冠心病合并心房颤动患者PCI术后出血风险预测列线图的构建及验证  

The construct and testing of prognostic nomogram concerning bleeding after percutaneous coronary intervention in patients with coronary disease combined with atrial fibrillation

作　　者：赵忠平[1] 丁晓云[1] 罗正义[1] Zhao Zhongping;Ding Xiaoyun;Luo Zhengyi(Cardiology department,the People’s Hospital of Rugao City,Rugao 226500,China)

机构地区：[1]江苏如皋市人民医院心血管内科,226500

出　　处：《心脑血管病防治》2020年第6期553-556,共4页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

摘　　要：目的构建冠心病合并心房颤动患者经皮冠状动脉介入治疗(PCI)术后出血风险预测列线图,并进行验证。方法回顾性纳入2017年6月至2019年6月间于如皋市人民医院行PCI术的冠心病合并心房颤动患者243例,主要观察指标为PCI术后半年发生出血的患者和未出血患者的年龄、血肌酐(Cr)、PCI路径等术后临床资料,采用Logistic多因素回归对促成出血的相关因素进行分析,应用R软件建立影响因素列线图预测模型,并进行验证。结果因资料不全排除15例后共纳入患者228例;出血患者年龄和Cr水平高于未出血患者(t=5.903、6.029,P<0.05),出血患者桡动脉路径例数、应用新型口服抗凝药(NOAC)例数、左室射血分数(LVEF)均低于未出血患者(χ^2=5.612、6.026,t=-3.005,P<0.05)。多因素Logistic回归分析显示,年龄和Cr为术后半年内出血的危险因素[OR(95%CI)=1.188(1.096~1.287)、1.056(1.025~1.087),P<0.01],桡动脉路径和NOAC为保护因素[OR(95%CI)=0.216(0.078~0.601)、0.294(0.104~0.837),P<0.05]。列线图预测PCI术后出血发生的一致性指数(C-index)为0.915(95%CI=0.874~0.943)。结论年龄、PCI路径、Cr等因素构建的列线图可有效预测冠心病合并心房颤动患者PCI术后半年内出血情况,具有良好的临床应用价值。Objective To construct prognostic nomogram concerning bleeding after percutaneous coronary intervention(PCI)in patients with coronary disease combined with atrial fibrillation and test it.Methods 243 patients with coronary disease combined with atrial fibrillation treated by PCI in the people’s hospital of Rugao city from June 2017 to June 2019 were retrospective analyzed.Clinical data such as age,creatinine(Cr),PCI pathway of bleeding patients and non-bleeding patients within half a year after PCI were primary observed indicators.Logistic multivariate regression was used to analyze the factors contributing to bleeding,prognostic nomogram of risk factors was constructed by R software,and it was tested.Results 228 cases were employed finally after 15 cases were eliminated because of incomplete information.Age and the level of Cr in bleeding patients were higher than those in the non-bleeding patients(t=5.903,6.029;P<0.05).Cases of radial artery access and use of novel oral anticoagulants(NOAC),left ventricular ejection fraction(LVEF)in bleeding patients were lower than those in the non-bleeding patients(χ2=5.612,6.026;t=-3.005;P<0.05).Logistic regression showed that age and Cr[OR(95%CI)=1.188(1.096-1.287),1.056(1.025-1.087);P<0.01]were risk factors of bleeding after PCI within half a year,radial artery access and NOAC[OR(95%CI)=0.216(0.078-0.601),0.294(0.104-0.837);P<0.05]were the protective factors.The consistency index(C-index)of nomogram for predicting the occurrence of bleeding after PCI was 0.915(95%CI=0.874-0.943).Conclusion Nomogram consist of age,PCI pathway,Cr,etc.can effectively predict bleeding within half a year after PCI in patients with coronary disease combined with atrial fibrillation,which has good clinical value.

关 键 词：冠心病 心房颤动 列线图 出血 

分 类 号：R541.4[医药卫生—心血管疾病] R541.75[医药卫生—内科学]