引用本文:张婉尧,李 彬,鲁 明,任 勇,周 青,吴 萱.GRACE评分联合WMR对STEMI患者急诊PCI术后发生院内MACE的预测价值[J].中国临床新医学,2024,17(1):35-41.
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GRACE评分联合WMR对STEMI患者急诊PCI术后发生院内MACE的预测价值
张婉尧1,2,李 彬2,鲁 明2,任 勇2,周 青2,吴 萱2
1.武汉科技大学医学院,湖北 430065;2.湖北文理学院附属医院,襄阳市中心医院,湖北文理学院心血管病研究所,襄阳 441021
摘要:
[摘要] 目的 探讨全球急性冠状动脉事件注册(GRACE)评分联合白细胞(WBC)计数与平均血小板体积比(WMR)对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术后发生院内主要不良心血管事件(MACE)的预测价值。方法 回顾性分析2021年1月至2022年3月于襄阳市中心医院接受急诊PCI治疗的349例STEMI患者临床资料。根据院内MACE发生情况,将患者分为MACE组(n=47)和非MACE组(n=302)。比较不同分组患者的临床资料,采用Cox回归分析STEMI患者PCI术后发生院内MACE的危险因素,采用ROC曲线分析评估GRACE评分联合WMR对STEMI患者PCI术后发生院内MACE的预测价值。结果 与非MACE组相比,MACE组年龄较大,收缩压、舒张压和左心室射血分数(LVEF)较低;心率、Killip分级≥Ⅱ的比率、GRACE评分、WBC、WMR、中性粒细胞与淋巴细胞比值(NLR)、空腹血糖(FPG)、肌酐(Cr)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)和肌酸激酶MB同工酶(CK-MB)较高,差异均有统计学意义(P<0.05)。多因素Cox回归分析结果显示,较高的GRACE评分和WMR是促进STEMI患者发生院内MACE的独立危险因素(P<0.05)。ROC曲线分析结果显示,GRACE评分和WMR均能有效预测STEMI患者PCI术后发生院内MACE(P<0.05),且两者联合的预测效能更优[AUC(95%CI)=0.824(0.750~0.897),P<0.001],灵敏度和特异度分别为74.50%、80.50%。结论 GRACE评分联合WMR对STEMI患者PCI术后发生院内MACE具有良好的预测价值,有助于临床工作者进行更精准的风险分层和治疗决策制定。
关键词:  急性ST段抬高型心肌梗死  全球急性冠状动脉事件注册评分  白细胞计数与平均血小板体积比  主要不良心血管事件  风险预测  经皮冠状动脉介入治疗
DOI:10.3969/j.issn.1674-3806.2024.01.07
分类号:R 542.22
基金项目:湖北省自然科学基金项目(编号:2019CFB822);襄阳市科技研究与开发项目(编号:2020YL33)
The value of GRACE score combined with WMR in predicting the occurrence of in-hospital MACE after emergency PCI in STEMI patients
ZHANG Wanyao1,2, LI Bin2, LU Ming2, REN Yong2, ZHOU Qing2, WU Xuan2
1.School of Medicine, Wuhan University of Science and Technology, Hubei 430065, China; 2.Affiliated Hospital of Hubei University of Arts and Science, Xiangyang Central Hospital, Institute of Cardiovascular Diseases, Hubei University of Arts and Science, Xiangyang 441021, China
Abstract:
[Abstract] Objective To explore the value of global registry of acute coronary events(GRACE) score combined with white blood cell(WBC) count to mean platelet volume ratio(WMR) in predicting the occurrence of in-hospital major adverse cardiovascular events(MACE) after emergency percutaneous coronary intervention(PCI) in acute ST-segment elevation myocardial infarction(STEMI) patients. Methods The clinical data of 349 STEMI patients who received emergency PCI treatment in Xiangyang Central Hospital from January 2021 to March 2022 were retrospectively analyzed. According to the occurrence of in-hospital MACE, the patients were divided into MACE group(n=47) and non-MACE group(n=302). The clinical data of the patients in different groups were compared. Cox regression was used to analyze the risk factors for the occurrence of in-hospital MACE after PCI in the STEMI patients, and ROC curve analysis was used to evaluate the value of GRACE score combined with WMR in predicting the occurrence of in-hospital MACE after PCI in the STEMI patients. Results Compared with the non-MACE group, the MACE group were older, and had lower systolic blood pressure, diastolic blood pressure and left ventricular ejection fraction(LVEF), and higher heart rate, rates of Killip grade≥Ⅱ, GRACE score, WBC, WMR, neutrophil-to-lymphocyte ratio(NLR), fasting plasma glucose(FPG), creatinine(Cr), alanine aminotransferase(ALT), aspartate transaminase(AST), and creatine kinase MB isoenzyme(CK-MB), and the differences were statistically significant(P<0.05). The results of multivariate Cox regression analysis showed that higher levels of GRACE score and WMR were independent risk factors for promoting the occurrence of in-hospital MACE in the STEMI patients(P<0.05). The results of ROC curve analysis showed that both GRACE score and WMR were effective in predicting the occurrence of in-hospital MACE after PCI in the STEMI patients(P<0.05), and the combined prediction efficiency of the two indicators was better[AUC(95%CI)=0.824(0.750-0.897), P<0.001], and the sensitivity and specificity were 74.50% and 80.50%, respectively. Conclusion The combination of GRACE score and WMR has good predictive value for in-hospital MACE in STEMI patients after PCI, which helps clinical workers to make more accurate risk stratification and treatment decisions.
Key words:  Acute ST-segment elevation myocardial infarction(STEMI)  Global registry of acute coronary events(GRACE) score  White blood cell count to mean platelet volume ratio(WMR)  Major adverse cardiovascular events(MACE)  Risk prediction  Percutaneous coronary intervention(PCI)