应激性高血糖比值对急性ST段抬高型心肌梗死患者院内死亡及机械性并发症的预测价值

The predictive value of stress hyperglycemia ratio on in-hospital mortality and mechanical complications in patients with acute ST-segment elevation myocardial infarction

摘要:

目的]评估应激性高血糖比值(SHR)对急性ST段抬高型心肌梗死(STEMI)患者院内死亡及机械性并发症的预测价值。 [方法]本研究是一项回顾性研究,收集2019年6月—2023年7月期间在遂宁市中心医院诊断为急性STEMI患者995例。基线资料比较采用t检验或Mann-Whitney U检验及χ²检验；采用Logistic回归分析探讨SHR与急性STEMI患者院内死亡和机械性并发症风险的关系；采用基于Logistic回归模型的限制性立方条样分析探讨SHR与院内死亡和机械性并发症风险是否存在非线性关系；采用ROC曲线评估SHR的诊断效能；亚组分析评估SHR在各个亚组中的预测效能。 [结果]高SHR患者心血管死亡率显著升高(P＝0.007)。高SHR是急性STEMI患者院内全因死亡(模型1:OR＝3.085,95%CI:1.719～5.538,P＜0.001；模型2:OR＝2.738,95%CI:1.4439～5.132,P＝0.002)、心血管死亡(模型1:OR＝3.406,95%CI:1.869～6.228,P＜0.001；模型2:OR＝3.053,95%CI:1.595～5.817,P＜0.001)、室壁瘤形成(模型1:OR＝3.203,95%CI:1.665～6.069,P＜0.001；模型2:OR＝3.93,95%CI:1.785～8.663,P＜0.001)、心脏破裂(模型1:OR＝2.461,95%CI:1.389～4.312,P＝0.002；模型2:OR＝2.302,95%CI:1.214～4.274,P＝0.009)及复合终点(模型1:OR＝3.719,95%CI:2.226～6.332,P＜0.001；模型2:OR＝2.919,95%CI:1.576～5.405,P＜0.001)的独立危险因素。SHR水平与院内全因死亡(非线性P＝0.250)、心血管死亡(非线性P＝0.129)、室壁瘤形成(非线性P＝0.588)、心脏破裂(非线性P＝0.787)及复合终点(非线性P＝0.399)的发生风险呈正相关线性关系；SHR对院内全因死亡(AUC＝0.694)、心血管死亡(AUC＝0.697)、室壁瘤形成(AUC＝0.706)、心脏破裂(AUC＝0.667)及复合终点(AUC＝0.730)的诊断效能较好,且SHR在各亚组中的预测效能稳定。 [结论]高SHR是急性STEMI患者出现院内死亡及心脏机械性并发症的独立危险因素,SHR对急性STEMI患者的预后具有重要的预测价值。

Abstract:

Aim To explore the predictive value of stress hyperglycemia ratio (SHR) for in-hospital mortality and mechanical complications in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods This study constituted a retrospective investigation that collected 995 patients diagnosed with acute STEMI at Suining Central Hospital from June 2019 to July 2023. Comparisons of baseline data were conducted using t-test, Mann-Whitney U test and chi-square test; Logistic regression was used to analyze the association between SHR and the risk of in-hospital mortality and mechanical complications in acute STEMI patients; Restricted cubic spline analysis based on the Logistic regression model was utilized to explore non-linear relationship between SHR and the risk of in-hospital mortality and mechanical complications; ROC curve was used to evaluate the diagnostic efficacy of SHR; Subgroup analysis was used to assess the predictive efficacy of SHR in each subgroup. Results Patients with high SHR had a significantly higher cardiovascular mortality (P＝0.007). High SHR was an independent risk factor for in-hospital all-cause mortality (Model 1:OR＝3.5,5%CI:1.719～5.538, P＜0.001; Model 2:OR＝2.8,5%CI:1.4439～5.132, P＝0.002), cardiovascular mortality (Model 1:OR＝3.6,5%CI:1.869～6.228, P＜0.001; Model 2:OR＝3.3,5%CI:1.595～5.817, P＜0.001), ventricular aneurysm (Model 1:OR＝3.3,5%CI:1.665～6.069, P＜0.001; Model 2:OR＝3.3,5%CI:1.785～8.663, P＜0.001), cardiac rupture (Model 1:OR＝2.1,5%CI:1.389～4.312, P＝0.002; Model 2:OR＝2.2,5%CI:1.214～4.274, P＝0.009) and composite endpoint (Model 1:OR＝3.9,5%CI:2.226～6.332, P＜0.001; Model 2:OR＝2.9,5%CI:1.576～5.405, P＜0.001) in patients with acute STEMI. SHR was positively correlated in a linear relationship with the risk of in-hospital all-cause mortality (P for non-linearity＝0.250), cardiovascular mortality (P for non-linearity＝0.129), ventricular aneurysm (P for non-linearity＝0.588), cardiac rupture (P for non-linearity＝0.787) and composite endpoint (P for non-linearity＝0.399). The SHR had excellent diagnostic efficacy for in-hospital all-cause mortality (AUC＝0.694), cardiovascular mortality (AUC＝0.697), ventricular aneurysm (AUC＝0.706) , cardiac rupture (AUC＝0.667) and composite endpoint (AUC＝0.730), meanwhile SHR predicted efficacy consistently across subgroups. Conclusions High SHR is an independent risk factor for in-hospital all-cause mortality, cardiovascular mortality and cardiac mechanical complications in patients with acute STEMI. SHR holds significant predictive value for the prognosis of patients with STEMI.