构建预测模型预测老年STEMI患者PCI术后3年内主要不良心血管事件的发生风险  

Development of a predictive model for the risk of major adverse cardiovascular events in elderly STEMI patients receiving PCI within 3 years

作　　者：张子龙[1] 沈鑫[1] 何林龙 王钊[1] 高方明[1] 李国庆[1] ZHANG Zi-long;SHEN Xin;HE Lin-long;WANG Zhao;GAO Fang-ming;LI Guo-qin(Department of Cardiovascular Medicine,Xinjiang Uygur Autonomous Region People′s Hospital,Urumuqi 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院心血管内科,新疆乌鲁木齐830001

出　　处：《海南医学院学报》2021年第11期827-833,共7页Journal of Hainan Medical University

基　　金：新疆维吾尔自治区自然科学基金资助项目(2020D01C107)。

摘　　要：目的:构建与验证1个可预测接受冠心病介入治疗(pecutaneous coronary intervention,PCI)的老年ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者3年内发生主要不良心血管事件风险的预测模型。方法:本研究为一项回顾性队列研究,将1745例研究对象按照3∶1的比例随机分为建模队列与验证队列。应用LASSO回归模型与多因素Cox回归分析接受了PCI治疗的老年STEMI患者3年内发生主要不良心血管事件风险的独立危险因素。应用R软件(3.5.3版)构建预测接受了PCI治疗的老年STEMI患者3年内发生主要不良心血管事件风险的列线图模型,并对该模型进行比较与验证。结果:LASSO回归模型与多因素Cox回归分析结果示,年龄、糖尿病病史、心房颤动病史、心功能分级、冠脉造影结果和GRACE风险评分是接受了PCI治疗的老年STEMI患者3年内发生主要不良心血管事件风险的独立危险因素。对该预测模型进行内部和外部的验证,建模队列中AUC值为0.890(95%CI:0.856~0.924);验证队列中AUC值为0.861(95%CI:0.830~0.957)。Hosmer-Lemeshow检验结果提示该预测模型具有良好稳定性。结论:本研究中简单、易用的列线图模型可以有效地预测接受了PCI治疗的老年STEMI患者3年内发生主要不良心血管事件的个体化风险。Objective:To develop and validate a predictive model for the risk of major adverse cardiovascular events(MACEs)in elderly patients with ST-segment elevation myocardial infarction(STEMI),undergoing pecutaneous coronary intervention(PCI)within 3 years.Methods:This study is a retrospective cohort study,in which 1745 subjects were randomly divided into the modeling cohort and the verification cohort according to a ratio of 3∶1.LASSO regression model and multivariate Cox regression were used to analyze independent risk factors.R software(version 3.5.3)was used to construct a nomogram model to predict the risk,and the efficiency of this model was verified.Results:The results of LASSO regression model and multivariate Cox regression analysis showed that age,history of diabetes,history of atrial fibrillation,cardiac function classification,coronary angiography results,and GRACE risk score were the independent risk factors.The prediction model was verified internally and externally.The AUC value in the modeling cohort was 0.890(95%CI:0.856-0.924);the AUC value in the verification cohort was0.861(95%CI:0.830-0.957).The Hosmer-Lemeshow test indicated that the prediction model had a good stability.Conclusion:The simple nomogram model in this study can effectively predict the individualized risk of MACEs in elderly STEMI patients undergoing PCI treatment within 3 years.

关 键 词：老年人 ST段抬高型心肌梗死 队列研究 预测模型 

分 类 号：R542.22[医药卫生—心血管疾病]