Predictive Value Of Total Bilirubin Level Combined With TIMI And GRACE Scores For Major Cardiovascular Adverse Events In Patients After PCI With Non-ST-Elevation Myocardial Infarction

Objective:This study investigated the predictive value of serum total bilirubin(TBIL)levels at admission combined with TIMI and GRACE scores for non-STsegment elevation myocardial infarction(NSTEMI)after percutaneous coronary intervention(PCI).The predictive value of Major adverse cardiovascular event(MACE)in patients after Percutaneous Coronary Intervention(PCI).Methods:In this study,358 patients diagnosed with NSTEMI in the emergency department of the Affiliated Hospital of Chengde Medical College between October 2019 and December 2021 were retrospectively collected,and the general data of the patients were collected,including gender,age,past history(history of smoking,alcohol consumption,hypertension,diabetes,hyperlipidemia,cerebral infarction),body mass index(BMI),heart rate,systolic blood pressure,diastolic blood pressure,Killip classification,electrocardiogram,cardiac ultrasound,coronary angiography results,etc.;laboratory tests of patients on admission,including routine blood,liver function,kidney function,lipid analysis,blood glucose,electrolytes,oral medications during hospitalization,etc,and GRACE score and TIMI score were calculated,and the endpoint event was the occurrence of MACE in patients with NSTEMI,such as malignant arrhythmias(ventricular tachycardia,ventricular fibrillation,ventricular flutter,tip-twisting ventricular tachycardia,third-degree atrioventricular block),cardiogenic shock,stroke,all-cause death,new-onset heart failure,or readmission for heart failure.Patients were first divided into low bilirubin group T1(≤10.60 umol /L N=120 patients,medium bilirubin group T2:(10.61-15.01 umol /L N=119 patients,and high bilirubin group T3:(≥15.02 umol /L N=119 patients)according to their total bilirubin level at the time of admission by the trichotomization method.Then patients were divided into incident(MACE group,N=110 cases)and non-event(non-MACE group,N=248 cases)according to whether they developed MACE within 28 days after PCI in NSTEMI patients;then the above baseline data and laboratory test results were analyzed univariately by statistical tools,and the Pearson test was used to analyze the risk of TBIL and the development of MACE factors.With the occurrence of MACE in NSTEMI patients as the dependent variable,the variables that were statistically significant for univariate binary logistic regression analysis were selected for multi-factor binary logistic regression analysis of their independent risk factors,and the subject work curve(ROC)was used to analyze the TBIL,TIMI score,GRACE score and the combined index of the three to predict,The efficacy of the occurrence of MACE was analyzed by using the subject work curve(ROC)to predict the efficacy of TBIL,TIMI score,GRACE score and the combined index of the three to predict the occurrence of MACE in patients with NSTEMI,and the column line graph model was constructed with the three as variables to plot the calibration curve and ROC curve.Results:1.Comparison of measurement data of different bilirubin level subgroupsA total of 358 patients were included in this trial,and all patients were divided into three groups based on the bilirubin level within 24 h of admission by the trilateration method: low bilirubin group T1(≤10.60 umol /L,N=120cases,medium bilirubin group T2:(10.61-15.01 umol /L,N=119 cases,high bilirubin group T3:(≥15.02 umol /L,N=119 cases).In the comparison between groups,UA,RBC,HGB,HCT,PCT,CK-MB,GRACE score,gender,smoking history,MACE,and postoperative cerebrovascular lesions were statistically significant(P < 0.05);the rest such as age,heart failure attack,diabetes history,heart rate,blood pressure,Scr,TC,TG,lesion vascular composition ratio,malignant arrhythmia,and in-hospital There was no statistical significance between groups in terms of age,heart failure attack,history of diabetes,heart rate,blood pressure,Scr,TC,TG,lesion vascular composition ratio,malignant arrhythmia,and in-hospital death(P > 0.05).2.Comparison of clinical baseline information of patients in the MACE and non-MACE groupsThe patients were divided into event group(MACE group)and non-event group(non-MACE group)according to the presence or absence of MACE in NSTEMI patients;among them,there were 110 cases(30.72%)in the MACE group and 248 cases(69.28%)in the non-MACE group.After analysis,it was found that there were no statistically significant differences between the MACE and non-MACE groups in terms of gender,past history(history of smoking,history of alcohol consumption,hypertension,diabetes,hyperlipidemia,cerebral infarction),heart rate,systolic