Risk Factors of Death in Patients with Acute ST-segment Elevation Myocardial Infarction after PCI and the Combined Application of CTRP-1 with GRACE Score in Prognosis Evaluation of PCI Treated Patients

  Objective  To explore the risk factors of 12-month mortality in patients with acute ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI), and to evaluate the combined use of inflammatory factor complement Cq1/tumor necrosis factor-related protein-1 (CTRP-1) with global acute coronary event registration (GRACE) score in the patients with STEMI after PCI in terms of prognostic prediction for 12-month mortality risk.

  Methods  326 acute STEMI patients were included retrospectively, with 33 patients in the death group and 293 patients in the survival group. Clinical data of patients and serum CTRP-1 concentration detected by enzyme-linked immunosorbent assay (ELISA) were collected, and all patients were evaluated by GRACE score. The cut-off point of CTRP-1 for predicting mortality was determined by receiver operating characteristic (ROC) curve. Cox regression model was used to analyze the risk factors of death. The predictive value of CTRP-1 combined with GRACE score was tested by Kaplan-Meier survival analysis.

  Results  Compared with the survival group, the average arterial pressure, left ventricular ejection fraction (LVEF) and left main lesion rate were lower, creatinine and troponin T were higher in the death group (P < 0.05). The mass concentration of CTRP-1 in the death group was higher than that in the survival group (P < 0.001). The proportion of patients in the high-risk group of GRACE score was 66.7% in the death group and 20.1% in the survival group. The area under the ROC curve of CTRP-1 was 0.874 (P < 0.001), and the sensitivity and specificity of predicting death were 92.5% and 73.6% respectively with the cut-off point of CTRP-1 187.9 ng/mL. Cox regression model showed that mean arterial pressure, LVEF, GRACE score and high CTRP-1 (>187.9 ng/mL) were independent risk factors for predicting death. Survival analysis showed that the cumulative survival rate of patients with high CTRP-1 level was lower than low CTRP-1 level in the high-risk group of GRACE score (P < 0.001).

  Conclusions  Mean arterial pressure, LVEF value, GRACE score and CTRP-1 are risk factors for predicting mortality. Combined application of CTRP-1 with GRACE score has clinical value in prognostic evaluation of acute STEMI patients.