Objective To investigate the relationship between expression levels of membrane occupation and recognition nexus of linker domain protein 4(MORN4)and cluster differentiation 40 ligand(CD40L)in peripheral blood extracellular vesicles after percutaneous coronary intervention(PCI)and SYNTAX-Ⅱ score and prognosis in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods Retrospective analysis of 268 patients with acute STEMI who underwent PCI in the Department NO 2.of Cardiology,Affiliated Hospital of Shaanxi University of Chinese Medicine from June 2020 to May 2023.Patients were divided into MACE group and non MACE group based on major adverse cardiovascular events(MACE)occurred during the 1-year follow-up period.Quantitative real-time PCR(RT-qPCR)was used to detect the mRNA expression levels of MORN4 and CD40L in circulating extracellular vesicles in peripheral blood of the two groups.The clinical data and expressions of MORN4 and CD40L were compared between the two groups.Pearson correlation analysis of MORN4,CD40L and SYNTAX-Ⅱ scores.Multi-factor Logistics regression model was used to analyze the risk factors of MACE after PCI.The receiver operating characteristic(ROC)curve was plotted,the area under curve(AUC)was calculated,and the value of MORN4 and CD40L expression levels in predicting the occurrence of MACE was analyzed.Results Within 1 year after surgery,75 patients developed MACE.Clinical data comparison showed that the MACE group had higher numbers of diseased vessel branches,stent numbers,and SYNTAX-Ⅱ scores compared to the non MACE group,and the differences were statistically significant(χ2/t=4.451,2.625,11.553,all P<0.05).The expression levels of MORN4 mRNA(2.16±0.54)and CD40L mRNA(1.87±0.25)in the MACE group were higher than those in the non-MACE group(1.24±0.31,1.13±0.19),and the differences were statistically significant(t=17.429,26.092,all P<0.05).Pearson correlation analysis showed,MORN4 and CD40L expression were positively correlated with SYNTAX-Ⅱ score(r=0.548,0.523,all P<0.05).SYNTAX-Ⅱ score,MORN4 and CD40L expression were independent risk factors for MACE after PCI in patients with acute STEMI(Wald χ2=24.426,4.569,3.038,all P<0.05).When the cutoffvalues of MORN4 and CD40L were set to 1.79 and 1.52,respectively,their combined prediction of AUC(95%CI)sensitivity and specificity for MACE occurrence was superior to single indicator prediction(Z=1.972,2.393,all P<0.05).Conclusion The detection of MORN4 and CD40L expression in circulating extracellular vesicles of acute STEMI patients after PCI has a positive significance in evaluating the degree of coronary artery disease and the occurrence of MACE.The combined detection of MORN4 and CD40L has high clinical value in predicting the occurrence of MACE after surgery and can be used as effective molecular markers for evaluating the short-term prognosis of patients.

Objective To investigate the relationship between expression levels of membrane occupation and recognition nexus of linker domain protein 4(MORN4)and cluster differentiation 40 ligand(CD40L)in peripheral blood extracellular vesicles after percutaneous coronary intervention(PCI)and SYNTAX-Ⅱ score and prognosis in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods Retrospective analysis of 268 patients with acute STEMI who underwent PCI in the Department NO 2.of Cardiology,Affiliated Hospital of Shaanxi University of Chinese Medicine from June 2020 to May 2023.Patients were divided into MACE group and non MACE group based on major adverse cardiovascular events(MACE)occurred during the 1-year follow-up period.Quantitative real-time PCR(RT-qPCR)was used to detect the mRNA expression levels of MORN4 and CD40L in circulating extracellular vesicles in peripheral blood of the two groups.The clinical data and expressions of MORN4 and CD40L were compared between the two groups.Pearson correlation analysis of MORN4,CD40L and SYNTAX-Ⅱ scores.Multi-factor Logistics regression model was used to analyze the risk factors of MACE after PCI.The receiver operating characteristic(ROC)curve was plotted,the area under curve(AUC)was calculated,and the value of MORN4 and CD40L expression levels in predicting the occurrence of MACE was analyzed.Results Within 1 year after surgery,75 patients developed MACE.Clinical data comparison showed that the MACE group had higher numbers of diseased vessel branches,stent numbers,and SYNTAX-Ⅱ scores compared to the non MACE group,and the differences were statistically significant(χ2/t=4.451,2.625,11.553,all P<0.05).The expression levels of MORN4 mRNA(2.16±0.54)and CD40L mRNA(1.87±0.25)in the MACE group were higher than those in the non-MACE group(1.24±0.31,1.13±0.19),and the differences were statistically significant(t=17.429,26.092,all P<0.05).Pearson correlation analysis showed,MORN4 and CD40L expression were positively correlated with SYNTAX-Ⅱ score(r=0.548,0.523,all P<0.05).SYNTAX-Ⅱ score,MORN4 and CD40L expression were independent risk factors for MACE after PCI in patients with acute STEMI(Wald χ2=24.426,4.569,3.038,all P<0.05).When the cutoffvalues of MORN4 and CD40L were set to 1.79 and 1.52,respectively,their combined prediction of AUC(95%CI)sensitivity and specificity for MACE occurrence was superior to single indicator prediction(Z=1.972,2.393,all P<0.05).Conclusion The detection of MORN4 and CD40L expression in circulating extracellular vesicles of acute STEMI patients after PCI has a positive significance in evaluating the degree of coronary artery disease and the occurrence of MACE.The combined detection of MORN4 and CD40L has high clinical value in predicting the occurrence of MACE after surgery and can be used as effective molecular markers for evaluating the short-term prognosis of patients.