blood pressure,use of ACEI class drugs and ARB class drugs,and number of coronary lesion branches(all P > 0.05),while there were no statistically significant differences in terms of age,diastolic blood pressure,Killip ≥ 2 class ST-segment excursion,ejection fraction,β-blocker class drug use,GRACE score and TIMI score were statistically significant(all P < 0.05).3.Comparison of laboratory indicators between the MACE and nonMACE groupsCompared with the non-MACE group,TBIL,RBC,HGB,Hematocrit(HCT)levels decreased,uric acid(UA)and Creatine kinase isoenzyme(CKMB)levels increased in the MACE group,and the differences were statistically significant(P < 0.05).The differences were statistically significant(P < 0.05),and the levels of BMI,Albumin(ALB),Triglyceride(TG),High density lipoprotein(HDL),Low density lipoprotein(LDL),and Glucose(GLU)were increased between the two groups.Glucose,GLU,Serum creatinine(Scr),White blood cell(WBC),Lymphocyte(LYMPH),Neutrophils(NEUT),Procalcitonin,PCT,Red blood cell distribution width(RDW),K+,Ca+,etc.were not statistically different(P > 0.05).4.Correlation analysis between TBIL and baseline information and each indexThe results of Pearson correlation analysis showed that TBIL was negatively correlated with age,GRACE score and TIMI score(P < 0.05),positively correlated with Hemoglobin(HGB)and Red blood cell(RBC)(P <0.05),and not significantly correlated with diastolic blood pressure,Killip ≥2,ST segment shift,ejection fraction,UA(P > 0.05).blood cell(RBC)(P <0.05),and no significant correlation with diastolic blood pressure,Killip ≥2,ST-segment shift,ejection fraction,and UA(P > 0.05).5.Analysis of independent risk factors for the occurrence of MACE within 28 days after PCI in patients with NSTEMIUsing the occurrence of MACE within 28 days after PCI in NSTEMI patients as the dependent variable,variables with statistical significance for univariate binary logistic regression analysis were selected: age,diastolic blood pressure,ejection fraction,GRACE score,TIMI score,TBIL,RBC,HGB and HCT as independent variables for multivariate binary logistic regression analysis.The results showed that GRACE score and TIMI score were independent risk factors for the occurrence of MACE in NSTEMI patients within 28 days after PCI,while TBIL level was a protective factor for the prognosis of NSTEMI patients undergoing PCI.6.The predictive value of TBIL,GRACE score,TIMI score and the combination of the three for the occurrence of MACE in NSTEMI patients within 28 days after PCIThe ROC curves for TBIL,GRACE score,TIMI score and TBIL+GRACE score+TIMI score were plotted,and the resulting AUC,sensitivity and specificity were recorded,and the optimal threshold values were derived using the Yordon index.The AUC of TBIL,GRACE score,TIMI score,and TBIL+GRACE score+TIMI score were 0.657,0.832,0.764,and 0.851,respectively,as measured by the ROC curves,and the optimal critical values of the first three were 12.91 umol/L,158 points,and 4 points,respectively,and the sensitivities were 72.7%,71.8%,71.8%,and 81.8%,71.8%,and the specificity was 50.8%,83.5%,55.6%,90.7%,respectively.TBIL+GRACE score+TIMI score had greater accuracy in predicting the occurrence of MACE in NSTEMI patients within 28 days after PCI(AUC: 0.851>0.832>0.764>0.657)and it has a higher specificity(90.7%).7.Construction of prediction modelBased on the results of logistic regression analysis,the independent risk factors TBIL,GRACE score,and TIMI score were incorporated into the R software,and the RMS package was used to build the column line graph risk prediction model;the calibration curve was used to evaluate the calibration degree of the column line graph model;it was found that the calibration curve and the ideal measured curve fit well,indicating that the predicted value and the ideal measured value were consistent,and the validity of the calibration curve could be evaluated by the C-The results showed that the C-index was 0.852,while the corrected C-index was 0.846.The ROC analysis was used to verify the predictive ability of the column line graph model for the occurrence of MACE in NSTEMI patients,and the area under the ROC curve was 0.852,and the optimal critical values in the ROC curve were 0.447(0.911-0.718),and these results indicate that the model has good predictive performance.Conclusion.The TBIL,TIMI score,and GRACE score all have predictive value for the occurrence of MACE in NSTEMI patients,but the combination of the three has higher specificity and better predictive effect.The column line graph model developed by has good predictive ability for evaluating the risk of MACE in NSTEMI patients,and helps to provide a more effective tool for clinical intervention and prognosis prediction in NSTEMI patients.