| Objective:To investigate the effects of cardiac troponin I(cTnⅠ)and door-toballoon(D2B)time on prognosis of ST-segment elevation myocardial infarction(STEMI)patients undergoing a primary percutaneous coronary intervention(PCI)..Methods:We divided the consecutive 1,485 STEMI patients who underwent PCI from January 2015 to October 2019 at our hospital into three groups based on their admission cTnⅠ levels:normal group(<0.1 ng/mL),middle group(0.1 to less than 3 ng/mL),and high group(≥3 ng/mL)and then into two groups by their D2B times:>90 min(>90-D2B)and ≤90 min(≤90-D2B).30-day and 1-year follow-up records of adverse cardiovascular events including cardiac death and heart failure(HF)were systematically examined and analyzed.Kaplan-meier survival analysis and multivariate Logistic regression analysis were used to evaluate the effects of cTnⅠ and D2B time on the prediction of composite events(cardiac death and HF events)in STEMI patients undergoing a primary PCI.Results:1.Prognostic analysis of cTnⅠ and D2B time1)During the 30 days and 1-year follow-up after PCI,the incidence of cardiac death and HF composite events in the normal cTnⅠ group were lower than that in the others,and with the increasement of cTnⅠ level,the incidence of composite events showed an increasing trend(p<0.05).Cox analysis showed that cTnⅠ>3 ng/mL group compared with cTnⅠ<3 ng/mL group,the incidence of composite events increased 2.3 times during30 days and 2.7 times during 1 year follow-up.2)Survival analysis based on D2B time group showed that the incidence of composite events within 30 days was significantly higher in the>90-D2B group than in the ≤90-D2B group(p<0.05),but there was no significant difference in the 1-year follow-up.3)ROC curve analysis of 30-day composite events showed that the sensitivity and specificity of cTnⅠ>3 ng/mL were 53.23%and 69.05%,while the sensitivity and specificity of D2B times>90 min were 54.79%and 65.63%.At 1-year follow-up,the sensitivity and specificity of cTnⅠ>3 ng/mL were 59.8%and 69.57%,but there was no statistical difference in the prediction of composite events at D2B time(p>0.05).2.The combined application of cTnⅠ and D2B time1)The unadjusted estimated risk for composite clinical events during the pre-specified times and according to the admission cTnⅠ level and D2B time.When the D2B time was ≤90-min,there was no significant difference in the risk ratio of composite events during 30-day between the normal cTnⅠ group and the other two groups.however,the risk at 1 year follow-up was significantly increased in the high cTnⅠ expression groups compared with the normal cTnⅠ group.(p<0.05).In the>90-min-D2B group analysis,this prognostic impact on composite clinical events by a high cTnⅠ expression group was present not only for the 30-day but also for the 1-year follow-up.2)A multivariable logistic analysis revealed that the risk of composite events was significantly increased in the cTnⅠ high expression group compared with the normal group in both periods(30-day,adjusted HR:2.1,95%CI:1.19-3.64,P=0.01;1-year,adjusted HR:2.8,95%CI:1.3-5.82,P=0.008).In the analysis of the D2B times(≤90 min vs>90 min),with the exception of the normal cTnⅠ group,the risk ratio of composite events during 30-day increased with the delay of D2B time,and decreased with the shortening of D2B time(adjusted HR:0.62,95%CI:0.49-0.89,P=0.016).At 1-year follow-up,D2B time had no significant difference in predicting composite events(p>0.05).Conclusion:1.Admission cTnⅠ level and D2B time both are the important factors for predicting 30-day composite events in STEMI patients undergoing primary PCI.2.1 year follow-up results showed that admission cTnⅠ level could be used to predict the risk assessment of composite events among STEMI patients,and the prognostic risk increased significantly when cTnⅠ≥3 ng/mL,but D2B time on prognostic impact disappeared during the 1-year follow-up. |
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