| 杨程文,谭宜娜,成元志,等.ST段抬高型心肌梗死病人经皮冠状动脉介入治疗术后主要不良心血管事件的列线图模型建立和验证[J].安徽医药,2026,30(9):1787-1793. |
| ST段抬高型心肌梗死病人经皮冠状动脉介入治疗术后主要不良心血管事件的列线图模型建立和验证 |
| events after percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction |
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| DOI：10.3969/j.issn.1009-6469.2026.09.017 |
| 中文关键词: ST段抬高型心肌梗死 经皮冠状动脉介入治疗 主要不良心血管事件 多因素分析 列线图 |
| 英文关键词: ST.segment elevation myocardial infarction Percutaneous coronary intervention Major adverse cardiovascular events Multivariate analysis Nomogram |
| 基金项目:中关村国家自主创新示范区“重大前沿原创技术成果转化和产业化”项目( 2019F000G501)；绵阳市卫生健康委 2023年鼓励科研项目( 202327) |
| 作者 | 单位 | E-mail | | 杨程文 | 川北医学院附属三台医院、三台县人民医院,心血管内科,四川绵阳 621100 | | | 谭宜娜 | 川北医学院附属三台医院、三台县人民医院,胸心外科,四川绵阳 621100 | | | 成元志 | 川北医学院附属三台医院、三台县人民医院,心血管内科,四川绵阳 621100 | 13795764647@163.com | | 周立远 | 川北医学院附属三台医院、三台县人民医院,心血管内科,四川绵阳 621100 | | | 胡家 | 川北医学院附属三台医院、三台县人民医院,心血管内科,四川绵阳 621100 | | | 叶世权 | 川北医学院附属三台医院、三台县人民医院,心血管内科,四川绵阳 621100 | |
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| 中文摘要: |
| 目的分析 ST段抬高型心肌梗死( STEMI)病人经皮冠状动脉介入治疗( PCI)术后主要不良心血管事件( MACE)相关因素，建立其列线图预测模型并进行验证。方法回顾性研究。选择 2018年 1月至 2023年 6月川北医学院附属三台医院接诊的 STEMI病人 633例，以 7∶3比例分为训练集 443例、验证集 190例，收集可能影响 STEMI病人 PCI术后 MACE的相关因素。根据 MACE是否发生将训练集分为两组: MACE组和非 MACE组，比较两组各指标，在单因素分析上行 LASSO回归筛选变量后行多因素 logistic回归分析，再以训练集、验证集进行验证。结果训练集 443例病人中共有 124例( 28.0%)在 PCI术后 12个月内出现 MACE，MACE组与非 MACE组病人的吸烟史［64.52%(80/124)比 47.96%(153/319)］、靶血管前降支占比［58.06%(72/124)比 41.69%(133/319)］、低密度脂蛋白［( 3.53±1.24)mmol/L比( 3.16±1.04)mmol/L］、高密度脂蛋白［( 1.02±0.29)mmol/L比( 1.21± 0.33)mmol/L］、甘油三酯［( 1.94±0.42)mmol/L比( 1.81±0.34)mmol/L］、肌酐［( 73.18±17.04)μmol/L比( 64.91±16.97)μmol/L］、 D-二聚体( D-D)［( 416.92±214.27)μg/L比( 370.06±185.43)μg/L］、 N末端脑钠肽前体( NT-proBNP)［( 3 288.14±1 070.57)ng/L比(2 901.84±917.43)ng/L］、左室射血分数( LVEF)［( 52.87±5.18)%比( 54.21±4.88)%］、血管病变数［( 1.87±0.42)条比( 1.77±0.30)条］、全球急性冠状动脉事件注册( GRACE)评分［( 134.69±16.27)分比( 129.51±13.78)分］，差异有统计学意义( P<0.05)。在 LASSO回归基础上行多因素 logistic回归分析结果显示:吸烟史、低密度脂蛋白、 D-D、NT-proBNP、LVEF、GRACE评分为 STEMI病人 PCI术后 MACE的独立性相关因素( P<0.05)。该研究模型方程为 ln［P(/ 1.P)］=.4.550+0.747×吸烟史 +0.304×低密度脂蛋白+0.001×D-D+0.001×NT-proBNP.0.050×LVEF+0.023×GRACE。受试者操作特征曲线(ROC曲线)结果显示，训练集预测 STEMI病人 PCI术后 MACE的曲线下面积( AUC)为 0.71［95%CI:(0.65，0.76)］灵敏度为 67.7%，特异度为 67.7%；验证集 AUC为 0.70［95%CI:(0.64，0.75)］灵敏度为 74.3%，特异度为 57.3%。校准曲线结果显，示，预测曲线与标准曲线基本拟合， Hosmer-Lemeshow拟合优度检验 χ2=3.58，P，=0.058，提示模型预测准确度较高。决策曲线分析结果显示，当模型预测概率为 0.15~0.90时病人获益率高于所有病人均进行干预及均不进行干预。结论 STEMI病人 PCI术后 MACE的发生与吸烟史、低密度脂蛋白、 D-D、 NT-proBNP、LVEF、GRACE评分有关，基于上述因素建立的列线图模型可用于预测此类病人 MACE的发生风险。 |
| 英文摘要: |
| Objective To analyse the factors associated with major adverse cardiovascular events (MACE) after percutaneous coro.nary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI), and to develop and validate a nomogram prediction model.Methods This retrospective study included 633 STEMI patients admitted to Santai Hospital of North Sichuan Medi.cal College from January 2018 to June 2023. Patients were divided into a training set (443 cases) and a validation set (190 cases) at a 7:3 