摘要
目的调查冠心病(CHD)患者经皮冠状动脉介入术(PCI)术后主要不良心血管事件(MACE发生的影响因素,并建立有效预测CHD患者PCI术后发生MACE的列线图预测模型并进行验证。方法选取华中科技大学同济医学院附属同济医院2022年1月至2024年8月收治的346例确诊的CHD患者为研究对象,根据7∶3的比例随机分为建模组242例和验证组104例,建模组根据患者是否发生MACE分为发生组(85例)和未发生组(157例)。通过Logistic回归分析筛选CHD患者发生MACE的影响因素;采用R软件及RMS程序包构建CHD患者发生MACE的列线图风险预测模型;采用ROC曲线、校准图形验证模型的区分度以及一致性。结果与未发生组相比,发生组患者B型利钠肽(BNP)、心电图Q-T间期离散度(QTd)、冠状动脉中重度钙化、支架数量≥2个的占比明显升高[(522.19±55.37)ng/L比(449.06±50.24)ng/L、(85.47±9.68)ms比(72.51±8.23)ms、33.82%比19.75%、30.59%比14.01%,均P<0.05)],白蛋白(ALB)、左心室射血分数(LVEF)、左心房内径(LAD)水平明显降低[(32.54±4.49)g/L比(41.59±5.61)g/L、(33.08±4.65)%比(40.25±5.18)%、(42.18±5.24)mm比(49.37±5.36)mm,均P<0.05];BNP(OR=1.023)、ALB(OR=0.708)、QTd(OR=1.290)、LVEF(OR=0.773)、LAD(OR=0.739)、冠状动脉中重度钙化(OR=19.708)均为CHD患者发生MACE的影响因素(P<0.05);构建列线图预测模型预测发生MACE风险的曲线下面积(AUC)为0.955(95%CI0.933~0.977),说明区分度良好,校正曲线趋近于理想曲线,实际值与预测值一致性良好;验证组中,列线图预测MACE发生风险的AUC为0.901(95%CI 0.846~0.957)。结论BNP、ALB、QTd、LVEF、LAD、冠状动脉中重度钙化为CHD患者PCI术后发生MACE的影响因素,进一步成功构建列线图预测模型,经过验证分析该列线图预测模型可有效预测CHD患者PCI术后发生MACE的风险。
Objective To investigate the influencing factors of major adverse cardiovascular events(MACE)in patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI),and to establish an effective column chart model for predicting MACE in CHD patients after PCI and validate it.Methods From January 2022 to August 2024,totally 346 confirmed CHD patients admitted to our hospital were regarded as subjects.They were stochastically assigned into the modeling group of 242 cases and the validation group of 104 cases according to a 7∶3 ratio.The patients were assigned into the occurrence group(85 cases)and the non occurrence group(157 cases)based on whether they had MACE.Logistic regression analysis was applied to screen the influencing factors of MACE in the patients.The R software and rms package were applied to construct the column chart risk prediction model for MACE in the patients.ROC curves and calibration graphs were applied to verify the discriminability and consistency of the model.Results Compared with the non occurrence group,the B-type natriuretie peptide(BNP),QT-interval dispersion(QTd),proportions of severe coronary artery calcification,and the numbers of stents≥2 in the occurrence group were obviously higher[(522.19±55.37)ng/L vs.(449.06±50.24)ng/L、(85.47±9.68)ms vs.(72.51±8.23)ms、33.82%vs.19.75%、30.59%vs.14.01%,all P<0.05)],while the levels of albumin(ALB),left ventricular ejection fraction(LVEF)and left anterior descending artery(LAD)were obviously lower[(32.54±4.49)g/L vs.(41.59±5.61)g/L、(33.08±4.65)%vs.(40.25±5.18)%、(42.18±5.24)mm vs.(49.37±5.36)mm,all P<0.05].BNP(OR=1.023),ALB(OR=0.708),QTd(OR=1.290),LVEF(OR=0.773),LAD(OR=0.739)and moderate to severe coronary artery calcification(OR=19.708)were all the influencing factors for MACE in CHD patients(P<0.05).The area under the curve(AUC)for predicting MACE risk using a column chart prediction model was 0.955(95%CI 0.933-0.977),indicating good discrimination,the calibration curve tended towards the ideal curve,and the actual value was in good agreement with the predicted value;in the validation group,the AUC predicted by the column chart for the risk of MACE occurrence was 0.901(95%CI 0.846-0.957).Conclusion BNP,ALB,QTd,LVEF,LAD and the moderate to severe calcification of coronary arteries are all the contributing factors to the occurrence of MACE in CHD patients after PCI.The column chart prediction model has been further successfully constructed,and after verification and analysis,the column chart prediction model can effectively predict the risk of MACE in CHD patients after PCI.
作者
桂元
蒋毅
詹继东
黄沁
张祎
张静
GUI Yuan;JIANG Yi;ZHAN Ji-dong;HUANG Qin;ZHANG Yi;ZHANG Jing(Department of Internal Medicine,Huazhong University of Science and Technology Hospital,Wuhan 430074,China)
出处
《中国心血管病研究》
2025年第1期29-34,共6页
Chinese Journal of Cardiovascular Research
基金
湖北省卫生计生委科研项目(WJ2017M053)。
关键词
冠心病
主要不良心血管事件
影响因素
列线图模型
Coronary heart disease
Major adverse cardiovascular events
Influencing factors
Column chart model
