入院血浆乳酸浓度预测急性心肌梗死患者院内主要心血管不良事件发生风险价值研究OA

Objective To investigate the relationship between plasma lactate levels on admission and the risk of in-hospital major adverse cardiovascular events(MACE)in patients with acute myocardial infarction(AMI).Methods This retrospective case-control study included 1,780 AMI patients admitted to Beijing Friendship Hospital from Jan.2018 to Dec.2023.Baseline data and laboratory test results(including plasma lactate levels)were collected,and the primary outcome was in-hospital MACE.Patients were grouped according to the lactate level on admission.The relationship between lactate level and the risk of major adverse cardiovascular events(MACE)was analyzed by constructing three progressively complex logistic regression models and employing restricted cubic splines(RCS).The cut-off value of lactate level in each model was determined by taking the odds ratio(OR)=1,and the predictive efficacy was calculated.Results Logistic regression models showed that lactate concentration was positively correlated with the risk of major adverse cardiovascular events(MACE),but the restricted cubic spline analysis revealed a U-shaped nonlinear relationship between the two,indicating that both low and high lactate concentrations increased the risk of MACE occurrence.The model with a lactate cut-off value of 2.203 mmol/L achieved the best balance of sensitivity and specificity in predicting MACE risk,while the model with a cut-off value of 1.442 mmol/L had higher specificity but lower sensitivity,resulting in a poorer predictive performance.Conclusion A plasma lactate level of 2.203 mmol/L on admission can serve as an indicator for predicting the risk of in-hospital MACE,aiding in the early prediction of high-risk AMI patients with MACE and guiding more aggressive interventions.