).Conclusion Serum Gas6 levels and CHA₂DS₂-VASc scores were strongly associated with the short-term occurrence of MACE after PCI in STEMI patients, and the combination of the two was of high value in predicting the short-term occurrence of MACE after PCI in STEMI patients.