摘要
目的:探索冠心病合并中度缺血性二尖瓣反流(ischemic mitral regurgitation,IMR)患者外科治疗围术期危险因素并构建模型,以预测此类患者外科围术期死亡和主要并发症的风险。方法:回顾性分析2009年9月至2021年10月,北京安贞医院诊断为冠心病合并中度IMR并接受外科手术治疗患者的临床资料。以围术期死亡和主要并发症为终点,随机将这些患者的70%划分为训练集,剩余30%的患者划分为验证集。在训练集中应用二元多因素Logistic回归探寻危险因素,并构建模型,绘制列线图,并在验证集中验证模型的区分度和校准度。结果:本研究共纳入的949例患者,179例(18.9%)患者发生终点事件(围术期死亡或出现主要并发症),训练集(n=664)和验证集(n=285)分别有120例(18.1%)和59例(20.7%)患者发生终点事件。多因素Logistic回归分析表明中枢神经系统病史、术前放置主动脉内球囊内反搏、使用体外循环、体表面积<1.75m^(2)、TnI>0.7μg/mL、LVEF≤40%、肌酐清除率<70 mL/min以及LVEDD≥55mm是冠心病合并中度IMR患者外科术后发生围术期死亡及主要终点事件的危险因素。根据以上8个预测因子构建出的模型在训练集中区分度良好,一致性指数(concordance index,C-index)为0.715(95%CI:0.665~0.766),且模型的准确度较高。模型在验证集中的C-index为0.722(95%CI:0.645~0.798)。在预测的主要终点事件发生风险低于50%的患者中,校准曲线表明预测风险和观测风险基本一致。结论:建立冠心病合并中度IMR患者外科手术围术期风险预测模型,可有效预测此类患者围术期全因死亡及主要并发症的发生率,有助于在此类人群中识别出高危手术患者。
Objective:Surgery is the most effective method for the treatment of coronary heart disease(CHD)presenting with moderate ischemic mitral regurgitation(IMR).However,there is no effective strategy to evaluate the prognosis of these patients.In this study,we explored perioperative risk factors of perioperative death and major complications that can be used to establish a prediction model for patients with CHD and presenting with moderate IMR undergoing surgery.Methods:This was a retrospective study involving patients diagnosed with CHD and presenting with moderate IMR who had received surgical treatment in Beijing Anzhen Hospital.The primary endpoints were perioperative death and major complications.The patients were randomly assigned to the training set(70%)and the validation set(30%).Multivariate Logistic regression was used to identify independent risk factors using data from the training set,which were used to establish the prediction model.A column graph was then drawn,and the discrimination and calibration of the model verified in the verification set.Results:Patients who had endpoint events(postoperative death or major complications)were 179 patients(18.9%),consisting of 120 patients(18.1%)in the training set(n=664)and 59 patients(20.7%)in the verification set(n=285).Multivariate Logistic regression analysis showed that the history of central nervous system,preoperative placement of intra-aortic balloon pump(IABP),use of cardiopulmonary bypass,body surface area(BSA)<1.75m^(2),TnI>0.7 ng/mL,LVEF≤40%,creatinine clearance(CrCl)<70 mL/min and LVEDD≥55mm were independent risk factors for perioperative primary endpoint events in patients with CHD presenting with moderate IMR.The prediction model had good discrimination and high accuracy,with the C-index in the training and verification set being 0.715(95%CI:0.665-0.766)and 0.722(95%CI:0.645-0.798),respectively.The calibration curve showed consistency in the predicted and observed risks in patients with a predicted primary endpoint event risk of less than 50%.Conclusions:The prediction model for surgical complications in patients with CHD and presenting with moderate IMR can effectively predict the incidence of perioperative all-cause death and major complications,and help to identify high-risk surgical patients in this population.
作者
张魁
闫鹏云
付威
周宁
刘韬帅
宋跃
曹剑
刘恺闻
贾俊航
吴立松
李扬
郑居兵
董然
ZHANG Kui;YAN Pengyun;FU Wei;ZHOU Ning;LIU Taoshuai;SONG Yue;CAO Jian;LIU Kaiwen;JIA Junhang;WU Lisong;LI Yang;ZHENG Jubing;DONG Ran(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)
出处
《心肺血管病杂志》
CAS
2023年第6期570-577,共8页
Journal of Cardiovascular and Pulmonary Diseases
基金
北京市科学科技委员会“首都市民健康项目培育”(Z151100003915084)
北京市科技新星计划(Z201100006820088)。
关键词
冠心病
中度缺血性二尖瓣反流
预测模型
Coronary heart disease
Moderate ischemic mitral regurgitation
Prediction model
