摘要
目的探讨经皮冠状动脉介入术(percutaneous coronary intervention,PCI)中植入血管支架后早期血栓发生的影响因素并构建列线图预测模型,评价模型的应用价值。方法筛选2019年1月至2025年1月国家心血管病质控平台数据库中经PCI植入血管支架的患者14000例,按照7∶3的比例随机分为建模组(n=9800)和验证组(n=4200)。根据早期支架内血栓发生情况将建模组分为早期支架内血栓组(n=150)和非早期支架内血栓组(n=9650)。采用logistic回归分析建模组早期支架内血栓发生的影响因素,使用R语言软件4.0“rm”包构建列线图预测模型。采用校准曲线和临床决策曲线进行列线图预测模型内部验证。采用受试者操作特征曲线(receiver operating characteristic curve,ROC)和曲线下面积(area under the curve,AUC)进行列线图预测模型外部验证。结果早期支架内血栓组和非早期支架内血栓组高血压、高血脂、血管支架材质、血管内皮损伤、钙化病变旋磨术、抗血小板药物使用、术后感染等基线资料差异具有统计学意义(P均<0.05)。高血压、高血脂、金属裸支架、血管内皮损伤、未行钙化病变旋磨术、抗血小板药物不规范使用、术后感染等是导致早期支架内血栓发生的独立危险因素(P均<0.05)。内部验证结果显示,列线图模型预测建模组早期支架内血栓的C指数为0.815(95%CI:0.593~0.884),校准曲线一致性良好,临床决策曲线能够提供净收益。外部验证结果显示,列线图模型预测建模组和验证组早期支架内血栓的ROC拟合较为理想(P>0.05),AUC差异无统计学意义(P>0.05)。结论PCI术后早期支架内血栓列线图预测模型具有一定的临床应用价值,能够为相关并发症的防治提供一定的参考。
Objective To explore the influencing factor of early stent thrombosis(ST)after implantation of vascular stent in percutaneous coronary intervention(PCI),and to construct a Nomogram prediction model and evaluate the application value of it.Methods A total of 14000 patients who underwent PCI surgery and had vascular stents implanted in National Cardiovascular Disease Quality Control Platform database from January 2019 to January 2025 were selected and randomly divided into a modeling group(n=9800)and validation group(n=4200)in a 7∶3 ratio.The modeling group was divided into an early ST group(n=150)and non-early ST group(n=9650)based on the occurrence of early ST.Logistic regression analysis was used to analyze the influencing factor of early ST in the modeling group.A Nomogram prediction model was constructed by using R language software 4.0“rm”package.Calibration curve and clinical decision curve were used for the internal validation of Nomogram prediction model.ROC and AUC were used for the external validation of Nomogram prediction model.Results The differences in baseline data such as hypertension,hyperlipidemia,vascular stent material,endothelial injury,calcification lesion rotational atherectomy,antiplatelet drug use and postoperative infection between early ST group and non-early ST group were statistically significant(all P<0.05).Hypertension,hyperlipidemia,bare metal stent,endothelial injury,absence of calcified lesion rotational atherectomy,improper use of antiplatelet drugs and postoperative infection were the independent risk factors for the occurrence of early ST(all P<0.05).The internal validation results showed that C-index of Nomogram model for predicting early ST in the modeling group was 0.815(95%CI:0.593-0.884),and the calibration curve had good consistency.The clinical decision curve could provide net benefits.The external validation results showed that Nomogram model had relatively ideal ROC fit for predicting early ST between the modeling group and the validation group(P>0.05),with no statistically significant difference in AUC(P>0.05).Conclusions Nomogram prediction model for early ST after PCI has certain clinical application value and can provide reference for the prevention and treatment of related complications.
作者
白玉石
王振坤
李彦
田龙
BAI Yushi;WANG Zhenkun;LI Yan;TIAN Long(Interventional Operating Room,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,Hebei,China)
出处
《中国分子心脏病学杂志》
2025年第3期6848-6854,共7页
Molecular Cardiology of China
基金
河北省医学科学研究课题计划项目(20232068)。
关键词
冠状动脉介入术
早期支架内血栓
影响因素
列线图
Percutaneous coronary intervention
Early stent thrombosis
Influencing factor
Nomogram
