甘油三酯葡萄糖指数对ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗后微血管阻塞的预测价值

Predictive value of triglyceride-glucose index on microvascular obstruction after emergency PCI in patients with ST-segment elevation myocardial infarction

摘要:

目的]探讨甘油三酯葡萄糖(TyG)指数与急性ST段抬高型心肌梗死(STEMI)患者接受经皮冠状动脉介入治疗(PCI)术后微血管阻塞(MVO)之间的相关性。 [方法]选取2018年6月—2021年6月期间在南京大学医学院附属鼓楼医院经绿色通道接受急诊PCI且术后1周内行心脏磁共振检查的310例STEMI患者为研究对象进行前瞻性分析。根据患者是否发生MVO,将其分为MVO组(183例)和无MVO组(127例)。比较两组患者临床资料的差异,限制性立方样条(RCS)描述TyG指数与MVO发生的线性关系,采用单因素和多因素Logistic回归分析矫正混杂因素识别MVO发生的独立危险因素。 [结果]经多因素Logistic回归排除混杂因素,结果显示TyG指数为STEMI患者急诊PCI术后发生MVO的独立危险因素,TyG指数每增加1个单位,MVO的发生风险会升高1.24倍(OR＝2.24,95%CI:1.07～4.71,P＝0.033)。RCS曲线分析结果显示,TyG指数与急诊PCI术后发生MVO呈线性关系(P非线性＝0.47),当TyG指数＞9.5时,急诊PCI术后发生MVO的风险显著上升。 [结论]TyG指数的增加与接受急诊PCI的STEMI患者MVO的发生呈正相关,对STEMI患者MVO的早期预防和危险分层具有重要的临床意义。

Abstract:

Aim To investigate the association of triglyceride-glucose (TyG) index with microvascular obstruction(MVO) after percutaneous coronary intervention(PCI) in patients with ST-segment elevated myocardial infarction(STEMI). Methods Individual patient-data were pooled from 310 patients with STEMI underwent emergency PCI in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from June 2018 to June 2021 for a prospective analysis. A week following the operation, cardiac magnetic resonance imaging was used to evaluate the MVO region and the patients were divided into two groups based on whether MVO occured after PCI:the MVO group (n＝183) and the non-MVO group (n＝127). The clinical data of the two groups were compared, and the linear relationship between TyG index and MVO was described using restricted cubic splines(RCS). Univariate and multivariate Logistic regression analysis were used to correct for confounding factors and identify independent risk factors for MVO occurrence. Results After adjustment for confounding factors, TyG index was an independent risk factor for MVO after emergency PCI in STEMI patients, and every 1-unit increased in TyG index, the risk of MVO increased by 1.24 times (OR＝2.4,5%CI:1.07～4.71, P＝0.033). The RCS curve analysis results showed that there was a linear relationship between the TyG index and the occurrence of MVO after emergency PCI (non-linear correlation test P＝0.47).When the TyG index was greater than 9.5, the risk of MVO after emergency PCI significantly increased. ConclusionAn increased TyG index is postively associated with the incidence of MVO in STEMI patients who have undergone PCI, and has clinical significantce for early prevention and risk stratification of MVO in STEMI patients.