血清sST2水平与STEMI患者早期再灌注性心律失常的相关性

Correlation between serum sST2 level and early reperfusion arrhythmia in STEMI patients

摘要:

目的]探讨血清可溶性生长刺激表达基因2蛋白(sST2)水平与急性ST段抬高型心肌梗死(STEMI)患者行急诊经皮冠状动脉介入治疗(PCI)术后早期再灌注性心律失常(ERA)的相关关系。 [方法]回顾性选取2020年11月—2022年8月就诊于辽宁省人民医院心脏中心行急诊PCI的STEMI患者202例,根据PCI术后48 h内有无ERA分为ERA组和无ERA组,比较两组患者血清sST2水平及临床资料,应用单因素及多因素Logistic回归分析探讨血清sST2水平与ERA发生的相关性,应用限制性立方样条图模型分析ERA发生的独立危险因素。 [结果]PCI术后48 h发生ERA患者83例(41.1%)。与无ERA组比较,ERA组患者胸痛至再灌注时间更短、血清sST2水平更高(P＜0.001)。多因素Logistic回归分析显示,对于STEMI患者,血清sST2水平升高(sST2≥45.03 μg/L)、再灌注时间早(胸痛至再灌注成功时间≤5.23 h)、高血栓负荷、梗死相关动脉(IRA)为右冠状动脉是其急诊PCI后发生ERA的独立危险因素。限制性立方样条图模型提示STEMI患者血清sST2水平与PCI术后ERA发生风险呈非线性相关(P＜0.01),截断点为45.12 μg/L。ROC曲线分析显示,血清sST2水平预测PCI术后发生ERA的ROC曲线下面积为0.827(95%CI:0.771~0.883)。 [结论]PCI术前血清sST2水平高,是STEMI患者术后发生ERA的独立危险因素。血清sST2＞45.12 μg/L时,其水平与ERA发生风险呈正相关。

Abstract:

Aim To investigate the correlation between serum solube growth stimulation expressed gene 2 protein (sST2) and early reperfusion arrhythmia (ERA) after emergency percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods A total of 202 STEMI patients who underwent emergency PCI from November 2020 to August 2022 in the Cardiac Center of Liaoning Provincial People's Hospital were divided into two groups based on the occurrence of ERA within 48 hours after PCI:ERA group and non-ERA group.Serum sST2 level and clinical data were compared between the groups. Univariable and multivariable Logistic regression analysis were used to explore the association between serum sST2 level and ERA occurrence, and restricted cubic spline model was applied to identify independent risk factors for ERA. Results There were 83 (41.1%) patients experienced ERA within 48 hours after PCI. Compared with the non-ERA group, the patients in ERA group had shorter time from chest pain to reperfusion and higher serum sST2 level (P＜0.001). Multivariate Logistic regression analysis showed that for STEMI patients, elevated serum sST2 level (sST2≥45.03 μg/L), early reperfusion time (chest pain to successful reperfusion time≤5.23 h), high thrombosis burden, and right coronary artery as the infarct related artery (IRA) were independent risk factors for ERA after emergency PCI. The restricted cubic spline model suggested that the serum sST2 level of STEMI patients was nonlinearly correlated with the risk of ERA after PCI (P＜0.01), and the cutoff point was 45.12 μg/L. ROC curve analysis showed that the area under the ROC curve of serum sST2 level in predicting ERA occurrence after PCI was 0.827 (95%CI:0.771~0.883). Conclusion The high serum sST2 level before PCI is an independent risk factor for ERA occurrence after PCI in patients with STEMI. When serum sST2 ＞45.12 μg/L, its level is positively correlated with the risk of ERA.