Predicting value of white cell count and total bilirubin on clinical outcomes in patients with ST-elevation myocardial infarction following percutaneous coronary intervention: a cohort study
Predicting value of white cell count and total bilirubin on clinical outcomes in patients with ST-elevation myocardial infarction following percutaneous coronary intervention: a cohort study
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白细胞计数和总胆红素对经皮冠状动脉介入治疗后 ST 段抬高型心肌梗死患者临床结局的预测价值：一项队列研究
DOI：
10.1136/bmjopen-2019-031227
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发表时间：
2020-02-01
期刊：
影响因子：
2.9
通讯作者：
Li, Xiao-Mei
中科院分区：
文献类型：
--
作者：
Tuxun, Munire;Zhao, Qian;Li, Xiao-Mei
目的 评估基于白细胞计数 (WCC) 和总胆红素 (TB) 的组合方程预测接受直接经皮冠状动脉介入治疗 (PCI) 的急性 ST 段抬高型心肌梗死 (STEMI) 患者不良临床结果的能力。设计一项单中心、前瞻性队列研究。设置新疆医科大学第一附属医院。方法 纳入615例行PCI术后STEMI患者。入院时收集了 WCC 和 TB。使用逻辑回归来确定组合方程。主要终点为院内死亡率和主要不良心血管事件（MACE），包括住院期间和36个月内心源性死亡、心源性休克、恶性心律失常（室性心动过速、心室颤动）、严重心功能不全、非致命性心肌梗死、心绞痛再入院、严重心功能不全（心III-IV级）、支架再狭窄和靶血管血运重建。随访期。结果 77例患者住院期间发生MACE（院内死亡17例）。以WCC和TB作为自变量对院内MACE进行一类logistic回归分析，logit回归模型为：logit(P)=−8.00+0.265 WCC+0.077 TB，WCC和TB联合对评价院内死亡率更有价值（曲线下面积0.804，95%CI 0.678～ 0.929，p<0.001）。多因素logistic回归分析显示，联合检测是院内MACE的独立危险因素（OR 5.85，95%CI 3.425至9.990，p=0.032）。随访期间，172 名患者（29.5%）出现 MACE。但联合检测并不能预测长期临床结果。结论 与单独检测相比，WCC 和 TB 联合检测是 STEMI 患者院内结局的独立预测因子。
Objectives A combined equation based on white cell count (WCC) and total bilirubin (TB) was assessed for its ability to predict adverse clinical outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PCI). Design A single-centre, prospective cohort study. Setting The First Affiliated Hospital of Xinjiang Medical University. Method A total of 615 patients with STEMI postprimary PCI were enrolled. WCC and TB were collected at admission. Logistic regression was used to determine the combined equation. The primary endpoints were in-hospital mortality and major adverse cardiovascular events (MACE), which composed of cardiac death, cardiac shock, malignant arrhythmia (ventricular tachycardia, ventricular fibrillation), severe cardiac insufficiency, non-fatal myocardial infarction, angina pectoris readmission, severe cardiac insufficiency (cardiac III–IV level), stent restenosis and target vessels revascularisation during the hospitalisation and 36 months follow-up period. Result 77 patients occurred in MACE during the hospitalisation (17 in-hospital mortality). WCC and TB were taken as an independent variables to make a category of logistic regression analysis of in-hospital MACE, the logistic regression model was: logit (P)=−8.00+0.265 WCC+0.077 TB, the combination of WCC and TB was more valuable on evaluating the in-hospital mortality (area under the curve 0.804, 95% CI 0.678 to 0.929, p<0.001). Multivariate logistic regression analysis showed that combined detection was an independent risk factor for in-hospital MACE (OR 5.85, 95% CI 3.425 to 9.990, p=0.032). During the follow-up period, 172 patients (29.5%) developed MACE. But the combined detection did not predict the long-term clinical outcome. Conclusion The combination of WCC and TB is an independent predictor for in-hospital outcomes in patients with STEMI than single detection.