摘要
目的建立预测ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)后2年主要不良心血管事件(MACE)的临床预后列线图。方法纳入2018年1月至2021年5月于新乡市中心医院收治的393例接受急诊PCI的STEMI患者信息进行回顾性分析。根据PCI术后2年是否发生MACE,将患者分为MACE组(n=66)和非MACE组(n=327),比较两组临床数据;采用最小绝对值收敛和选择算子(LASSO)回归筛选出具有非零系数的预测因子,并使用多元Cox回归分析急诊PCI术后2年MACE的独立风险因素;基于预测因素构建列线图模型,并使用C指数评估模型的预测性能。绘制受试者工作特征(ROC)曲线和临床决策曲线(DCA),以评估列线图模型和心肌梗死溶栓(TIMI)危险评分在预测MACE方面的有效性。结果LASSO回归结果显示入院时收缩压、Killip心功能分级Ⅲ~Ⅳ级、左室射血分数(LVEF)、D-二聚体、同型半胱氨酸(Hcy)、N末端脑钠肽前体(NT-proBNP)、主动脉内球囊反搏(IABP)是具有非零系数的重要预测因子,其中Killip心功能分级Ⅲ~Ⅳ级、LVEF、Hcy、NT-proBNP是STEMI患者PCI术后2年MACE的独立危险因素(P<0.05)。用上述独立预测因子构建列线图模型,内部验证C指数为0.714(95%CI:0.647~0.781,P<0.001),ROC曲线下面积(0.758,95%CI:0.697~0.820,P<0.001)大于TIMI危险指数(0.669,95%CI:0.544~0.765,P<0.001)和GRACE评分(0.633,95%CI:0.521~0.736,P<0.001);H-L拟合优度检验结果为χ2=0.44,P=0.51,说明模型校准曲线接近理想模型。DCA分析表明,与TIMI危险指数或GRACE评分相比,列线图模型显示了对于预测整个队列中MACE更显著的正净收益。结论Killip心功能分级Ⅲ~Ⅳ级、LVEF、Hcy和NT-proBNP是STEMI患者PCI术后2年MACE的独立危险因素,基于上述因素构建的列线模型具有较高的预测效力和可行性。
Objective To establish a nomogram for predicting clinical prognosis of major adverse cardiovascular events(MACE)in patients with ST-segment elevation myocardial infarction(STEMI)2 y after emergency percutaneous coronary intervention(PCI).Methods The data was retrospectively analyzed in STEMI patients undergone PCI(n=393)in Central Hospital of Xinxiang City from Jan.2018 to May 2021.The patients were divided,according to whether MACE occurred 2 y after PCI or not,into MACE group(n=66)and non-MACE group(n=327).The clinical data was compared between 2 groups.The minimum absolute value convergence and selection operator(LASSO)regression was used to screen the predictive factors with non-zero coefficients,and the multivariate Cox regression was used to analyze the independent risk factors of MACE 2 y after emergency PCI.A nomograph model was established based on prediction factors,and prediction performance of the model was reviewed by using C index.The effectiveness of nomogram model and risk scores of thrombolysis in myocardial infarction(TIMI)in predicting MACE was reviewing by using ROC curve and clinical decision curve analysis(DCA).Results The results of LASSO regression analysis showed that admission systolic blood pressure(SBP),grades III to IV of Killip,left ventricular ejection fraction(LVEF),D-dimer(D-D),homocysteine(Hcy),N-terminal pro-brain natriuretic peptide(NT-proBNP)and intra-aortic balloon pumps(IABP)all were important predictive factors with non-zero coefficients.The gradesⅢtoⅣof Killip,LVEF,Hcy and NT-proBNP were independent risk factors of MACE in STEMI patients after PCI for 2 y(P<0.05).The nomograph was established with the above independent predictors.The internal validation C index was 0.714(95%CI:0.647~0.781,P<0.001),and area of ROC curve(0.758,95%CI:0.697~0.820,P<0.001)was greater than TIMI risk index(0.669,95%CI:0.544~0.765,P<0.001)and GRACE scores(0.633,95%CI:0.521~0.736,P<0.001).The results of H-L goodness of fit-test showed(χ2=0.44,P=0.51),indicated that calibration curve of the model was close to ideal model.The results of DCA showed that the nomogram model had more significant positive net benefit for predicting MACE in the total cohort compared with TIMI risk index or GRACE scores.Conclusion The gradesⅢtoⅣof Killip,LVEF,Hcy and NT-proBNP are independent risk factors of MACE in STEMI patients 2 y after PCI.The nomograph model based on these factors has high predictive power and feasibility.
作者
侯雨岩
张芙成
苏淑红
吴晓
王志方
Hou Yuyan;Zhang Fucheng;Su Shuhong;Wu Xiao;Wang Zhifang(Third Department of Cardiovascular Medicine,Central Hospital of Xinxiang City,Xinxiang 453000,China;不详)
出处
《中国循证心血管医学杂志》
2024年第1期50-55,共6页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
河南省医学科技攻关计划联合共建项目(LHGJ20200942)。
