| Objective: Correlations between the infarct site,soluble ST2 level,and infarct size,left ventricular function,and prognosis in patients with STEMI were analyzed.Methods: Selected 120 patients with acute ST elevation myocardial infarction(STEMI)hospitalized in the emergency department of our hospital from September 2021 to September2022,Patients were divided into two groups according to the site of infarction,In the anterior wall group,62 patients(anterior wall AMI included anterior wall(V1-3),anterior wall(V2-4),anterior wall(V4-6),extensive anterior wall(V1-6,include I,a VL lead)),58 patients in the non-anterior wall group(inferior wall(II,III,a VF),posterior wall(V7-9),right chamber(V3R-V5R)).All the above patients were admitted within 12 hours of disease onset,and all have been treated with emergency PCI.In addition,120 patients with health examination during the same period were selected as the control group.General data of the enrolled patients were collected,such as gender,age,smoking history,alcohol consumption history,medical history of hypertension,medical history of diabetes mellitus,hyperlipidemia history,vascular recanalization time of the offender.The venous blood was collected on an empty stomach in the morning,and ELISA was used to detect the soluble ST2(s ST2)level,and the N-terminal peptide precursor(NT-pro BNP)and blood lipid level were tested.The echocardiographic index(end-diastolic diameter of left ventricle(LVEDD),end-systolic diameter of left ventricular(LVESD),left ventricular ejection fraction(LVEF))of healthy subjects and myocardial infarction patients 5-7 days after hospitalization was recorded;The ECG results of patients with myocardial infarction were collected and the Selvester QRS integral method was used to estimate the area of myocardial infarction;in the presence of angina,myocardial infarction,arrhythmia,heart failure and heart failure progression,and sudden cardiac death 3 months after discharge.All patients in the AMI group received standard secondary prevention treatment for CHD during hospitalization and after discharge.The resulting data was then statistically processed.Comparing differences between general clinical data and relevant laboratory indicators between AMI and healthy control groups and anterior wall and non-anterior wall group,respectively.Correlation of serum s ST2 levels with the infarct size and cardiac function indexes in different sites were analyzed.According to whether STEMI patients had MACE events after discharge,they were divided into MACE group and non-MACE group.Serum s ST2 and NT-pro BNP levels were compared between the two groups,binary Logistic regression analysis was used to determine the risk factors for MACE events,and the predictive value of s ST2 and NT-pro BNP for MACE events was analyzed using the receiver working characteristic curve(Receiver operating characteristic curve,ROC curve).Results:(1)There were no significant differences in sex,smoking,drinking and diabetes between the AMI group and the control group(P>0.05).There were significant differences in age,hyperlipidemia and hypertension between the AMI group and the control group(P<0.05).There were no statistically significant differences in age,gender,smoking history,alcohol history,diabetes,hypertension,hyperlipidemia,and recanalization time between the anterior and non-anterior wall group(P>0.05).(2)The levels of s ST2,NT-pro BNP and LVEDD and LVESD in the AMI group were higher than those in the healthy control group(P<0.05).The differences were statistically significant(P<0.05).The value of LVEF in the AMI group was significantly lower than that in the control group(P<0.05).The levels of s ST2,NT-pro BNP and LVEDD and LVESD in anterior wall myocardial infarction group were higher than those in non-anterior wall myocardial infarction group(P<0.05).The value of LVEF in patients with anterior wall cardiac obstruction was significantly lower than that in non-anterior wall group(P<0.05),and the infarct area in anterior wall group was larger than that in non-anterior wall group,and the difference was statistically significant(P<0.05).(3)Correlation analysis showed that the level of s ST2 in the anterior wall group was negatively correlated with LVEF(r =﹣0.37,P < 0.003),positively correlated with LVEDD(r = 0.37,P < 0.003),positively correlated with LVESD(r = 0.50,P < 0.001),and positively correlated with infarction size(r= 0.36,P = 0.004).In the non-anterior wall group,the level of s ST2 was negatively correlated with LVEF(r =﹣0.35,P < 0.007),positively correlated with LVEDD(r = 0.67,P < 0.001),positively correlated with LVESD(r = 0.49,P < 0.001),and positively correlated with infarction size(r = 0.58,P < 0.001).(4)Within 3 months of follow-up,the levels of s ST2 and NT-pro BNP in the MACE event group were significantly higher than those in the non-event group.(5)Binary Logistic regression analysis showed that s ST2(OR:1.11;95%CI: 1.04-1.18)and NT-pro BNP(OR:2.12;95%CI:1.10-4.08)were risk factors for MACE events in patients with AMI within 3 months.(6)The ROC curve showed that the area under the curve of serum s ST2 was 0.76.when the cutoff value was 34.66,the sensitivity and specificity were 65.38%and 84.04%,respectively.The area under the NT-pro BNP curve is 0.73,and the cut-off value is 2961,the sensitivity and specificity are 53.83% and 82.98% respectively,and the area under the combined curve is 0.82,the sensitivity is 76.92%,and the specificity is 82.66%.Conclusion : In patients with acute ST-segment elevation myocardial infartion,anterior myocardial infarction has a greater impact on cardiac function.The serum s ST2 level of the patients was closely related to its cardiac function and infarct area.Patients with high ST2 level and NT-pro BNP level have high 3-month MACE incidence,and s ST 2 level and NT-pro BNP level are risk factors for poor prognosis of STEMI patients.They can be used to evaluate the occurrence of MACE events within 3 months in STEMI patients,with good predictive value for MACE events,and the combined prediction effect of s ST 2 level and NT-pro BNP is more valuable. |
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