| Acute ST-segment elevation myocardial infarction(STEMI)is one of the most important diseases that threaten human health.At present,it is mainly on the basis of coronary atherosclerosis.unstable plaque rupture leads to bleeding,platelet aggregation and secondary thrombosis is the main cause of the complete occlusion of the coronary that resulting in myocardial damage and irreversible necrosis caused by myocardial ischemia and hypoxia,and further lead to papillary muscle dysfunction,acute heart failure,heart rupture,embolism,post-infarction syndrome,and so on,which seriously affect the clinician treatment strategies and reduce the treatment enthusiasm of patients and family members.Current studies have shown that local and systemic inflammatory responses to STEMI acute episodes play an important role in disease progression and prognosis.The relationship between changes in a number of serological markers associated with local and systemic inflammatory responses,such as C-reactive protein(CRP),Troponin T(TNT),brain natriuretic peptide(BNP)and the prognosis of STEMI patients are being more and more attention.Prealbumin(PA)is a hometetrameric protein synthesized by the hepatic,PA as a rapid turnover visceral protein that can reflect the body’s nitrogen metabolism which regarded as a good indicator of the nutritional status of patients.It is also a non-specific defensive protein,most of the circulating prealbumin remains ligand-free and it can combine a variety of pathogens and body toxicity metabolites to resulting in their own consumption in the inflammatory response phase.In recent years,Abroad Studies have shown that PA can be used as a predictor of major adverse events within 1 year after peripheral arterial angiography.Lower levels of PA are also significantly associated with poor prognosis in patients with heart failure.Some studies have done a lot of research about PA changes in patients with Kawasaki disease,coronary heart disease and acute myocardial infarction which suggesting that PA has important value in assessing the degree of vascular disease,the extent of inflammation and the short-term prognosis of acute myocardial infarction as an indicator of inflammation and acute stress response.However,STEMI as a transmural myocardial infarction,compared with stable angina pectoris(SAP),unstable angina pectoris(UAP),non-ST-elevation myocardial infarction(NSTEMI)have different treatment.At the present,The studies of the relationship between the short-term prognosis and the level of PA in patients with STEMI is relatively low.Therefore,Our study provides a theoretical reference for the clinical treatment of PA level as a therapeutic target by comparing the short-term prognosis of STEMI patients with PA level.I n this study,we used a retrospective survey method.There were 160 patients with STEMI selected in Zhangjiakou First Hospital from January 2013 to June 2015.Age,heart rate,systolic blood pressure,previous history of hypertension,history of diabetes,history of smoking,blood lipids,liver function,cardiac function and other information were required to record.All patients Immediately draw blood when the patients sent to our hospital.All patients were treated with percutaneous coronary intervention(PCI)after admission.PCI was performed by two senior physicians in our hospital.The patients were given preloaded doses of aspirin enteric-coated tablets 300 mg,Clopidogrel tablets 600 mg,stent placement criteria for coronary artery stenosis greater than 75% or more,statistics of the three lesions vascular number.Patients were divided into event groups and non-incident groups according to whether or not cardiac events occurred during hospitalization in STEMI patients.The event group were 58 cases;non-event were cases.Statistical analysis was performed using SPSS Version 17.0.consistent with the normal distribution of data using student’ t test,three or more groups of data using analysis of variance(ANOVA);non-normal distribution data using rank sum test.Categorical variables using chi-square test.The independent predictors of cardiovascular events were analyzed using univariate and multivariate logistic regression models,and the optimal curve of cardiac events was calculated by plotting the receiver operating characteristic curve(ROC curve).All data were examined by bilateral test,P <0.05 that the difference was statistically significant.There were statistically significant differences in the level of coronary artery stenosis which indicated that PA was low in two and three coronary artery stenosis.Spearman correlation analysis showed that serum prealbumin levels were negatively correlated with the severity of coronary artery disease.The STEMI patients were divided into event group and non-event group.Baseline data include Age,diabetes mellitus were significantly higher in the event group than in the non-event group,The proportion of men in the event group,systolic blood pressure,prealbumin,left ventricular ejection fraction(LVEF)was lower than that in the non-event group,There was no significant difference in heart rate,history of hypertension,smoking,left ventricular end diastolic diameter,anterior wall myocardial infarction,blood lipid,troponin T and stent placement.Aspertate aminotransferase(AST),alanine transaminase(ALT)were significantly higher in the event group than in the non-event group,and it was possible that acute myocardial infarction resulted in a reversible loss of liver.Univariate analysis showed that gender,age,diabetes mellitus,systolic blood pressure,LVEF and PA were the prognostic factors of patients with STEMI.However,multivariate analysis showed only diabetic history,systolic blood pressure,LVEF,PA is the prognostic factors of patients.In this study,the area under the curve of PA predicting patients’ cardiovascular events was 0.709 by plotting the receiver operating characteristic curve.The difference was statistically significant and the optimal threshold was 20.85 mg / dl.According to the threshold measured by ROC,the patients were divided into two groups: pre-albumin <20.85 mg / dl and ≥20.85 mg / dl.Compared with ≥20.85 mg / dl group,<20.85 mg / dl group in the ventricular fibrillation,high degree of atrioventricular block,cardiogenic shock,heart failure,total adverse events were significantly higher.There was no significant difference between the two groups in newly diagnosed atrial fibrillation or atrial flutter,postoperative recurrence of myocardial infarction and death.The results suggest that PA is important for predicting the prognosis of patients with STEMI.The above studies have shown that PA may be used as an independent predictor of cardiac events in STEMI patients during hospitalization,as is the case with traditional predictors.Therefore,routine detection of serum PA in patients with STEMI may have important clinical implications for patients’ early assessment of disease and prognosis. |
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