| Objective:Exploring the relationship between prealbumin(PAB),lipoprotein associated phospholipase A2(Lp PLA2)levels and Zwolle score in patients with acute ST segment elevation myocardial infarction(STEMI)undergoing emergency percutaneous coronary intervention(PCI),as well as PAB The predictive value of Lp-PLA2 and others on hospital MACE.Methods:A total of 162 STEMI patients who underwent emergency PCI at the People’s Hospital of Cangzhou City from December 2019 to August 2022 were selected,of which 22 were missing data,13 were excluded,and 127 were ultimately included.This study used a retrospective analysis method and divided patients into low-risk group(≤ 3 points),medium risk group(4-9 points),and high-risk group(≥ 10 points)based on the Zwolle score.The basic clinical data,biochemical indicators such as PAB and Lp-PLA2,and coronary TIMI blood flow grading after PCI were analyzed one by one.Divide patients into MACE group and non MACE group based on whether they have experienced in-hospital MACE,and analyze the differences in PAB and Lp-PLA2 between the two groups.Single factor analysis of variance,non parametric rank sum test,and other methods were used for correlation statistical analysis.logistic regression analysis was used for correlation analysis.Kaplan Meier analysis was used for survival analysis,and receiver operating characteristic curves(ROC)were used to analyze the relationship between laboratory indicators and hospital MACE.P<0.05 indicates a statistically significant difference.Results:1.Baseline data comparison: There were no statistically significant differences in general information such as reperfusion time,lesion site,gender,smoking and drinking history,and past medical history among the three groups of patients(P>0.05).Age(P<0.001)and Killip score(P<0.001)were used as the grouping criteria for Zwolle score,and there were statistically significant differences among the three groups.2.Inter group comparison results: Analyzing the relationship between PAB,Lp-PLA2 levels and Zwolle score grouping,it was found that the PAB levels in the low-risk group with Zwolle score were(248.47 ± 52.74)mg/L,the medium risk group was(231.26 ± 57.47)mg/L,and the high-risk group was(193.17 ± 46.31)mg/L.There was a statistically significant difference in the overall mean PAB levels among the three groups(P<0.05).The Lp PLA2 levels in the low-risk group were(523.99 ± 174.83)U/L,the medium risk group was(513.5 ± 136.50)U/L,and the high-risk group was(452.54 ± 121.19)U/L.There was no statistically significant difference in the overall mean Lp PLA2 levels among the three groups(P>0.05).There was no statistically significant difference in the overall levels of hs CRP,HCY,LPa,and Cr among the three groups(P>0.05).3.Correlation analysis: According to the Zwolle score,patients were divided into low-risk and medium high risk groups,and included in PAB,Lp PLA2,hs CRP,LPa,Cr,HCY,etc.to construct a multivariate logistic regression equation.The results showed that the decrease in PAB level had a statistically significant impact on the grouping of Zwolle scores(P<0.05).There was no statistically significant difference in the effects of Lp PLA2,hs CRP,LPa,Cr,and HCY on the grouping of Zwolle scores(P>0.05).4.MACE analysis: According to whether the patient has experienced MACE during hospitalization,they can be divided into MACE group(n=27)and non MACE group(n=100).The PAB levels in the MACE group were(216.23 ± 54.72)mg/L,while those in the non MACE group were(245.73± 54.24)mg/L.There was a statistically significant difference in the overall mean PAB levels between the two groups(P<0.05).The Lp PLA2 levels in the MACE group were(467.89 ± 139.15)U/L,while those in the non MACE group were(529.52 ± 163.02)U/L.There was no statistically significant difference in the overall mean of Lp PLA2 levels between the two groups(P>0.05).The median Cr level in the MACE group was 80.00(72.60,92.00)umol/L,while the median Cr level in the non MACE group was 68.00(56.25,81.00)umol/L.There was a statistical difference in the overall distribution of Cr levels between the two groups(P<0.05).Using chi square test,it was found that there were 18 Killip grade Ⅰ patients(66.70%),4 Killip grade Ⅱ patients(14.80%),and 5 Killip grade Ⅲ-Ⅳ patients(18.50%)in the MACE group.There was a statistical difference in the distribution of Killip grades between the two groups(P<0.05).Logistic regression analysis of MACE: The decrease in PAB levels had a statistically significant impact on MACE(P<0.05);The decrease in Cr level had a statistically significant impact on MACE(P<0.05);The impact of Killip grading on MACE was statistically significant(P<0.05);The Zwolle score had no statistically significant impact on MACE(P>0.05).5.ROC curve: By plotting the ROC curve,it was found that PAB predicted an AUC of 0.645(P<0.05)for MACE in the hospital,with a statistically significant difference.The optimal threshold is 247.20mg/L,with a sensitivity of 81.50% and a specificity of 51.00%.Cr predicted that the AUC of MACE in the hospital was 0.666(P<0.05),and the difference was statistically significant.The optimal threshold is 72.30umol/L,sensitivity is77.80%,and specificity is 59.00%.6.Survival analysis: Kaplan Meire survival analysis showed that the survival curves of PAB were different between the MACE group and the non MACE group(Log Rank P=0.049;Breslow,P=0.075),and the non MACE group was superior to the MACE group.The survival curve of Zwolle score was different between the MACE group and the non MACE group(Log Rank P=0.002;Breslow,P=0.003),and the low-risk and medium risk groups were better than the high-risk groups.Conclusions:1.The PAB level has significant difference and correlation between different groups of Zwolle score.2.The level of PAB is correlated with the MACE in hospital,which can be used as an independent predictor of the MACE in hospital,and has a judgment value for the long-term survival rate of emergency STEMI PCI patients.3.Zwolle score is valuable for judging the short-term and long-term survival rate of emergency STEMI patients.4.Cr is correlated with hospital MACE and can be used as an independent predictor of hospital MACE.5.Lp-PLA2 has no statistical difference between the Zwolle score groups,and has no significant correlation with in-hospital MACE,which fails to show the predictive value of in-hospital MACE. |
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