Relationship between SYNTAX score and serum N-terminal pro-brain natriuretic peptide, homocysteine and prognosis in patients with acute myocardial infarction
10.3760/cma.j.cn115455-20200226-00196
- VernacularTitle:急性心肌梗死患者SYNTAX评分与血清N-末端脑钠肽前体、同型半胱氨酸及预后关系
- Author:
Wen CHEN
1
;
Wenjun SHU
;
Xiuli MO
;
Guo CHEN
Author Information
1. 广东省廉江市人民医院心血管内科 524400
- From:
Chinese Journal of Postgraduates of Medicine
2020;43(7):643-650
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To study the correlation between serum N-terminal pro-brain natriuretic peptide (NT-proBNP), homocysteine (Hcy) and SYNTAX score, and further clarify the prognostic significance of NT-proBNP and Hcy in patients with acute myocardial infarction (AMI).Methods:The clinical data of 303 patients with AMI from January 2014 to January 2016 in Lianjiang People′s Hospital of Guangdong Province were retrospectively analyzed. Patients were evaluated using version 2.11 of the SYNTAX score system. The SYNTAX score ≤ 22 scores was divided into the low risk group (103 cases), SYNTAX score 23 to 32 scores was divided into the medium risk group (85 cases), and the SYNTAX score ≥ 33 scores was divided into the high risk group (115 cases). The clinical data and laboratory examination results were collected. Univariate and multivariate Logistic regression analysis were used to analyze the influencing factors of SYNTAX score high risk. The optimal cutoff value of NT-proBNP and Hcy evaluating the SYNTAX score high risk was analyzed by receiver operating characteristic (ROC) curve. Kaplan-Meier survival curve was plotted to compare all-cause mortality of patients with different evaluation indicators. The influencing factors of prognosis in patients with AMI were analyzed by multivariate Cox risk regression analysis.Results:The patients were followed up for 0.1 to 4.5 (4.30 ± 0.76) years, The all-cause death was in 28 cases, and the all-cause mortality rate was 9.2% (28/303). There were statistical difference in age, smoking rate, diabetes mellitus rate, family history rate of coronary artery disease (CAD), left ventricular ejection fraction (LVEF), ST-elevation myocardial infarction (STEMI) rate, white blood cell, fasting blood glucose (FBG), estimation glomerular filtration rate (eGFR), troponin T (TnT), NT-proBNP and Hcy among the 3 groups ( P<0.01 or <0.05). SYNTAX score was positively correlated with NT-proBNP and Hcy ( r = 0.622 and 0.699, P<0.01). Multivariate Logistic regression analysis result showed that diabetes mellitus, LVEF, TnT, NT-proBNP and Hcy were the independent risk factors of SYNTAX score high risk in patients with AMI ( P<0.01 or <0.05). ROC curve analysis result showed that the area under curve (AUC) of NT-proBNP evaluating the SYNTAX score high risk was 0.807 (95% CI 0.757 to 0.850, P<0.05), the optimal cutoff value was 1 816 μg/L, with a sensitivity of 81.03% and a specificity of 82.26%; the AUC of Hcy evaluating the SYNTAX score high risk was 0.743 (95% CI 0.689 to 0.791, P<0.05), the optimal cutoff value was 17.55 μmol/L, with a sensitivity of 66.67% and a specificity of 79.84%. Kaplan-Meier survival curve analysis result showed that the all-cause mortality in high risk group was significantly higher than that in low risk group and medium risk group (17.4% vs. 2.9% and 5.9%), the all-cause mortality in patients with NT-proBNP> 1 816 μg/L was significantly higher than that in patients with NT-proBNP ≤ 1 816 μg/L (16.2% vs. 5.6%), the all-cause mortality in patients with Hcy>17.55 μmol/L was significantly higher than that in patients with Hcy ≤ 17.55 μmol/L (14.2% vs. 5.7%), and there were statistical differences ( P<0.01 or <0.05). Multivariate Cox risk regression analysis result showed that age, diabetes mellitus, SYNTAX score, TnT, NT-proBNP (>1 816 μg/L) and Hcy (>17.55 μmol/L) were the independent influencing factors of all-cause mortality in patients with AMI ( HR = 1.530, 1.368, 2.065, 1.414, 1.821 and 1.510; 95% CI 1.108 to 2.113, 1.012 to 3.485, 1.810 to 2.356, 1.248 to 2.714, 1.606 to 2.064 and 1.278 to 1.783; P<0.05 or <0.01). Conclusions:NT-proBNP>1 816 μg/L and Hcy>17.55 μmol/L can not only reflect the degree, severity and complexity of coronary atherosclerosis, but also predict the prognosis in patients with AMI.
