Expression and clinical significance of the HIF-1α/VEGF signalling pathway in elderly patients with acute myocardial infarction.

OBJECTIVE: To investigate the expression level of hypoxia-inducible factor-1α (HIF-1α)/vascular endothelial growth factor (VEGF) signaling pathway in elderly patients with acute myocardial infarction (AMI), and to analyze its relationship with the prognosis of AMI.

METHODS: A total of 160 elderly patients with AMI were selected from October 2023 to September 2024 in Nanjing Medical University Affiliated Wuxi People's Hospital as the study group, 160 individuals who underwent physical examination during the same period were selected as the control group according to the 1:1 matching principle. The levels of serum HIF-1α and VEGF were compared between the two groups. The study group was treated with percutaneous coronary intervention (PCI). According to the prognosis of patients at 12 months after operation, they were divided into good subgroup and poor subgroup. The clinical data, serum HIF-1α and VEGF levels of the two subgroups were compared. The effect of serum HIF-1α and VEGF on prognosis and its predictive value were analyzed. The accuracy-recall rate (PR) curve was drawn to evaluate the performance of combined prediction. The area under the curve (AUC) was calculated, the DeLong test was used to compare AUCs, and the precision-recall (PR) curve was drawn to evaluate the performance of combined prediction.

RESULTS: The levels of serum HIF-1α and VEGF in the study group were higher than those in the control group (P < 0.05). The time from onset to admission, the proportion of Killip class IV, the proportion of multivessel disease, N-terminal pro-brain natriuretic peptide (NT-proBNP), HIF-1α and VEGF in the poor subgroup were higher than those in the good subgroup, while left ventricular ejection fraction was lower (P < 0.05). Before and after correction of multivessel disease and NT-proBNP, serum HIF-1α and VEGF levels were the influencing factors of prognosis in patients with AMI (P < 0.05). The AUC of serum HIF-1α and VEGF levels alone and combined prediction were 0.717,0.748 and 0.900, respectively, the AUC of combined prediction was significantly higher than that of the two alone (Z = 3.315,2.832, P = 0.001,0.005), and the best sensitivity and specificity were 83.33% and 84.87%. The DCA curve showed that the combined prediction of serum HIF-1α and VEGF levels in the probability range of 5%-70% could obtain significant positive net benefits. The PR curve showed that the PR-AUC value of serum HIF-1α and VEGF levels in evaluating prognosis was 0.767, which had a high recall rate and accuracy rate.

CONCLUSION: Serum HIF-1α and VEGF levels are highly expressed in elderly patients with AMI, and are closely related to the prognosis of patients. The combination of the two can be used to predict the prognosis of patients, provide a reference for the assessment and prognosis of elderly patients with AMI, facilitate early identification of high-risk groups, and provide a reference for subsequent personalized program development.