心肌肌钙蛋白I变异性与急性心肌梗死患者PCI后发生主要不良心脑血管事件的关系:一项前瞻性队列研究OA

Objective To investigate the relationship between cardiac troponin I(cTnI)variability and major adverse cardiovascular and cerebrovascular events(MACCE)in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods In this study,a prospective cohort study design was used to continuously select 816 patients with AMI who underwent emergency PCI in the Cardiovascular Center of the First Affiliated Hospital of Xinjiang Medical University from June 30,2019 to June 30,2023 as the study subjects.The clinical data of the patients were collected,and the cTnI and its coefficient of variation at admission were recorded.After discharge,the patients were followed up by telephone once a year until 2025-12-01,and the occurrence of MACCE was recorded.Kaplan-Meier method was used to draw the survival curve,and Log-rank test was used to compare the survival curves.Univariate and multivariate Cox regression analysis was used to explore the influencing factors of MACCE in AMI patients after PCI.The dose-response relationship between the coefficient of variation of cTnI and the risk of MACCE after PCI in AMI patients was analyzed by restricted cubic spline(RCS)curve.Results According to the tertile of cTnI coefficient of variation,the patients were divided into the low variability group(<0.796),the medium variability group(0.796-1.336)and the high variability group(>1.336),with 272 cases in each group.There were significant differences in the incidence of hypertension,hemoglobin,white blood cell count,TG,albumin,AST and cTnI at admission,and cTnI coefficient of variation among the three groups(P<0.05).Among the 816 patients,MACCE occurred in 252 cases(30.88%).The cumulative incidence of MACCE in the low variability group and the medium variability group was higher than that in the high variability group(P<0.05).Univariate Cox regression analysis showed that hypertension,platelet count at admission,creatinine at admission,and cTnI variability may be the influencing factors of MACCE in AMI patients after PCI(P<0.05).Multivariate Cox regression analysis showed that platelet count at admission and cTnI variability were independent influencing factors of MACCE in AMI patients after PCI(P<0.05).The results of RCS curve analysis showed that the coefficient of variation of cTnI was negatively correlated with the risk of MACCE in AMI patients after PCI(Poverall=0.014,Pnon-linear=0.148).When the coefficient of variation of cTnI>1.17,with the increase of the coefficient of variation of cTnI,the risk of MACCE in AMI patients after PCI showed a continuous and monotonous downward trend.Conclusion Low variability and moderate variability of cTnI are independent risk factors for MACCE in AMI patients after PCI,and the coefficient of variation of cTnI is linearly negatively correlated with the risk of MACCE in AMI patients after PCI.