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血清FAR对非ST段抬高型急性冠脉综合征患者支架植入治疗预后的预测价值
作者:李明康1  汤海霞1  秦雨晗1  罗二飞1  汤成春2  鄢高亮2 
单位:1. 东南大学 医学院, 江苏 南京 210009;
2. 东南大学附属中大医院 心内科, 江苏 南京 210009
关键词:非ST段抬高型急性冠脉综合征 冠状动脉支架植入术 纤维蛋白原/白蛋白值 预后 
分类号:R543.3;R816.2
出版年·卷·期(页码):2020·39·第三期(259-265)
摘要:

目的:探讨血清纤维蛋白原/白蛋白值(FAR)对非ST段抬高型急性冠脉综合征(NSTE-ACS)患者首次支架植入术后短期预后的预测价值。方法:连续入选2018年1月至12月在东南大学附属中大医院心内科首次接受冠状动脉内药物洗脱支架植入术治疗的NSTE-ACS患者548例。根据受试者工作特征(ROC)曲线确定入院FAR预测6个月主要不良心血管事件(MACE)的最佳临界值,分为低FAR组和高FAR组。比较两组患者支架植入术后随访6个月MACE(包括全因死亡、再发心肌梗死、再次血运重建和因心衰再入院)的发生率。采用多因素Cox回归分析评估FAR是否为NSTE-ACS患者首次支架植入术后6个月MACE的独立危险因素。结果:ROC曲线结果显示FAR预测6个月MACE最佳临界值为9.86%(曲线下面积是0.646,敏感度66.7%,特异度62.2%)。据此,331例归为低FAR组,217例归为高FAR组。与低FAR组相比,高FAR组患者年龄较大,血白细胞计数、肌酐和纤维蛋白原水平更高,而血红蛋白、白蛋白和左室射血分数水平更低,并且高FAR组冠状动脉病变更加复杂,3支病变比例更高。6个月随访结果显示,与低FAR组相比,高FAR组患者再次血运重建、因心衰再入院等MACE发生率更高(P<0.05)。多因素Cox回归分析显示,作为分类变量或连续变量,FAR均是NSTE-ACS患者首次支架植入术后MACE发生的独立危险因素(HR=2.379,95%CI 1.228~4.609,P=0.010;HR=1.102,95%CI 1.012~1.200,P=0.025)。结论:入院血清FAR是NSTE-ACS患者首次支架植入术后6个月MACE的独立预测因子,具有一定预测价值。

Objective:To evaluate the prognostic value of fibrinogen-to-albumin ratio in predicting short-term outcome of non-ST-segment elevation acute coronary syndrome(NSTE-ACS) patients firstly implanted with drug-eluting stent(DES). Methods:A total of 548 consecutive NSTE-ACS patients firstly implanted with DES in our department from January 2018 to December 2018 were enrolled in this single-center prospective study. Patients were divided into low and high FAR groups bsed on an optimal cut off value of fibrinogen-to-albumin ratio (FAR) on admission to predict 6-month major adverse cardiovascular events (MACE). The clinical characteristics, coronary artery lesions and 6-month MACE including all-cause mortality, myocardial reinfarction, repeated revascularisation and readmission for heart failure were compared between the two groups. Results:By receiver operating characteristic curve(ROC) analysis, the optimal cut-off value of FAR to predict 6-month MACE was 9.86%(area under the curve 0.646, sensitivity 66.7%, specificity 62.2%). Compared with the low FAR group (n=331), patients in the high FAR group(n=217) were older, had higher level of neutrophil count, creatinine and fibrinogen levels, but lower level of hemoglobin, albumin and LVEF. With higher prevalence of three-vessel disease, coronary artery stenosis was severer in the high FAR group. The 6-month incidence of repeated revascularisation, readmission for heart failure and MACE was also higher in the high FAR group compared with the low FAR group. Multivariate Cox analysis indicated that FAR was an independent predictor of MACE in this patient cohort either as a categorical variable (HR=2.379, 95%CI 1.228-4.609, P=0.010) or as a continuous variable (HR=1.102, 95%CI 1.012-1.200, P=0.025). Conclusion:Our study demonstrates that FAR on admission is an independent predictor of 6-month MACE in NSTE-ACS patients firstly implanted with DES.

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