Relationship between soluble tumor necrosis factor-like weak inducer of apoptosis,high-sensitivity C-reactive protein levels and short-term major adverse cardiovascular events after discharge in acute myocardial infarction patients and the construction of
Objective To explore the relationship between soluble tumor necrosis factor-like weak inducer of apoptosis(sTWEAK),high-sensitivity C-reactive protein(hs-CRP)levels and the occurrence of major adverse cardiovascular events(MACE)in the short term after discharge in patients with acute myocardial infarction(AMI),and to construct a risk prediction model.Methods A total of 135 patients with AMI admitted to Nanyang Second General Hospital from October 2019 to October 2022 were selected as the research subjects.They were followed up for 6 months after discharge,and the occurrence of MACE was recorded.Patients with MACE were included in the MACE group,and the patients without MACE were included in the non-MACE group.The serum levels of sTWEAK and hs-CRP,as well as clinical data such as age,gender,body mass index(BMI),smoking history,drinking history,anemia,diabetes history,hypertension history,hyperlipidemia history,stroke history,old myocardial infarction,anterior wall infarction,Killip heart function classification,coronary artery lesion number,coronary artery Gensini score,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ),white blood cell count,serum creatine kinase isoenzyme(CK-MB)level,serum cardiac troponin T(cTnT)level,and the time from onset to reperfusion were compared between the two groups.The risk factors for short-term MACE after discharge of AMI patients were analyzed by using a logistic regression model.Based on the logistic regression analysis results,a model for predicting the risk of short-term MACE after discharge of AMI patients was established,and its prediction efficiency and calibration capability were evaluated by using the receiver operating characteristic(ROC)curve and calibration curve.Results The incidence rate of MACE within 6 months after discharge in AMI patients was 27.73％(33/135).The proportion of patients over 60 years old,proportion of patients with smoking history,percentage of coronary artery lesions in two or more branches,APACHE Ⅱ score,and serum cTnT,sTWEAK and hs-CRP levels in the MACE group were significantly higher than those in the non-MACE group(P＜0.05).There were no statistically significant differences in gender distribution,BMI,drinking history,anemia,diabetes history,hypertension history,hyperlipidemia history,stroke history,old myocardial infarction,atrial fibrillation,anterior wall infarction,Killip heart function classification,time from onset to reperfusion,coronary artery Gensini score,white blood cell count,and serum CK-MB level between the MACE group and the non-MACE group(P＞0.05).Logistic regression model analysis showed that age over 60 years old,coronary artery lesions in two or more branches,high APACHE Ⅱ score,high serum cTnT level,high serum sTWEAK level,and high serum hs-CRP level were risk factors for the occurrence of short-term MACE after discharge of AMI patients(P＜0.05).A risk prediction model for MACE occurrence after discharge of AMI patients was constructed based on age,number of coronary artery branches with lesions,APACHE Ⅱ score,serum cTnT level,serum sTWEAK level,and serum hs-CRP level.The area under the curve of this model for predicting MACE was 0.860(95％confidence interval:0.784-0.916),with a sensitivity of 84.85％(95％confidence interval:68.100-94.900)and a specificity of 83.72％(95％confidence interval:74.200-90.800).The Hosmer-Lemeshow goodness-of-fit test showed there was no statistically significant difference between the predicted probability of short-term MACE occurrence after discharge of AMI patients and the actual probability(x2=5.541,P＞0.05).Conclusion High levels of serum sTWEAK and hs-CRP are risk factors for the occurrence of MACE after discharge in AMI patients.The risk prediction model constructed based on these two indicators has good performance for predicting MACE and can provide a reference for clinical guidance on the management and treatment of AMI patients after discharge.
维普
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