| ObjectiveTo investigate the predictive Value of the Combined Assessment of HPR,Lp-PLA2 and GRACE Score to the Prognosis in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.MethodsThere were 150 patients diagnosed AMI and all patients were examined by coronary angiography in TEDA International Cardiovascular Hospital from September 2015 to January 2016 and all people were followed up to 1 year at least.Admission plasma Lp-PLA2,other laboratory biochemical tests and imaging examinations were measured in all eligible patients admitted to hospital before CAG and platelet aggregation at 12-24 h after PCI.Lp-PLA2 levels were grouped according to the American AACE standard: Lp-PLA2 concentration > 223 ?g/L was defined as high-risk group,< 200 ?g/L defined as low-risk group,200-223 ?g/L defined as the risk group.The GRACE score was calculated from the clinical data of the patient.Major Adverse Cardiac Events were followed up for 1 year after discharge by outpatient medical records and telephone.The single factor and multivariate logistic regression were used to analyze the predictive factors of MACE events in patients,and the receiver operator characteristic curve of the subjects was plotted and compared with the area under the curve.ResultsOur study collected 150 cases of patients meeting the requirement,including 106 cases of male and 44 cases of female,with an average age of 60 years old,98 patients with hypertension,22 patients with diabetes,10 cases with hyperlipidemia and90 cases with history of smoking.Single or double branch of coronary artery lesions in 87 cases,three or left main lesion 63 cases.Follow-up was 11.35±3 months.There were 20 cases(13.33%)of adverse cardiovascular events during follow-up,1 case(0.67%)of nonfatal myocardial infarction,4 cases(2.67%)of non-planned target vessel revascularization,6 cases(4.00%)of unintended hospitalization due to angina or heart failure,1 case of cardiac death(0.67%),7 cases(4.67%)of recurrence ofchest pain,and 1 case of nonfatal stroke(0.67%).The comparison of the between different platelet response groups patients showed that ST segment elevation myocardial infarction,GRACE score,Lp-PLA2 lever,heart rate during admission,fasting blood glucose,TNI,triglyceride and LEVF were different.,P< 0.05.Pearson correlation analysis showed that there was a positive correlation between HPR and Lp-PLA2 levels(r = 0.220,p = 0.007).And there was a positive correlation between HPR and Lp-PLA2 lever(r = 0.486,p = 0.000).The incidence of MACE in the high-risk group of Lp-PLA2 was significantly higher than that the low risk group and the middle-risk group,and the incidence of MACE in the middle-risk group was higher than that the low risk group,P < 0.05.The incidence of MACE was higher in the HPR group than in the non-HPR group in the total population,P < 0.05.Single factor and multivariate analysis of MACE events showed that Lp-PLA2 lever,HPR and GRACE score were independent risk factors for MACE in AMI patients.ROC analysis indicated that HPR,GRACE score and Lp-PLA2 level had the important predictive value for lone term prognosis of patients with AMI after PCI,respectively.ROC analysis indicated that the combination of high platelet response,GRACE score and Lp-PLA2 level had a better predictive value for MACE occurrence.ConclusionsThis study showed that HPR and GRACE score had a obvious correlation.HPR and Lp-PLA2 levels have a clear correlationl.HPR,Lp-PLA2 level are independent predictors of long-term adverse cardiovascular events after acute interventional therapy in patients with acute myocardial infarction.The combination of HPR,GRACE score and Lp-PLA2 levels can improve the predictive ability of the occurrence of adverse cardiovascular events in patients with with AMI after primary PCI. |
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