The predictive value of serum D-dimer and sRAGE levels for short-term adverse prognosis in elderly patients with coronary heart disease after interventional therapy
Aim To explore the predictive value of serum D-dimer and the soluble receptor for advanced glyca-tion end products(sRAGE)levels in the short-term poor prognosis of elderly patients with coronary heart disease after per-cutaneous coronary intervention(PCI).Methods The clinical data of 316 elderly patients with coronary heart disease first diagnosed in Huanggang Central Hospital from April 2019 to June 2020 were collected.According to whether the pa-tients had major adverse cardiovascular events(MACE)during the follow-up period,they were divided into MACE group(n=52)and non MACE group(n=264).The independent influencing factors of postoperative MACE were analyzed by univariate analysis and multivariate Logistic regression,the nomogram prediction model was established and verified accord-ing to the independent influencing factors of patient prognosis.The threshold effect of D-dimer and sRAGE levels was de-termined by curve fitting and threshold effect analysis,and the influence of D-dimer and sRAGE levels on MACE was eval-uated by Kaplan-Meier curve.Results During the one-year postoperative period,52(16.46％)of the 316 elderly patients with coronary heart disease who were included experienced MACE.Body mass index(BMI),proportion of hy-pertension,proportion of diabetes,GRACE score,number of stents,apoliporotein(Apo)B,ApoB/ApoA,low density lipoprotein cholesterol(LDLC),liporotein(a)[Lp(a)]and D-dimer levels of patients in the MACE group were higher than those in the non MACE group,and sRAGE levels were lower than those in the non MACE group,with statistically sig-nificant differences(P＜0.05).Multivariate Logistic regression analysis showed that high GRACE score,high Lp(a)and high D-dimer levels were independent risk factors for MACE in elderly patients with coronary heart disease after PCI treat-ment,and high sRAGE level was protective factor(P＜0.05).Curve fitting found that the probability of MACE increased with the increase of D-dimer level and the decrease of sRAGE level.The Kaplan-Meier curve shows that the incidence of MACE in patients with higher D-dimer levels is significantly higher than that in patients with low D-dimer levels(P＜0.001),and the incidence of MACE in patients with lower sRAGE levels is significantly higher than patients with higher sRAGE levels(P＜0.001).The nomogram model was constructed based on independent prognostic factors,and its con-sistency index was 0.796(95％CI:0.723～0.834),ROC curve AUC was 0.851(95％CI:0.806～0.892),which has a good degree of discrimination.Conclusion High level of D-dimer and low level of sRAGE are important risk factors for MACE after PCI in elderly patients with coronary heart disease,and have a high predictive value for short-term adverse prognosis after PCI.
D-dimersoluble receptor for advanced glycation end productsinterventional therapycoronary heart diseasepoor prognosispredictive value
万方数据
维普
