| 吕玮坤,王文丽,董欢乐,等.ST段抬高型急性心肌梗死经皮冠状动脉介入治疗后并发恶性心律失常列线图模型构建与验证[J].安徽医药,2026,30(2):341-347. |
| ST段抬高型急性心肌梗死经皮冠状动脉介入治疗后并发恶性心律失常列线图模型构建与验证 |
| Construction and validation of a nomogram model for malignant arrhythmias after PCI in patients with acute ST-segment elevation myocardial infarction |
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| DOI：10.3969/j.issn.1009-6469.2026.02.025 |
| 中文关键词: ST段抬高型心肌梗死 经皮冠状动脉介入治疗 心律失常，心性 疾病预测模型 冠状动脉粥样硬化心脏病 临床预后 左心功能 |
| 英文关键词: ST-segment elevation myocardial infarction Percutaneous coronary intervention Arrhythmias,cardiac Disease pre-diction model Coronary atherosclerotic heart disease Clinical prognosis Left ventricular function |
| 基金项目:陕西省重点研发计划项目( 2020SF-277、2023-YBSF-674) |
| 作者 | 单位 | E-mail | | 吕玮坤 | 陕西中医药大学第二附属医院心血管内科,陕西西安 712000 | | | 王文丽 | 陕西中医药大学第二附属医院心血管内科,陕西西安 712000 | 422907080@qq.com | | 董欢乐 | 陕西中医药大学第二附属医院心血管内科,陕西西安 712000 | | | 张骞 | 陕西中医药大学第二附属医院心血管内科,陕西西安 712000 | | | 翟夏 | 陕西中医药大学第二附属医院心血管内科,陕西西安 712000 | | | 陈敏娜 | 陕西中医药大学第二附属医院心血管内科,陕西西安 712000 | | | 张望 | 陕西中医药大学第二附属医院心血管内科,陕西西安 712000 | | | 邢雪 | 陕西中医药大学第二附属医院心血管内科,陕西西安 712000 | | | 牛铁 | 陕西中医药大学第二附属医院心血管内科,陕西西安 712000 | | | 董静 | 陕西中医药大学第二附属医院心血管内科,陕西西安 712000 | |
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| 中文摘要: |
| 目的构建 ST段抬高型急性心肌梗死( STEMI)经皮冠状动脉介入( PCI)治疗后并发恶性心律失常的列线图模型，并验证该模型的准确性。方法选取 2020年 1月至 2023年 1月在陕西中医药大学第二附属医院接受 PCI治疗的 STEMI病人 620例，所有参与者均被跟踪观察了 6个月。根据随访期间是否出现恶性心律失常事件，将受试者分为发生恶性心律失常组( 72例)和未发生恶性心律失常组( 548例)。采用 logistic回归分析来确定导致 STEMI病人在 PCI手术后并发恶性心律失常的独立风险因素，并基于这些发现构建了一个列线图模型。使用 Bootstrap方法对建立的模型进行了准确性的内部验证，同时通过受试者操作特征曲线( ROC曲线)评估了该临床模型的预测性能，并利用决策曲线分析( DCA)评价了模型对于实际应用的价值。结果与未发生恶性心律失常组相比，发生组年龄更大［(68.65±6.87)岁比( 60.76±5.98)岁， t=10.34，P<0.01］糖尿病比例更高 |
| 英文摘要: |
| Objective To construct a nomogram model for predicting malignant arrhythmia in ST-segment elevation myocardial in-farction (STEMI) patients after percutaneous coronary intervention (PCI) and to validate the accuracy of the model.Methods Sampleswere selected from all STEMI patients who underwent PCI at the Second Affiliated Hospital of Shaanxi University of Traditional Chi-nese Medicine between January 2020 and January 2023. All participants were followed up for six months. Based on the occurrence ofmalignant arrhythmia during follow-up, the subjects were divided into two groups: the malignant arrhythmia group (72 cases) and the non-malignant arrhythmia group (548 cases). Logistic regression analysis was used to identify independent risk factors for malignant ar-rhythmia in STEMI patients after PCI, and a nomogram model was constructed based on these findings. The Bootstrap method was em-ployed for internal validation of the model's accuracy. The predictive performance of the clinical model was evaluated using the receiv-er operating characteristic curve(ROC curve), and its practical application value was assessed using decision curve analysis (DCA).Re. sults Compared with the non-malignant arrhythmia group (n=548), the malignant arrhythmia group (n=72) had higher age [(68.65± 6.87)years vs. (60.76±5.98)years, t=10.34, P<0.01], a higher prevalence of diabetes (59.7% vs. 37.2%,χ2=13.44, P<0.01), more patients with preoperative Killip class 3-4 (52.8% vs. 29.6%,χ2=15.70, P<0.01), more postoperative TIMI flow ≤2 (33.3% vs. 16.2%,χ2=12.48, P <0.01), longer onset-to-PCI time [(7.65±1.87)h vs. (6.78±1.26)h, t=5.16, P<0.01], and higher white blood cell counts [(13.87±2.35)×10./ L vs. (10.56±2.74)×10./L, t=11.01, P<0.01]. Moreover, LVEF was lower [(49.54±6.92)% vs. (51.34±6.60)%, t=.2.10, P=0.039], while LDL-C [(3.79±0.98)mmol/L vs. (3.55±0.90)mmol/L, t=2.04, P=0.045], BNP [(305.31±66.37)ng/L vs. (287.81±68.69)ng/L, t=2.10, P= 0.039], and cTnI [(0.75±0.04)μg/L vs. (0.74±0.04)μg/L, t=2.08, P=0.040] were higher in the malignant arrhythmia group. Multivariableanalysis identified postoperative TIMI flow grade, age, diabetes, preoperative Killip class, white blood cell count, and onset-to-PCI time as independent risk factors. The nomogram showed good discrimination [AUC=0.89, 95%CI:(0.72, 0.93)] and internal validation [C-in-dex=0.88, 95%CI:(0.82, 0.92)] with good calibration; decision curve analysis demonstrated net clinical benefit across a broad threshold range.Conclusions The study demonstrates that postoperative TIMI flow grade, age, history of diabetes, preoperative Killip classifica-tion, white blood cell count, and time from symptom onset to PCI are significant independent risk factors for malignant arrhythmia inSTEMI patients after PCI. The constructed nomogram model effectively predicts the clinical outcomes of such patients and holds sub-stantial clinical applicability. |
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