| 急性冠脉综合征患者经皮冠状动脉介入术后院内MACE发作风险预测模型构建 |
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| 引用本文： | 李洋洋,梁力晖,陈柏林,汪雁归. 急性冠脉综合征患者经皮冠状动脉介入术后院内MACE发作风险预测模型构建[J]. 心脏杂志, 2022, 34(5): 531-536. DOI: 10.12125/j.chj.202203019 |
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| 作者姓名： | 李洋洋 梁力晖 陈柏林 汪雁归 |
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| 作者单位： | 1.老年医学中心 湖南师范大学附属第一医院 湖南省人民医院 |
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| 基金项目： | 湖南省科技厅重点研发项目资助（2017SK2152） |
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| 摘 要： | 目的 探讨急性冠脉综合征患者经皮冠状动脉介入术后院内MACE发生的独立危险因素,并构建风险预测模型。 方法 选取2019年6月～2021年6月我院治疗的276例急性冠脉综合征患者,依据患者经皮冠状动脉介入术后院内是否发生MACE分为MACE组（73例）和非MACE组（203例）。单因素分析两组患者的临床病理特征,多因素Logistic回归分析急性冠脉综合征患者经皮冠状动脉介入术后院内发生MACE的危险因素,使用ROC曲线来评价模型。 结果 276例急性冠脉综合征患者经皮冠状动脉介入术后院内MACE的发生率为26.45%;两组患者的临床资料比较,结果发现,MACE组患者年龄≥60（P<0.05）、吸烟（P<0.05）、饮酒史（P<0.05）、高血压（P<0.01）、心功能Killip分级≥3（P<0.05）、糖尿病（P<0.05）占比均高于非MACE组;BMI（P<0.05）、中性粒细胞计数（P<0.05）、WBC（P<0.05）、NT-Pro BNP（P<0.01）、LDL-C（P<0.05）、Scr（P<0.01）、C反应蛋白（P<0.01）、总胆固醇（P<0.05）、甘油三酯（P<0.01）、血糖（P<0.05）、D-二聚体（P<0.01）、肌钙蛋白（P<0.01）显著高于非MACE组;淋巴细胞计数（P<0.01）、红细胞计数（P<0.01）、血红蛋白浓度（P<0.01）、血钠（P<0.05）、血钙（P<0.01）、尿酸（P<0.05）、白蛋白（P<0.01）显著低于非MACE组。多因素Logistic回归分析结果表明年龄（P<0.05）、吸烟（P<0.05）、WBC（P<0.01）、NT-proBNP（P<0.05） 以及Scr（P<0.01）是ACS患者PCI术后院内发生MACE的独立危险因素,LVEF是保护因素（P<0.05）。6项独立影响因素总分为279.14,对应风险值为0.82,预测ACS患者PCI术后院内发生MACE的概率为82 %。ROC曲线分析显示,模型ROC曲线下面积为0.846,95 %置信区间为0.781~0.878,灵敏度与特异度分别为85.36 %和87.74 %,表明该模型预测能力较强。 结论 年龄、吸烟、WBC、NT-proBNP及Scr是ACS患者PCI术后院内发生MACE的独立危险因素,LVEF是保护因素。
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| 关 键 词： | 急性冠脉综合征 主要不良心血管事件 经皮冠状动脉介入术 预测模型 |
| 收稿时间： | 2022-03-04 |
Construction of a in-hospital MACE attack risk prediction model for patients with acute coronary syndrome after percutaneous coronary intervention |
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| Affiliation: | 1.Geriatric Center2.Department of Geriatric3.Department of Respiratory Medicine4.Department of General Practice, First Affiliated Hospital, Hunan Normal University & Hunan Provincial People’s Hospital, Changsha 410005, Hunan, China5.Shanghai Pudong New Area People’s Hospital, Shanghai 201299, China |
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| Abstract: | AIM To explore the in-hospital independent risk factors of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) and to construct a risk prediction model. METHODS Two hundred and seventy-six ACS patients treated in our hospital from June 2019 to June 2021 were selected and divided into MACE group (73 cases) and non-MACE group (203 cases) according to whether the patients had MACE during hospitalization after PCI. The clinicopathological characteristics of the two groups of patients were analyzed by univariate analysis, risk factors of MACE in the hospital after PCI were analyzed by multivariate Logistic regression and the predictive power of the model was valued by ROC curves. RESULTS The incidence of mace in 276 patients with acute coronary syndrome after percutaneous coronary intervention was 26.45%; The clinical data of two groups of patients were compared. The results showed that patients in group MACE were older than 60 (P<0.05), smoking (P<0.05), drinking history (P<0.05), hypertension (P<0.01), heart function Killip grade 3 (P<0.05) and diabetes (P<0.05) accounted for higher than those in non MACE group. BMI (P<0.05), neutrophil count (P<0.05), WBC (P<0.05), NT Pro BNP (P<0.01), LDL-C (P<0.05), SCR (P<0.01), C-reactive protein (P<0.01), total cholesterol (P<0.05), triglyceride (P<0.01), blood glucose (P<0.05), D-Dimer (P<0.01) and troponin (P<0.01) were significantly higher than those in non mace group; Lymphocyte count (P<0.01), erythrocyte count (P<0.01), hemoglobin concentration (P<0.01), blood sodium (P<0.05), blood calcium (P<0.01), uric acid (P<0.05) and albumin (P<0.01) were significantly lower than those in non mace group. Multivariate logistic regression analysis showed that age (P<0.05), smoking (P<0.05), WBC (P<0.01), NT proBNP (P<0.05) and SCR (P<0.01) were independent risk factors for mace after PCI, and LVEF was protective factor (P<0.05). The total score of six independent influencing factors was 279.14, and the corresponding risk value was 0.82. It was predicted that the probability of mace in the hospital after PCI in patients with ACS was 82%. The ROC curve analysis shows that the area under the ROC curve of the model is 0.846, the 95% confidence interval is 0.781～0.878, and the sensitivity and specificity are 85.36% and 87.74% respectively, indicating that the prediction ability of the model is strong. CONCLUSION Age, smoking, WBC, NT proBNP and SCR are independent risk factors for mace in the hospital after PCI, and LVEF is the protective factor. |
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