心电图复极参数联合血清hs-CRP和NT-proBNP对急性ST段抬高型心肌梗死患者PCI术后主要不良心血管事件的预测价值OA

Objective To investigate the predictive value of electrocardiographic repolarization parameters combined with serum high-sensitivity C-reactive protein(hs-CRP)and N-terminal pro-B-type natriuretic peptide(NT-proBNP)for major adverse cardiovascular events(MACE)after percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 150 patients with acute STEMI who underwent PCI in Chengde Central Hospital from January 2022 to January 2025 were selected as the study subjects.Based on the occurrence of MACE within 6 months after PCI,patients were divided into the MACE group(38 cases)and the non-MACE group(112 cases).General data,initial left ventricular ejection fraction(LVEF)on admission,time from onset to reperfusion,electrocardiographic repolarization parameters within 24 hours postoperation[QT interval dispersion(QTd),T-wave peak-to-end interval(Tp-e interval),fragmented QRS(fQRS)],and serum levels of hs-CRP and NT-proBNP were compared between the two groups.Logistic regression analysis was used to identify the influencing factors of MACE,and receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value of QTd,Tp-e interval,hs-CRP,and NT-proBNP for MACE.Results LVEF in the MACE group was lower than that in the non-MACE group(P<0.05),and the time from onset to reperfusion was longer than that in the non-MACE group(P<0.05).The MACE group also had longer QTd and Tp-e interval(P<0.05),a higher proportion of fQRS,and higher levels of hs-CRP and NT-proBNP compared to the non-MACE group(P<0.05).Logistic regression analysis showed that electrocardiographic repolarization parameters(QTd,Tp-e interval),serum hs-CRP,and NT-proBNP were influencing factors of MACE(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of QTd,Tp-e interval,hs-CRP,and NT-proBNP alone for predicting MACE after PCI in patients with acute STEMI were 0.877,0.800,0.858,and 0.902,respectively,with sensitivities of 76.32%,81.58%,71.05%,and 84.21%,and specificities of 89.29%,75.00%,91.96%,and 91.96%,respectively.The AUC of NT-proBNP was the highest among the single parameters.The AUC of the combination of these four parameters was 0.994,which was significantly higher than that of QTd(Z=3.435,P<0.001),Tp-e interval(Z=4.191,P<0.001),hs-CRP(Z=3.551,P<0.001),and NT-proBNP(Z=2.598,P<0.001)alone,with a sensitivity of 97.37%and a specificity of 96.43%.Conclusion Electrocardiographic repolarization parameters(QTd,Tp-e interval),serum hs-CRP,and NT-proBNP have high predictive value for MACE in patients with acute STEMI after PCI.Combined detection can further improve the sensitivity and specificity of prediction.