ratio. Relevant factors potentially affecting the occurrence of MACE after PCI were collected. The training set was further divided intoa MACE group and a non-MACE group based on the occurrence of MACE within 12 months after PCI. After univariate analysis, LASSOregression was used to screen variables, and multivariate logistic regression analysis was performed to identify independent risk factors.The model was then validated in both the training and validation sets.Results Of the 443 patients in the training set, 124 (28.0%) de.veloped MACE within 12 months after PCI. The MACE group had a significantly higher proportion of patients with smoking history[64.52% (80/124) vs. 47.96% (153/319)], a higher proportion of the left anterior descending artery as the target vessel [58.06% (72/124) vs. 41.69% (133/319)], higher levels of low-density lipoprotein [(3.53±1.24) mmol/L vs. (3.16±1.04) mmol/L], triglycerides [(1.94±0.42) mmol/L vs. (1.81±0.34) mmol/L], creatinine [(73.18±17.04) μmol/L vs. (64.91±16.97) μmol/L], D-dimer (D-D) [(416.92±214.27) μg/L vs. (370.06±185.43) μg/L], N-terminal pro-B-type natriuretic peptide (NT-proBNP) [(3 288.14±1 070.57) ng/L vs. (2 901.84±917.43) ng/ L], a greater number of diseased vessels (1.87±0.42 vs. 1.77±0.30), and higher Global Registry of Acute Coronary Events (GRACE) risk scores [(134.69±16.27) points vs. (129.51±13.78) points], and significantly lower levels of high-density lipoprotein [(1.02±0.29) mmol/L vs. (1.21±0.33) mmol/L] and left ventricular ejection fraction (LVEF) [(52.87±5.18)% vs. (54.21±4.88)%] (all P<0.05). Multivariate lo. gistic regression analysis based on LASSO selection showed that smoking history, low-density lipoprotein, D-D, NT-proBNP, LVEF, and GRACE score were independent risk factors for MACE in STEMI patients after PCI (P<0.05). The model equation was: ln[P/(1.P)]= . 4.550+0.747×smoking history+0.304×low-density lipoprotein+0.001×D-D+0.001×NT-proBNP . 0.050×LVEF+0.023×GRACE. Re. ceiver operating characteristic curve (ROC curve) analysis showed that the area under the curve (AUC) for predicting MACE was 0.71[95% CI: (0.65, 0.76)] in the training set, with a sensitivity of 67.7% and specificity of 67.7%, and 0.70 [95% CI: (0.64, 0.75)] in thevalidation set, with a sensitivity of 74.3% and specificity of 57.3%. The calibration curve demonstrated close agreement between pre.dicted and observed probabilities, and the Hosmer-Lemeshow goodness-of-fit test result was χ2=3.58, P=0.058, indicating high predic.tion accuracy. Decision curve analysis showed that the model provided a net benefit when the threshold probability ranged from 0.15 to0.90, compared with the treat-all or treat-none strategies.Conclusions The occurrence of MACE after PCI in STEMI patients is associ. ated with smoking history, low-density lipoprotein, D-D, NT-proBNP, LVEF, and GRACE score. The nomogram model based on thesefactors can be used to predict the risk of MACE in these patients. |
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