| Objective:The purpose of this study was to discuss the predictive value of s ST2 levels combined with TDI for early ventricular remodeling after emergency percutaneous coronary intervention in patients with STEMI.Methods:This prospective,observational and longitudinal study included patients who visited our hospital from June 2022 to January 2023 for emergency primary percutaneous coronary intervention(PCI)for STEMI.Serum s ST2 test was performed on each patient after emergency PCI.Routine echocardiography was reviewed three months after discharge,and 96 patients who met the criteria were included in the study.According to the results of routine echocardiography,the patients were divided into two groups: the group without ventricular remodeling(n=61)and the group with ventricular remodeling(n=35).The clinical endpoint was that the left ventricular systolic and/or diastolic volume increased by at least 15% within 3 months.Baseline data,laboratory data,cardiac ultrasound indices,relevant data during PCI and oral medication were collected and compared between the two groups.SPSS26.0 was used for statistical analysis.Variables with P<0.1 in descriptive statistics were included in the univariate logistic regression analysis.Variables with P<0.1 in the univariate regression analysis were included in the multivariate logistic regression analysis.For continuous variables with statistical significance(P < 0.05)in the multivariate logistic regression,the receiver operating characteristic curve(ROC)was drawn.The area under the curve(AUC)was obtained,and the predictive ability of s ST2 levels combined with TDI indicaters on early ventricular remodeling was evaluated.Results:1.A total of 96 patients were included in this study,of which 35(36.5%)had early ventricular remodeling.2.The proportion of patients with diabetes mellitus,hypertension,cerebrovascular disease and a history of smoking was higher in the group with ventricular remo-deling.Serum s ST2,NT-pro BNP,peak value of CK-MB and TNI,C-reactive pro-tein,LDL-C were higher in the group of patients with ventricular remodeling.T-he differences in echocardiographic indices of SV,EF,E/e’ ratio and EAT thick-ness were statistically significant(P < 0.05).3.Variables with P<0.1 in the univariate regression analysis were included in the multivariate logistic regression analysis,the results showed that s ST2,E/e’ ratio,and EAT thickness were still risk factors for early ventricular remodeling.4.The ROC curve analysis showed that the s ST2 level higher than 60.69ng/ml had a sensitivity of 63% and a specificity of 72% for prediction of early ventricular remodeling(AUC=0.711,(0.604-0.817),P=0.001),the cut-off value of E/e ’ratio was10.84,the sensitivity was 63% and the specificity was 70%(AUC=0.702,(0.589-0.814),P=0.001).EAT thickness cut-off value is 6.61 mm,sensitivity was 66%,specificity was 64%(AUC=0.682,(0.575-0.790),P=0.003).The prediction model constructed by combining the above three indicators was called "joint prediction probability".Its AUC is 0.828,the cut-off value is 0.4,and the sensitivity was 71% and specificity was 82%(AUC=0.828,(0.740-0.916),P<0.001).Conclusions:1.In STEMI patients with hemodynamic reconstruction,serum s ST2 concentration,E/e’ratio and EAT thickness measured within 24 hours after myocardial infarction were independently correlated with early ventricular remodeling.2.Combining the three indicators of s ST2 concentration,E/e’ ratio and EAT thickness to construct a new predictive model greatly improved the predictive ability of early ventricular remodeling,indicating that baseline s ST2 concentration combined with parameters of TDI have a high predictive value for early ventricular remodeling in STEMI patients after PCI. |
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