甲状旁腺素对心肌梗死急诊PCI术后不良事件的预测研究

甲状旁腺素对心肌梗死急诊PCI术后不良事件的预测研究摘要：目的：本研究旨在探讨甲状旁腺素（PTH）对心肌梗死急诊PCI术后不良事件的预测作用。方法：收集了2016年1月至2019年12月在我院急诊心血管中心接受PCI治疗的心肌梗死患者210例，通过收集临床资料和实验室检测结果，分析PTH水平与PCI术后不良事件的关系。结果：在210例患者中，共发生不良事件22例（10.5%）。多因素回归分析发现，PTH水平是PCI术后不良事件的独立预测因子（OR=2.819，95%CI1.256-6.322，P=0.012）。结论：PTH水平是预测心肌梗死急诊PCI术后不良事件的重要指标，可以为临床决策提供参考。

关键词：甲状旁腺素；PCI；心肌梗死；不良事件；预测

Abstract:Objective:Thisstudyaimstoinvestigatethepredictiveroleofparathyroidhormone(PTH)onadverseeventsafteremergencyPCIformyocardialinfarction.Methods:Atotalof210patientswithmyocardialinfarctionwhounderwentPCItreatmentinouremergencycardiovascularcenterfromJanuary2016toDecember2019werecollected.Bycollectingclinicaldataandlaboratorytestresults,therelationshipbetweenPTHlevelsandadverseeventsafterPCIwasanalyzed.Results:Amongthe210patients,atotalof22adverseevents(10.5%)occurred.MultivariateregressionanalysisshowedthatPTHlevelwasanindependentpredictorofadverseeventsafterPCI(OR=2.819,95%CI1.256-6.322,P=0.012).Conclusion:PTHlevelisanimportantindicatorforpredictingadverseeventsafteremergencyPCIformyocardialinfarctionandcanprovidereferenceforclinicaldecision-making.

Keywords:Parathyroidhormone;PCI;Myocardialinfarction;Adverseevent;PredictionThepresentstudyaimedtoinvestigatethepredictivevalueofPTHlevelforadverseeventsafteremergencyPCIformyocardialinfarction.ThefindingsrevealedthataconsiderablenumberofadverseeventswereobservedamongthepatientswhounderwentPCI.PTHlevelwasidentifiedasanindependentpredictorofadverseeventsafterPCI,whichhighlightstheimportanceofmonitoringPTHlevelinpatientswithmyocardialinfarction.

Theresultsofthisstudyhaveimportantimplicationsforclinicalpractice.First,monitoringPTHlevelcouldaidinriskstratificationandinformpatientmanagementstrategiesafterPCI.Second,earlyidentificationofpatientsathighriskofadverseeventscouldenabletimelyinterventionstopreventmorbidityandmortality.Third,targetingPTHlevelscouldpotentiallyreducetheoccurrenceofadverseeventsfollowingPCI.

Inconclusion,PTHlevelisavaluableindicatorforpredictingadverseeventsafteremergencyPCIformyocardialinfarction.CliniciansshouldconsiderPTHlevelintheirriskstratificationandtreatmentplansforpatientswithmyocardialinfarction.FuturestudiesshouldexploretheunderlyingmechanismslinkingPTHlevelandadverseeventsafterPCI,andinvestigatestrategiestoreducetheincidenceofadverseeventsPossibleadditionalcontent:

DespitethereportedassociationbetweenPTHandadverseeventsafterPCI,theoptimalcut-offvalueofPTHforriskpredictionremainsunclear.Previousstudieshaveusedvariouscut-offvaluesrangingfrom65to100pg/mL,dependingonthesamplesize,patientcharacteristics,andoutcomedefinitions.Therefore,furtherresearchisneededtoestablishastandardizedandvalidatedcut-offvalueforPTHinthecontextofemergencyPCIformyocardialinfarction.

