The predictive value of platelet aggregation level in predicting short-term adverse cardiovascular events in patients with acute coronary syndrome
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摘要: 目的 探讨血小板聚集率对急性冠状动脉综合征(ACS)患者短期发生心血管不良事件的预测价值。方法 选取自2018年12月—2021年4月就诊于河北省人民医院的ACS患者169例。根据是否发生主要不良心血管事件(MACE)分为未发生事件组(A组，118例)和发生事件组(B组，51例)，比较两组基本资料及血小板聚集水平。结果 花生四烯酸聚集率A组为(15.37±13.06)%，B组为(31.26±23.90)%，两组差异有统计学意义(P < 0.001)。ADP血小板聚集率A组为(29.32±12.05)%，B组为(55.74±11.42)%，两组差异有统计学意义(P < 0.001)。ROC曲线显示，花生四烯酸聚集率预测ACS短期发生MACE事件的截点、曲线下面积、灵敏度、特异度分别为12.45%、0.724、90.2%、50.0%，ADP血小板聚集率预测ACS短期发生MACE事件的截点、曲线下面积、灵敏度、特异度分别为41.25%、0.949、94.1%、86.4%。结论 血小板聚集水平对ACS患者短期内发生心血管不良事件有一定的预测价值。Abstract: Objective To investigate the predictive value of platelet aggregation on short-term adverse cardiovascular events in patients with acute coronary syndrome.Methods A total of 169 patients with acute coronary syndrome were selected as the study subjects in Hebei General Hospital from December 2018 to April 2021. According to the occurrence of MACE events, the patients were divided into group A(n=118) and group B(n=51), and the clinical data and platelet aggregation levels of the two groups were compared.Results The average arachidonic acid aggregation rate and ADP platelet aggregation rate in group A were (15.37±13.06)% and (29.32±12.05)%, respectively. The mean arachidonic acid aggregation rate was (31.26±23.90)%, and the mean ADP platelet aggregation rate was (55.74±11.42)% in group B, with statistical difference between the two groups(P < 0.001). ROC curve analysis showed that the cut-off point, area under curve, sensitivity and specificity of arachidonic acid aggregation rate for predicting short-term MACE events in patients with acute coronary syndrome were 12.45%, 0.724, 90.2%, and 50.0% respectively. The cut-off point, area under curve, sensitivity and specificity of ADP platelet aggregation rate for predicting short-term MACE events in patients with acute coronary syndrome were 41.25%, 0.949, 94.1%, and 86.4% respectively.Conclusion Platelet aggregation level has certain predictive value for short-term adverse cardiovascular events in patients with acute coronary syndrome.
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表 1 两组患者临床基线特征比较
Table 1. Baseline clinical characteristics
例(%), X±S 指标 A组(118例) B组(51例) P值 男性 97(82.2) 32(62.7) 0.006 年龄/岁 60.30±9.50 65.33±9.32 0.008 BMI/(kg·m-2) 25.61±3.47 26.00±2.94 0.497 心肌梗死 18(15.3) 10(19.6) 0.485 冠脉介入 21(17.8) 16(31.4) 0.050 冠脉移植 2(1.7) 1(2.0) 0.905 溶栓 4(3.4) 1(2.0) 0.993 冠心病 54(45.8) 28(54.9) 0.275 外周血管疾病 13(11) 15(29.4) 0.003 脑梗死或TIA 11(9.3) 7(13.7) 0.394 心律失常 12(10.2) 6(11.8) 0.758 慢性肾病 0(0) 4(2.7) 0.011 高血压 76(64.4) 36(70.6) 0.435 1级 13(11.0) 3(5.9) 2级 22(18.6) 6(11.8) 3级 41(34.7) 27(52.9) 糖尿病 33(28.0) 13(25.5) 0.740 吸烟 47(39.8) 14(27.5) 0.124 高脂血症 12(10.2) 11(21.6) 0.047 家族史 35(29.7) 12(23.5) 0.414 心脏超声 LVEF/% 59.05±8.29 58.31±10.90 0.974 LVEDD/mm 47.75±4.28 48.88±5.54 0.363 LVESD/mm 32.64±5.04 33.33±6.82 0.926 诊断 0.098 STEMI 43(36.4) 10(20.0) NSTEMI 10(8.5) 5(10.0) UA 65(55.1) 35(70.0) 注：TIA：短暂性脑缺血发作；LVEF：左室射血分数；LVEDD：左室舒张末内径；LVESD：左室收缩末内径；STEMI：ST段抬高型心肌梗死；NSTEMI：非ST段抬高型心肌梗死；UA：不稳定型心绞痛。 
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