| Objective:Inflammatory hypothesis is an important mechanism for ST-segment elevation acute myocardial infarction.Percutaneous coronary intervention(PCI)has always been the vital treatment of STEMI.Fibrinogen participate in the presence and development of STEMI as an inflammatory marker.The aim of the current study is to evaluate the prognosticvalue of fibrinogen in STEMI patients following successful PCI in China.Methods:We selected 892 STEMI patients who were hospitalized from October 1,2015 to October 30,2016 in six hospitals in Da Lian where was able to perform direct PCI for STEMI.A total of 650 STEMI patients who underwent direct PCI were finally included excluding patients who lost follow-up or unsuccessful percutaneous coronary interventions or other patients who were in line with the exclusion criteria.Collect and record the basal information and laboratory data of patients who were in accordance with the present study.The clinical data mainly include:personal history,past history,blood biochemical indicators,blood lipids,coronary lesions and medication status.According to the fibrinogen cut-off value(3.38 g/L)calculated by the receiver operating characteristic curve(ROC curve),the plasma fibrinogen levels of all included patients were divided into two groups,low fibrinogen group(≤3.38 g/L,494 cases),high fibrinogen group(>3.38 g/L,156 cases).All patients enrolled were followed up two years.The primary endpoint in this study was all-cause death and secondary endpoint was major adverse cardiovascular events(MACE),including cardiac death,non-fatal myocardial infarction,revascularization and stroke.The general clinical characteristics of the two groups were compared using t test,rank sum test and x~2test.COX multivariate regression analysis was expcted to reveal the relationship between plasma fibrinogen levels and all-cause death and MACE in STEMI patients after PCI following up 2 years.Kaplan-Meier survival curves were used to analyze the incidence of all-cause death and MACE in the two groups.Results:A total of 650 STEMI patients undergoing direct PCI were enrolled in this study,with an average age of(62.19±12.58)years old,including 511 males,accounting for 78.6%,and 139 females,accounting for 21.4%.1.The receiver operating characteristic curve(ROC curve)evaluate the optimal cut-off value of fibrinogen was 3.38 g/L.Fibrinogen exceeding 3.38 g/L predicted that STEMI patients undergoing direct PCI have a specificity of 78.40%and a sensitivity of53.40%(ROC-AUC:0.637,95%CI:0.545-0.729 P=0.001).2.The comparison of the general data of the two groups showed that compared with the low fibrinogen group,high fibrinogen group were higher in a history of hypertension(49.3%vs 59.4%,P=0.029)and a history of diabetes(25.1%vs.35.5%,P=0.012),previous myocardial infarction(5.3%vs 12.3%,P=0.003),and history of revascularization(4.7%vs 14.1%,P=0.000),while the proportion of men(80.6%vs.72.4%,P=0.031)lower.Compared to low fibrinogen group,high fibrinogen group had increased fasting blood glucose level,white blood cell count,platelet count and D-dimer level on admission,the difference between the two groups was statistically significant(P<0.05).However,there were no significant differences in age,previous history of heart failure,previous history of stroke,neutrophil count,lymphocyte count,triglycerides(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),creatinine,blood uric acid level and left ventricular ejection fraction(EF).(all P values>0.05);3.The comparison of the incidence of all-cause death and MACE between the two groups showed that,the incidence proportion of all-cause death(18.6%vs5.9%,P=0.000)and MACE(14.7%vs 7.5%,P=0.006)in the high fibrinogen group were higher than the low fibrinogen group;4.The univariable COX analysis results display:Taking fibrinogen as a continuous variable,fibrinogen was the risk factor of all-cause death(HR=1.120,95%CI:1.078-1.165 P=0.000)and MACE(HR=1.097,95%CI:1.044-1.151 P=0.000)of STEMI patients after PCI 2 years.Taking fibrinogen as a stratified variable,the risk of all-cause death in STEMI patients with high fibrinogen(>3.38 g/L)after PCI 2 years was 3.391 times that of the low fibrinogen group(≤3.38 g/L)(HR=3.391,95%CI:2.026-5.676 P=0.000);the risk of MACE in the high fibrinogen group was 2.060 times that of the low fibrinogen group(HR=2.060,95%CI:1.224-3.467 P=0.006).The incidence of all-cause death(X~2=24.967,P=0.000)and MACE(X~2=7.835,P=0.005)between two groups had statistical difference through Log-Rank analysis.Kaplan-Meier survival analysis also illustrated that the cumulative survival rate of high fibrinogen group was significantly reduced compared with low fibrinogen group.5.Multi-factor COX analysis results demonstrate:5.1 When fibrinogen was used as a continuous variable,the results show:fibrinogen(HR=1.082,95%CI:1.031-1.136 P=0.001),age(HR=1.063,95%CI:1.033-1.093 P=0.000),neutrophils(HR=1.104,95%CI:1.046-1.164 P=0.000),creatinine(HR=1.009,95%CI:1.002-1.016 P=0.010),previous stroke history(HR=2.116,95%CI:1.029-4.349 P=0.041)were independent risk factors for all-cause death in STEMI patients undergoing PCI.Lymphocytes(HR=0.583,95%CI:0.363-0.934 P=0.025)and EF(HR=0.931,95%CI:0.904-0.958 P=0.000)were protective factors for all-cause death of STEMI patients undergoing PCI.Neutrophils(HR=1.056,95%CI:1.029-1.084,P=0.000),creatinine(HR=1.010,95%CI:1.003-1.017,P=0.008)and coronary multivessel lesion(HR=2.278,95%CI:1.212-4.282 P=0.011)were independent risk factors for adverse cardiovascular events in STEMI patients undergoing PCI;left ventricular ejection fraction level(HR=0.944,95%CI:0.917-0.972P=0.000)was a protective factor for adverse cardiovascular events in STEMI patients undergoing PCI.5.2 When fibrinogen was used as a stratified variable,multivariate analysis shows:fibrinogen(HR=2.100,95%CI:1.179-3.739 P=0.012),age(HR=1.058,95%CI:1.029-1.088 P=0.000),neutrophils(HR=1.100,95%CI:1.042-1.162 P=0.001),creatinine(HR=1.009,95%CI:1.002-1.016 P=0.015),previous stroke history(HR=2.407,95%CI:1.217-4.761 P=0.012)were independent risk factors for all-cause death in STEMI patients after PCI 2 years.Lymphocytes(HR=0.624,95%CI:0.406-0.959 P=0.031),left ventricular ejection fraction(EF)(HR=0.926,95%CI:0.900-0.953 P=0.000)were protection factors for all-cause death in such patients.Fibrinogen was not independent risk factors(HR=1.050,95%CI:0.980-1.126 P=0.166)for MACE in STEMI patients after PCI 2 years.Conclusion:1.Plasma fibrinogen level is an independent risk factor for all-cause death in acute STEMI patients after direct PCI 2 years.Compared to low level of fibrinogen,the incidence of all-cause death and major adverse cardiovascular events(MACE)in patients with high level of fibrinogen increased;2.When the plasma fibrinogen exceeds 3.38g/L,the specificity of predicting all-cause death of such patients is high.Fibrinogen has potential clinical reference value in predicting the prognosis of STEMI patients after PCI. |
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