The Value Of Serum Hcy Combined With Fib In Predicting The Adverse Outcome After PCI In Patients With Acute STEMI

Objective:To investigate the diagnostic value of serum homocysteine(Hcy)and fibrinogen(Fib)in predicting adverse outcomes after emergency percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI),including no postoperative reflow and adverse cardiovascular events(MACE)within 1 year after surgery.Methods: In this study,402 STEMI patients who underwent PCI treatment in our hospital were selected.According to the median level of Hcy and Fib measured immediately after admission(The median Hcy level was 15.55μmol/L;The median Fib level was 3.475g/L),the patients were divided into high Hcy and high Fib group(n=118),high Hcy and low Fib group(n=85),low Hcy and high Fib group(n=84),low Hcy and low Fib group(n=115).Baseline data of STEMI patients,laboratory examination before and after PCI operation,and cardiac ultrasound data were collected to compare the differences.In addition,according to the occurrence of postoperative no-reflow patients were divided into no-reflow group and normal blood flow group;According to the occurrence of MACE within 1 year after the operation,the patients were divided into MACE group and non-MACE group,and the differences in general data and relevant data before and after PCI were compared between the two groups.The influencing factors of postoperative non-reflow and MACE were analyzed by Logistic and COX regression.The cumulative survival rate of patients with different Hcy and Fib groups after PCI was compared by drawing survival curve.Finally,combined with the curve of the subjects’ working characteristics(ROC),the predictive efficiency of different levels of Hcy and Fib on postoperative no-reflow and MACE was evaluated.Results: Compared with the high Hcy and low Fib group,the low Hcy and high Fib group,and the low Hcy and low Fib group,the high Hcy and high Fib group had the highest incidence of no-reflow and MACE,that is to say,the incidence of no-reflow and MACE was higher when the Hcy and Fib were simultaneously increased,and the occurrence of MACE was more common with recurrent angina.The levels of Hcy and Fib in the group with no-reflow or MACE were significantly higher than those in the group without reflow.Both Hcy and Fib were independent risk factors for no-reflow and MACE.There were significant differences in cumulative survival after PCI between different Hcy and Fib groups,and the group with high Hcy and high Fib(59.3%)was the lowest.Compared with normal flow group and no-reflow group,the cumulative survival rate within 1 year after PCI in no-reflow group(54.5%)was lower.The diagnostic efficacy of single detection of Hcy and combined detection of Hcy+Fib in patients with no reflow after operation is basically the same,and both are better than the detection of Fib alone.The diagnostic efficacy of single detection of Fib and combined detection of Hcy+Fib in patients with postoperative MACE is basically the same,and both are better than the detection of Hcy alone.Therefore,the diagnostic efficacy of Hcy+Fib combined with prediction of postoperative adverse outcome is higher.In addition,the diagnostic efficacy of Hcy+Fib 、 Hcy+Fib+GRACE and Hcy+Fib+TIMI in predicting postoperative non-reflow was basically the same.The diagnostic efficacy of Hcy+Fib+GRACE and Hcy+Fib+TIMI in predicting postoperative MACE was basically consistent,and both were superior to Hcy+Fib.Conclusion: Both Hcy and Fib were independent risk factors for non-reflow and MACE in STEMI patients after PCI.The increase of Hcy and Fib levels has a good predictive value for the occurrence of adverse outcomes after PCI in STEMI patients,and the simultaneous increase of Hcy and Fib levels has a higher incidence of no-reflow,MACE and lower cumulative survival.The combination of Hcy+Fib is more effective in predicting the adverse outcome after PCI in patients with STEMI.