Abstract:

Objective　To explore the predictive value of latent transforming growth factor-β binding protein-2 (LTBP-2) combined with cardiopulmonary ultrasound (CPUS) in short-term prognosis of elderly patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods　A retrospective analysis was performed on 116 patients with AMI who underwent PCI in Xi'an Gaoxin Hospital during May 2020 and March 2023. There were 60 males and 56 females, aged 60-80 years, Killip grade: 37 cases of grade I, 51 cases of grade II, and 28 cases of grade III. The level of LTBP-2 and CPUS were measured. The patients were followed up for 3 months after operation to observe the prognosis, and they were divided into a good prognosis group and a bad prognosis group. The clinical data, LTBP-2 levels, and CPUS parameters of the two groups were compared. The influencing factors of major adverse cardiac events (MACE) after PCI in AMI patients were analyzed by multifactor logistic regression analysis, and the predictive value of LTBP-2 combined with CPUS in short-term prognosis was analyzed by the receiver operating characteristic curve (ROC). χ² test and independent sample t test were performed. Results　The incidence of poor short-term prognosis in elderly AMI patients after PCI was 26.72% (31/116). The LTBP-2, early diastolic peak velocity of the mitral valve inflow/early diastolic peak velocity of the mitral valve annulus (E/e'), left atrial volume index (LVAI), number of B lines, time from onset to interventional treatment, and proportion of severe coronary lesions in the poor prognosis group were all higher than those in the good prognosis group, and the left ventricular ejection fraction (LVEF) was lower than that in the good prognosis group (all P<0.05). The results of multivariate analysis showed that LTBP-2 (OR=3.221, 95%CI: 1.993-5.206), number of B-lines (OR=3.182, 95%CI: 1.663-6.087), degree of coronary lesions (OR=1.487, 95%CI: 1.082-2.043) were independent risk factors for prognosis, and LVEF (OR=0.328, 95%CI: 0.157-0.681) was an independent protective factor (all P<0.05). ROC analysis results showed that the sensitivities of LTBP-2, LVEF, number of B-lines, and their combination in predicting the short-term prognosis were 71.00%, 74.20%, 67.70%, and 87.10%, the specificities were 72.90%, 76.50%, 71.80%, and 91.80%, and the areas under the curves were 0.795, 0.816, 0.769, and 0.932, respectively (all P<0.05). Conclusion　LTBP-2 combined CPUS can predict the short-term prognosis of elderly AMI patients after PCI.

Key words:

Acute myocardial infarction, Percutaneous coronary intervention, Latent  , transforming growth factor-β binding protein-2,  , Cardiopulmonary ultrasound, Major adverse cardiovascular events, Short-term prognosis, Predictive value

摘要：

目的　探究潜在转化生长因子结合蛋白-2（LTBP-2）联合心肺联合超声（CPUS）对老年急性心肌梗死（AMI）患者经皮冠状动脉介入术（PCI）后短期预后的预测价值。方法　回顾性分析西安高新医院在2020年5月至2023年3月间收治的116例行PCI治疗的AMI患者。其中男性60例，女性56例；年龄为60~80岁；Killip分级Ⅰ级37例、Ⅱ级51例、Ⅲ级28例。对患者进行LTBP-2水平测定及CPUS检查。术后对患者进行为期3个月的随访，观察患者预后情况，并将其分为预后良好组和预后不良组。比较两组患者临床相关资料和LTBP-2水平、CPUS参数。多因素logistic回归分析AMI患者PCI术后发生主要心血管不良事件（MACE）的影响因素，受试者操作特征曲线（ROC）分析LTBP-2联合CPUS参数对患者短期预后的预测价值。行χ²检验、独立样本t检验。结果　老年AMI患者PCI术后短期预后不良发生率为26.72%（31/116）。预后不良组LTBP-2、二尖瓣口舒张早期峰值流速/二尖瓣环室间隔侧测量舒张早期峰值速度（E/e'）、左心房容积指数（LVAI）、B线数量、发病至介入治疗时间、冠状动脉重度病变占比均高于预后良好组，左心室射血分数（LVEF）低于预后良好组（均P<0.05）。多因素分析结果显示，LTBP-2（OR=3.221，95%CI：1.993～5.206）、B线数量（OR=3.182，95%CI：1.663～6.087）、冠状动脉病变程度（OR=1.487，95%CI：1.082～2.043）是患者预后的独立危险因素，LVEF（OR=0.328，95%CI：0.157～0.681）是独立保护因素（均P<0.05）。ROC分析结果显示，LTBP-2、LVEF、B线数量及三者联合预测患者短期预后的灵敏度分别为71.00%、74.20%、67.70%、87.10%，特异度分别为72.90%、76.50%、71.80%、91.80%，曲线下面积分别为0.795、0.816、0.769、0.932（均P<0.05）。结论　LTBP-2联合CPUS参数对老年AMI患者PCI术后短期预后有较好预测价值。

关键词:

急性心肌梗死, 经皮冠状动脉介入术, 潜在转化生长因子结合蛋白-2, 心肺联合超声, 主要不良心血管事件, 短期预后, 预测价值