老年冠心病病人PCI术后并发室性心律失常危险因素的探讨及风险列线图模型的建立

目的探讨老年冠心病病人经皮冠状动脉介入治疗(PCI)术后并发室性心律失常的危险因素,并建立风险列线图模型。方法回顾性分析2017年8月—2019年8月因冠心病于我院接受PCI的186例老年病人的临床资料,分析老年冠心病病人PCI术后并发室性心律失常的独立危险因素。纳入筛选出的独立危险因素建立列线图预测模型,并对模型的预测性及准确度进行验证。结果Logistic回归分析结果显示,糖尿病、心电图J波、冠状动脉多支病变、心肌梗死溶栓治疗(TIMI)血流分级0级、KillipⅣ级及发病至PCI时间是老年冠心病病人PCI术后并发室性心律失常的独立危险因素,均与老年冠心病病人PCI术后并发室性心律失常高度相关。基于糖尿病、心电图J波、冠状动脉多支病变、TIMI血流分级0级、KillipⅣ级及发病至PCI时间6项独立危险因素,建立预测老年冠心病病人PCI术后并发室性心律失常的列线图模型,并对该模型进行验证,预测值同实测值基本一致,说明本研究的列线图预测模型具有较好的预测能力。使用Bootstrap内部验证法对该列线图模型进行验证,一致性指数(C-index)为0.81695%CI(0.787,0.845)],说明建立的列线图模型具有良好的精准度和区分度。结论老年冠心病病人PCI术后并发室性心律失常的风险较高,糖尿病、心电图J波、冠状动脉多支病变、TIMI血流分级0级、KillipⅣ级及发病至PCI时间是老年冠心病病人PCI术后并发室性心律失常的独立危险因素,相关列线图预测模型的建立能够提高对老年冠心病病人PCI术后并发室性心律失常的诊断效能,对临床制定相关防治措施具有指导意义。

The Risk Factors of Ventricular Arrhythmia in Elderly Patients with Coronary Heart Disease after PCI and Establishment of Nomogram Risk Prediction Model

Objective To explore the risk factors of ventricular arrhythmia in elderly patients with coronary heart disease after percutaneous transluminal coronary intervention(PCI),and establish the nomogram risk prediction model.Methods The clinical data of 186 elderly patients who underwent PCI were retrospectively analyzed.Univariate and Logistic regression multivariate analysis were used to analyze the complications of elderly patients with coronary heart disease after PCI.The independent risk factors of ventricular arrhythmias in elderly patients with coronary heart disease after PCI were analyzed.Then the independent risk factors were included to establish the nomogram prediction model,and the predictability and accuracy of the model were verified.Results Logistic regression analysis results showed that diabetes,electrocardiogram(ECG)J wave,multiple coronary artery lesions,TIMI blood flow level 0,Killip classⅣ,the time from onset to PCI were independent risk factors for ventricular arrhythmia after PCI in elderly patients with coronary heart disease.The nomogram model for predicting ventricular arrhythmia after PCI in elderly patients with coronary heart disease was established and verified.The predicted value was basically consistent with the measured value,which indicates that the nomographic chart prediction model has better prediction ability.The C-index index was 0.81695%CI(0.787,0.845)],which indicates that the alignment chart model has better accuracy and discrimination.Conclusion The risk of ventricular arrhythmia after PCI in elderly patients with coronary heart disease is high.Diabetes,ECG J waves,multiple coronary artery lesions,TIMI blood flow level 0,Killip classⅣ,the time from onset to PCI are independent risk factors of ventricular arrhythmia after PCI in elderly patients with coronary heart disease.The nomogram prediction model can improve the diagnostic efficacy of ventricular arrhythmias in elderly patients with coronary heart disease after PCI.