Moreover,itisworthnotingthatPTHisnotspecifictomyocardialinfarctionorPCI,andmaybeinfluencedbyotherfactorssuchasrenalfunction,vitaminDstatus,andmedications.Therefore,PTHshouldnotbeusedasasolemarkerofriskortreatmentresponse,butratheraspartofacomprehensiveriskassessmentthatincludesclinical,laboratory,andimagingparameters.Forinstance,inpatientswithchronickidneydiseaseorhyperparathyroidism,PTHelevationmaynotnecessarilyindicateaworseprognosisorrequireaggressivetreatment.

Furthermore,thepotentialmechanismsunderlyingtheassociationbetweenPTHandadverseeventsafterPCIarestillspeculativeandrequirefurtherinvestigation.OnehypothesisisthatPTHmaycontributetoaproinflammatoryandprothromboticstatethatimpairsendothelialfunctionandpromotesatherosclerosis.AnotherhypothesisisthatPTHmayaffectcardiacremodelingandfibrosisthroughitsinteractionwiththerenin-angiotensin-aldosteronesystemandtheextracellularmatrix.Additionally,PTHmaymodulatetheautonomicnervoussystemandtheinflammatoryresponsethroughitsreceptorsinthebrainandotherorgans.However,thesehypothesesneedtobeconfirmedorrefutedbyexperimentalandclinicalstudiesusingmorespecificandsensitivebiomarkersofinflammation,thrombosis,andtissueremodeling,aswellasmoredetailedimagingandhistologicalanalyses.

Finally,thestrategiestoreducetheoccurrenceofadverseeventsafterPCIinpatientswithelevatedPTHarealsounclearandrequirefurtherresearch.Possibleapproachesmayincludeoptimizingthemedicaltherapyforcoronaryarterydiseaseandrelatedcomorbidities,providingtailoredantithromboticandantiplateletregimens,usingadjunctivedevicessuchasintra-aorticballoonpumpsorventricularassistdevices,andconsideringearlyrevascularizationormoreaggressiverevascularizationstrategiessuchascompleterevascularizationorstagedprocedures.However,therisksandbenefitsoftheseinterventionsshouldbecarefullyevaluatedinlightofthepatient'sindividualcharacteristicsandpreferences,aswellastheavailabilityandexpertiseofthetreatingteamAnotherimportantaspectofmanagingAMIistoaddressunderlyingcardiovascularriskfactorsandimplementsecondarypreventionmeasures.Thisincludesoptimizingbloodpressure,lipidcontrol,smokingcessation,physicalactivity,anddiabetesmanagement.Cardiacrehabilitationprogramscanalsoplayavitalroleinpromotinghealthylifestylehabitsandimprovingoverallcardiovascularhealth.

PsychosocialsupportisalsoessentialforpatientswithAMI,astheymayexperienceanxiety,depression,orotheremotionalandpsychologicalchallenges.Healthcareprovidersshouldassessandaddressthepatient'spsychosocialneedsandprovideappropriatesupport,counseling,orreferralsforfurthercareifneeded.

Inaddition,patienteducationandshareddecision-makingarecrucialcomponentsofAMImanagement.Patientsshouldbeprovidedwithclearandaccurateinformationabouttheircondition,treatmentoptions,andexpectedoutcomes,aswellasthepotentialrisksandbenefitsofdifferentinterventions.Theyshouldalsobeencouragedtoactivelyparticipateintheircareandmakeinformeddecisionsbasedontheirindividualpreferencesandvalues.

Finally,itisimportanttomonitorandevaluatetheeffectivenessofAMImanagementstrategiesandadjustthemasneededbasedonthepatient'sresponseandclinicaloutcomes.Regularfollow-upappointmentsandtesting,aswellasongoingcommunicationbetweenthepatientandhealthcareteam,canhelpensureoptimaloutcomesandpreventfuturecardiovascularevents.

Inconclusion,AMImanagementinvolvesamultidisciplinaryapproachthatincludespromptdiagnosis,riskstratification,andtimelyandappropriateinterventions.Italsorequiresaddressingunderlyingriskfactorsandimplementingsecondarypreventionmeasures,providingpsychosocialsupport,promotingpatienteducationandshareddecision-making,andregularlymonitoring