Predictive values of serum homocysteine, cystatin C and high sensitive C-reactive protein levels on heart failure after percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction

doi:10.3969/j.issn.1004-583X.2023.02.004

Abstract

Abstract:

Objective To investigate the value of serum homocysteine, Cystatin C and high-sensitivity C-reactive protein in predicting heart failure (HF) after percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction (STEMI). Methods A total of 168 patients with STEMI who underwent PCI from July 2020 to December 2020 were retrospectively selected as the research objects. They were followed up for 1 year. They were assgined to HF group (n=92) and non-HF group (n=76) according to the presence or absence of HF after PCI. The clinical data of the patients were collected and compared between the two groups were compared. Multivariate logistic regression was used to analyze the risk factors, and ROC curve was drawn to analyze the predictive value of serum homocysteine, Cystatin C and high-sensitivity C-reactive protein for HF after PCI in STEMI patients. Results The age, homocysteine, Cystatin C and high sensitive C-reactive protein levels in HF group were significantly higher than those in non-HF group, while the left ventricular ejection fraction (LVEF)level was significantly lower (P<0.05). There were no significant differences in gender, smoking history, drinking history,diabetes history, hypertension history, single vessel disease, heart rate, body mass index (BMI), troponin T, creatine kinase MB (CK-MB), triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, uric acid and creatinine between the two groups (P >0.05). Multivariate logistic regression analysis showed that age, homocysteine, Cystatin C, and high-sensitivity C-reactive protein were independent risk factors for HF after PCI in STEMI patients. ROC curve analysis showed that the area under the curve (AUC) of serum homocysteine, Cystatin C and hypersensitive C-reactive protein in predicting HF after PCI in STEMI patients was 0.706, 0.698 and 0.762 respectively, with the specificity of 0.609, 0.641 and 0.601 respectively, and the sensitivity of 0.724, 0.697 and 0.812 respectively. AUC of the combined prediction of serum homocysteine, Cystatin C and hypersensitive C-reactive protein was 0.817, with the specificity and sensitivity of 0.690 and 0.868, respectively. Conclusion Serum homocysteine, Cystatin C and high sensitive C-reactive protein are the risk factors of HF after PCI in STEMI patients, and their combination detection has a high clinical value in predicting HF after PCI in STEMI patients.

Key words: ST elevation myocardial infarction, heart failure, homocysteine, cystatin C, high sensitive C-reactive protein

CLC Number:

R542.22

Li Nana, Jiang Shan. Predictive values of serum homocysteine, cystatin C and high sensitive C-reactive protein levels on heart failure after percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction[J]. Clinical Focus, 2023, 38(2): 121-125.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.02.004

https://huicui.hebmu.edu.cn/EN/Y2023/V38/I2/121

Figures/Tables 4

Tab. 1 Comparison of general data between the two groups

项目	HF组( $n$ =92)	非HF组( $n$ =76)	统计值	$P$ 值
年龄(岁)	72.52±6.97	65.05±6.25	$t$ =7.229	0.000
男性[例(%)]	43(46.7)	40(52.6)	χ²=0.578	0.447
吸烟史[例(%)]	46(50.0)	35(46.1)	χ²=0.260	0.610
饮酒史[例(%)]	27(29.3)	20(26.3)	χ²=0.190	0.663
糖尿病史[例(%)]	21(22.8)	16(21.1)	χ²=0.076	0.782
高血压史[例(%)]	48(52.2)	30(39.5)	χ²=2.699	0.100
单支血管病变[例(%)]	25(27.2)	18(23.7)	χ²=0.266	0.606
心率(次/min)	83.24±13.48	79.45±13.89	$t$ =1.790	0.075
LVEF(%)	47.34±5.78	51.02±6.03	$t$ =-4.038	0.000
BMI(kg/m²)	23.61±1.05	23.40±1.34	$t$ =1.108	0.270

