Abstract

The aim of this study is to reveal the predictive power of biomarkers and SYNTAX (SX) score for short-term mortality in patients diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI) in the emergency department. This is prospective observational cohort study. Demographic characteristics of the patients, laboratory parameters on admission, left ventricular ejection fraction (LVEF) percentages, affected vessels in angiography (CAG) and the treatment strategy [medical therapy, percutaneous transluminal coronary angioplasty (PTCA), coronary angio by-pass graft] and SX scores were recorded on the data collection form. ROC curve was used to investigate the predictivity of blood urea nitrogen/albumin ratio (BAR), procalcitonin, C-reactive protein (CRP), high sensitivity cardiac troponin I (Hs-cTnI), CRP to serum albumin ratio (CAR), neutrophil to lymphocyte ratio (NLR) and SX scores in mortality. Multivariate analysis of biomarkers and SX score was performed to estimate the patients’ 30-day mortality. Of the 415 patients were included in the study. ROC analysis of BAR, CAR, CRP, Procalcitonin, Hs-cTnI, NLR and SX score to predict mortality was statistically significant. BAR (OR: 1.280, 95% CI: 1.113–1.472, p = .001) and SX score (OR: 1.071, 95% CI: 1.018–1.126, p = .007) were found to be independent predictors of 30 days mortality. LVEF reduction, SX score, the number of affected vessels and the frequency of LMCA lesions increase were found to be statistically significant in patients with BAR ≥4.8. BAR, which can be calculated easily and quickly on admission to the emergency department and in clinical practice, may be used to predict mortality in patients with NSTEMI.

摘要

本研究的目的是揭示生物标志物和 SYNTAX (SX) 评分对急诊科诊断为非 ST 段抬高型心肌梗死 (NSTEMI) 患者短期死亡率的预测能力。这是一项前瞻性观察性队列研究。患者的人口统计学特征、入院时的实验室参数、左心室射血分数 (LVEF) 百分比、血管造影 (CAG) 中受影响的血管和治疗策略 [药物治疗、经皮冠状动脉腔内成形术 (PTCA)、冠状动脉搭桥术]和 SX 分数记录在数据收集表上。ROC曲线用于研究血尿素氮/白蛋白比值（BAR）、降钙素原、C反应蛋白（CRP）、高敏心肌肌钙蛋白I（Hs-cTnI）、CRP与血清白蛋白比值（CAR）、中性粒细胞与淋巴细胞比率 (NLR) 和 SX 死亡率评分。对生物标志物和 SX 评分进行了多变量分析，以估计患者的 30 天死亡率。415 名患者被纳入研究。ROC分析BAR、CAR、CRP、降钙素原、Hs-cTnI、NLR和SX评分预测死亡率具有统计学意义。BAR (OR: 1.280, 95% CI: 1.113–1.472,p  = .001) 和 SX 评分 (OR: 1.071, 95% CI: 1.018–1.126, p  = .007) 被发现是 30 天死亡率的独立预测因子。在 BAR ≥ 4.8 的患者中发现 LVEF 降低、SX 评分、受累血管数量和 LMCA 病变增加的频率具有统计学意义。BAR 可以在急诊科和临床实践中轻松快速地计算出来，可用于预测 NSTEMI 患者的死亡率。