Correlation Between Serum 3-NT And Severity Of Acute ST Segment Elevation Myocardial Infarction And Its Prognostic Value In One Year After Emergency Percutaneous Coronary Intervention

Objective:To investigate the correlation between serum 3-nitroamino acid(3-NT)and the severity of patients with acute ST segment elevation myocardial infarction(STEMI)and its predictive value for prognosis one year after emergency percutaneous coronary intervention(PCI).Methods:Adapting prospective research method,STEMI patients(n=310)who were undergoing emergency PCI in the first Hospital of Shanxi Medical University from July 2016 to July2018 were selected.All the subjects were scored by SYNTAX.According to the results,they were divided into low risk group(n=87),middle risk group(n=190),high risk group(n=33).the clinical data,laboratory data and imaging examination of all patients were collected,and the plasma level of 3-NT were detected by ELISA at admission,immediately after PCI and 3 months after PCI.Correlation analysis was performed to detected the correlation between blood 3-NT concentration and SYNTAX score.all patients were followed up(1 year)to record the occurrence of MACE.Evaluate the predictive value of the plasma level of 3-NT in patients with STEMI to the prognosis of 1 year after PCI.Results:(1)The number of patients with hypertension,carotid atherosclerosis,left main artery or anterior descending artery occlusion in the high risk group was bigger than that in the low and middle risk group,the chest pain duration was higher than in the middle and low risk group(P<0.05).Total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),troponin I,uric acid(UA),homocysteine(HCY)and 3-NT in the high risk group werehigher than those in the low and middle risk group(P<0.05).(2)The study subjects'blood admission 3-NT was positively correlated with SYNTAX score(r_s=0.516,P<0.01).(3)The plasma level of blood 3-NT was measured at different time:The plasma level of blood 3-NT in the middle and high-risk group at the same time point are higher than those in the low-risk group(P<0.05),but there was no significant difference between admission and after PCI in the same group,but the plasma level of blood 3-NT at 3 months after PCI was lower than admission(P<0.05).(4)Taking the occurrence of MACE within 1 year after operation as the dependent variable,sex,age,hypertension,diabetes,carotid arteriosclerosis,left ventricle ejection fraction,total cholesterol,low density lipoprotein cholesterol,uric acid,serum 3-NT concentration and SYNTAX score were used as independent variables for multivariate Cox regression analysis.The results were as follows:carotid atherosclerosis(HR=2.141,95%CI1.262~3.630,P=0.005),total cholesterol(HR=1.483,95%CI 1.161~1.894,P=0.002),low density lipoprotein cholesterol(HR=1.368,95%CI 1.022~1.831,P=0.035),serum 3-NT concentration(HR=1.061,95%CI 1.002~1.124,P=0.042)and SYNTAX score (HR=1.104,95%CI 1.075~1.134,P<0.001)were independent risk factors for the occurrence of MACE within 1 year after operation.(5)Taking the occurrence of cardiac death within 1 year after operation as the dependent variable,sex,age,hypertension,diabetes,carotid arteriosclerosis,left ventricle ejection fraction,total cholesterol,low density lipoprotein cholesterol,uric acid,serum3-NT concentration and SYNTAX score were used as independent variables for multivariate Cox regression analysis.Results:SYNTAX score(HR=1.189,95%CI 1.097~1.289,P<0.001)was an independent risk factor for cardiac death within 1 year after operation.(6)Taking the occurrence of coronary revascularization within 1 year after operation as dependent variable,sex,age,hypertension,diabetes,carotid arteriosclerosis,left ventricle ejection fraction,total cholesterol,low density lipoprotein cholesterol,uric acid,serum 3-NT concentration and SYNTAX score were used as independent variables for multivariate Cox regression analysis.Results:carotid arteriosclerosis(HR=3.096,95%CI1.087~8.821,P=0.034),serum concentration of 3-NT(HR=1.126,95%CI 1.008~1.258,P=0.036)and SYNTAX score(HR=1.134,95%CI 1.082~1.188,P<0.001)were independent risk factors for the occurrence of coronary revascularization within 1 year after operation.(7)The ROC results showed that the area under the ROC curve of STEMI patients predicted by the concentration of 3-NT within one year after admission was 0.68,the diagnostic threshold was 22.672 ug/ml,the sensitivity was 74%,and the specificity was60%.Conclusion:There was a significant positive correlation between serum 3-NT and the severity of STEMI lesions,which was an independent risk factor for MACE within 1 year after emergency PCI,especially for coronary revascularization.