Tab. 1 Comparison of general data between the two groups

项目	HF组( $n$ =92)	非HF组( $n$ =76)	统计值	$P$ 值
年龄(岁)	72.52±6.97	65.05±6.25	$t$ =7.229	0.000
男性[例(%)]	43(46.7)	40(52.6)	χ²=0.578	0.447
吸烟史[例(%)]	46(50.0)	35(46.1)	χ²=0.260	0.610
饮酒史[例(%)]	27(29.3)	20(26.3)	χ²=0.190	0.663
糖尿病史[例(%)]	21(22.8)	16(21.1)	χ²=0.076	0.782
高血压史[例(%)]	48(52.2)	30(39.5)	χ²=2.699	0.100
单支血管病变[例(%)]	25(27.2)	18(23.7)	χ²=0.266	0.606
心率(次/min)	83.24±13.48	79.45±13.89	$t$ =1.790	0.075
LVEF(%)	47.34±5.78	51.02±6.03	$t$ =-4.038	0.000
BMI(kg/m²)	23.61±1.05	23.40±1.34	$t$ =1.108	0.270

Tab. 2 Comparison of biochemical index between the two groups

项目	HF组( $n$ =92)	非HF组( $n$ =76)	$t$ 值	$P$ 值
肌钙蛋白T(mg/ml)	6.53±0.48	6.47±0.43	0.812	0.481
肌酸激酶同工酶(U/L)	73.39±15.02	70.97±13.54	1.082	0.281
甘油三脂(mmol/L)	2.71±0.68	2.66±0.59	0.456	0.649
高密度脂蛋白胆固醇(mmol/L)	2.09±0.50	2.18±0.42	-1.285	0.200
低密度脂蛋白胆固醇(mmol/L)	3.38±0.92	3.33±1.06	0.311	0.756
尿酸(μmol/L)	337.00±84.49	318.34±89.30	1.388	0.167
肌酐(μmol/L)	77.06±15.37	72.85±16.11	1.728	0.086
同型半胱氨酸(mmol/L)	21.02±6.84	16.03±6.15	4.921	0.000
胱抑素C(mg/L)	1.73±0.48	1.39±0.42	4.740	0.000
超敏C-反应蛋白(mg/L)	14.42±3.78	10.61±3.60	6.660	0.000

Tab. 2 Comparison of biochemical index between the two groups

项目	HF组( $n$ =92)	非HF组( $n$ =76)	$t$ 值	$P$ 值
肌钙蛋白T(mg/ml)	6.53±0.48	6.47±0.43	0.812	0.481
肌酸激酶同工酶(U/L)	73.39±15.02	70.97±13.54	1.082	0.281
甘油三脂(mmol/L)	2.71±0.68	2.66±0.59	0.456	0.649
高密度脂蛋白胆固醇(mmol/L)	2.09±0.50	2.18±0.42	-1.285	0.200
低密度脂蛋白胆固醇(mmol/L)	3.38±0.92	3.33±1.06	0.311	0.756
尿酸(μmol/L)	337.00±84.49	318.34±89.30	1.388	0.167
肌酐(μmol/L)	77.06±15.37	72.85±16.11	1.728	0.086
同型半胱氨酸(mmol/L)	21.02±6.84	16.03±6.15	4.921	0.000
胱抑素C(mg/L)	1.73±0.48	1.39±0.42	4.740	0.000
超敏C-反应蛋白(mg/L)	14.42±3.78	10.61±3.60	6.660	0.000

Tab. 3 Analysis of HF risk factors after PCI in STEMI patients

变量	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
变量	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	0.150	0.034	18.976	0.000	1.161	1.086	1.242
LVEF	-0.099	0.037	7.272	0.007	0.906	0.843	0.973
同型半胱氨酸	0.080	0.033	5.909	0.015	1.083	1.016	1.155
胱抑素C	1.062	0.488	4.726	0.020	2.892	1.110	7.533
超敏C-反应蛋白	0.153	0.058	6.949	0.008	1.165	1.040	1.306

Tab. 3 Analysis of HF risk factors after PCI in STEMI patients

变量	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
变量	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	0.150	0.034	18.976	0.000	1.161	1.086	1.242
LVEF	-0.099	0.037	7.272	0.007	0.906	0.843	0.973
同型半胱氨酸	0.080	0.033	5.909	0.015	1.083	1.016	1.155
胱抑素C	1.062	0.488	4.726	0.020	2.892	1.110	7.533
超敏C-反应蛋白	0.153	0.058	6.949	0.008	1.165	1.040	1.306

Fig.1 Predictive value of serum homocysteine、cystatinC、and hypersensitive C-reactive protein for HF after PCI in STEMI patients

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