The Predictive Value Of CK-MB Area Under Curve For MACE During Hospitalization In STEMI Patients

Research backgroundAcute myocardial infarction(AMI)is a secondary thrombosis on the basis of coronary unstable plaque rupture and erosion,leading to a sudden interruption of coronary blood flow and the occurrence of myocardial ischemic necrosis.The major cardiovascular events(MACE)and its incidence during hospitalization are one of the important evaluation indicators for the emergency treatment quality of acute ST-segment elevation myocardial infarction(STEMI).Therefore,it is particularly important to identify early factors that increase the risk of major adverse cardiovascular events in STEMI patients.Factors associated with MACE include:time of ischemia,degree of myocardial damage,multivessel disease,left main disease,quality of reperfusion,presence or absence of underlying disease before myocardial infarction,severity of blood glucose,and blood glucose fluctuations and glycosylated hemoglobin levels,and so on.Among them,the most important is the degree of myocardial damage.It is well known that myocardial enzymes are important indicators for assessing the degree of myocardial damage.All along,clinical work and scientific research have used myocardial enzyme peak and peak time as important biochemical markers for assessing STEMI myocardial injury severity,disease severity,and even prognosis.In clinical practice work,the peak of myocardium enzyme is the observed peak,not the actual peak.The release of myocardial enzymes for STEMI patients is a continuous process.We should use an ideal evaluation index.And we express not only the peak and peak time,but also the rise and fall speed and duration.Observing this peak“point”does not accurately reflect the degree of myocardial damage.Our group believes that the relative ideal"area"of CK-MB AUC can more fully reflect the severity of myocardial injury and then study its predictive value for clinical prognosis.Currently,there is relatively little research on the predictive value of CK-MB AUC and the peak of CK-MB in the prediction of MACE during hospitalization in STEMI patients.Therefore,our group proposed that CK-MB AUC is better than CK-MB peak in assessing the severity of STEMI patients during hospitalization.Objective1.To analyze whether MACE is associated with CK-MB AUC during hospitalization in patients with ST elevation myocardial infarction(STEMI).2.To compare the value of CK-MB AUC and the peak of CK-MB to predict the MACE during hospitalization in patients with acute ST segment elevation myocardial infarction.MethodThis study was consecutively selected for the patients of STEMI diagnosed in the Emergency Room of Henan Province People’s Hospital between August 2017 and December 2017.A total of 81 patients with complete data and inclusion and exclusion criteria were collected,including 68 males and 13 females,the average age was(56.21±11.01)years old.According to the presence or absence of major adverse cardiovascular events(MACE)during hospitalization in STEMI patients,they were divided into two groups:MACE group(19 cases)and no MACE group(62 cases).According to the concentration and time of CK-MB detected during hospitalization,a curve was formed.According to the trapezoidal area method,the peaks of CK-MB and CK-MB AUC were counted and divided into CK-MB peak group(abbreviated as peak group)and CK-MB curve.The area under the group(referred to as AUC group).By calculating the area under the ROC curve,the magnitude of the predictive value of CK-MB AUC and CK-MB peaks during hospitalization of STEMI patients was compared.Recorded history of diabetes,hypertension,dyslipidemia,stroke,coronary heart disease,family history of cardiovascular disease,and smoking.Clinical baseline data were collected from patients,including clinical data such as age,gender,body mass index(BMI),length of hospital stay,and so on.Biochemical data such as the concentration of creatine kinase isoenzyme(CK-MB)and the corresponding blood draw time were collected.Coronary angiography(CAG)results were collected,including the number of coronary artery lesions,blood vessels of the offender,presence or absence of collateral circulation.SPSS 22.0 statistical software was used for statistical analysis of the data.When the measurement data conforms to a normal distribution,the measurement data is expressed as the mean±standard deviation(?X±S),and the measurement data sets are compared using the t-test.When the distribution of measurement data does not obey the normal distribution,non-parametric tests are used;the count data is expressed as a percentage,and theχ~2test is used for comparison between the two groups of samples.Finally,ROC curve was used to calculate the area under the ROC curve and its 95%confidence interval(95%CI,Confidence Interval),and then to compare the predictive value of CK-MB AUC and CK-MB peaks in the occurrence of MACE in STEMI patients during hospitalization.Hypothesis tests are performed using two-sided tests.The test level is set toα=0.05.p<0.05 is considered statistically significant.The method of calculating CK-MB AUC is recording CK-MB concentrations at the beginning,6h,12h,24h,48h,and 72h.And we specify the CK-MB concentration at the time of onset,and the entry time is 0.Then we draw the time-concentration curve,take the highest point of the curve as the peak of CK-MB,and calculate the CK-MB AUC using the trapezoidal area method.Results1.There was no statistical difference between MACE group and non-MACE group in gender,coronary heart disease,diabetes,hypertension,stroke and family history(P?0.05).Compared with the two groups,there was a statistically significant difference in age,smoking history,BMI,blood lipid levels.From the results of coronary angiography in both groups,there was no significant difference between the two groups in the number of diseased vessels,infarct-related vessels,and the presence of collateral circulation(P?0.05).2.The CK-MB AUC in MACE group was significantly higher than that in non-MACE group(P?0.05).The difference was statistically significant.3.In the ROC(Receiver operating characteristic curve,ROC)curve analysis of MACE during hospitalization of CK-MB AUC and the peak of CK-MB prediction STEMI patients,the area under the CK-MB AUC ROC curve was 0.654,95%confidence interval(0.493,0.814),P?0.05;the area under the peak ROC curve of CK-MB was 0.542,95%confidence interval(0.399,0.686),P?0.05.Conclusion1.CK-MB AUC is a factor that influences MACE during hospitalization in STEMI patients.2.CK-MB AUC is better than the peak of CK-MB in predicting the occurrence of MACE in STEMI patients during hospitalization.