Clinical Study On The Predictive Value Of Epinephrine And Free Triiodothyronine For MACE In Patients With STEMI After Emergency PCI

Objective:This study aims to explore the predictive value of Epinephrine(EPI)and Free triiodothyronine(FT3)for Major adverse cardiovascular events(MACE)in patients with ST segment elevation myocardial infarction(STEMI)after emergency Percutaneous coronary intervention(PCI).The aim is to identify high-risk patients early by two biological markers and seek targets for further clinical intervention.Methods: A total of 107 patients with STEMI after emergency PCI in our hospital from September 2020 to November 2021 were selected.Baseline data,biochemical test data and coronary angiography data were collected.EPI was measured by enzyme-linked immunosorbent assay,and FT3 was measured by electrochemiluminescence.The following analysis was planned: 1.Patients were divided into MACE group and nonMACE group,and various indicators of the two groups were compared;2.Analysis of follow-up MACE events;3.According to Receiver operating characteristic curve(ROC),the best cut-off values of EPI and FT3 which predict the occurrence of MACE were calculated respectively.Patients were respectively divided into high EPI group,low EPI group,high FT3 group and low FT3 group according to the best cut-off values,and the occurrence of MACE between the groups was compared respectively.4.To compare the predictive value of EPI,FT3,EPI combined with FT3 for MACE in patients with STEMI after emergency PCI.5.Survival analysis(Kaplan-Meier method and log-rank test)was used to investigate the relationship between EPI,FT3 and MACE in patients with STEMI after emergency PCI.6.COX proportional hazard regression model was used to investigate the risk factors for MACE in patients with STEMI after emergency PCI.Results: 1.According to the inclusion and exclusion criteria,107 patients with STEMI after emergency PCI were selected for the study,of which 19 patients had MACE and 88 patients did not have MACE.Compared with the non-MACE group,the patients in the MACE group were older,the proportion of Killip Ⅱ and above,NT-pro BNP and EPI were higher,while FT3 was lower,and the differences were statistically significant(P<0.05).The Gensini score of MACE group was significantly higher than that of nonMACE group(P<0.01).2.Follow-up analysis of MACE events: a total of 19 MACE events occurred in 107 patients,including 10 cases of heart failure,2 cases of unexpected target vessel revascularization,4 cases of severe angina pectoris readmission,1 case of malignant arrhythmia,and 2 case of nonfatal acute myocardial infarction.3.According to ROC analysis,the Area under the curve(AUC)of EPI for predicting MACE in patients with STEMI after emergency PCI was 0.699(95%CI: 0.579-0.819,P=0.007),the best cut-off value of EPI was 528.54,the sensitivity was 78.9%,and the specificity was 56.8%.The incidence of MACE in the high EPI group was significantly higher than that in the low EPI group(P=0.005).The AUC of FT3 for predicting MACE in patients with STEMI after emergency PCI was 0.733(95%CI: 0.616-0.850,P=0.001),the best cut-off value was 3.99,the sensitivity was 84.2%,and the specificity was 52.3%.According to the best cut-off value of FT3,the incidence of MACE in the low FT3 group was significantly higher than that in the high FT3 group(P=0.004).4.The AUC of EPI and FT3 combined group was 0.849(95%CI: 0.748-0.951,P=0.000),the best cut-off value was 0.712,the sensitivity was 73.7%,and the specificity was 87.5%.Compared with EPI and FT3 alone,the combination of EPI and FT3 showed stronger specificity and higher predictive value.5.Kaplan-Meier survival curve showed that the higher the EPI value,the higher the risk of MACE(log-rank test P=0.004),and the lower the FT3 value,the higher the risk of MACE(log-rank test P=0.003).6.Multivariate COX regression analysis showed that age(P=0.042),FT3(P=0.000),EPI(P=0.000)and Gensini score(P=0.004)were independent risk factors for MACE.Conclusions: 1.EPI and FT3 are significantly correlated with the occurrence of MACE in patients with STEMI after emergency PCI.The higher the EPI value or the lower the FT3 value,the higher the risk of MACE.2.Both EPI and FT3 have predictive value for MACE in patients with STEMI after emergency PCI,and the combination of the EPI and FT3 has higher specificity and higher predictive value.3.Multivariate COX regression analysis showed that both EPI and FT3 were independent risk factors for MACE in patients with STEMI after emergency PCI.