急性心肌梗死PCI术后并发心力衰竭的列线图预测模型研究  

Study of nomogram prediction model of heart failure after PCI in acute myocardial infarction

作　　者：周成龙 金先银[1] 赵军[1] 宁厚桂[1] 张晓明 任超 刘莉美[1] 周立红 刘丽娜 ZHOU Cheng-long;JIN Xian-yin;ZHAO Jun;NING Hou-gui;ZHANG Xiao-ming;REN Chao;LIU Li-mei;ZHOU Li-hong;LIU Li-na(Department of Emergency,People's Hospital of Huaibei City,Huaibei,Anhui,235100,China)

机构地区：[1]淮北市人民医院急诊科,安徽淮北235100

出　　处：《心血管康复医学杂志》2022年第5期586-590,共5页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:探讨急性心肌梗死(AMI)经皮冠状动脉介入(PCI)术后并发心衰的风险因素,并建立列线图预测模型。方法:选择本院收治的行急诊PCI术治疗的208例AMI患者,根据术后12个月内是否并发心衰分为心衰组(62例)与无心衰组(146例)。采用多因素Logistic回归性分析法分析AMI患者PCI术后并发心衰的影响因素,并建立列线图预测模型。结果:多因素Logistic回归性分析显示,年龄>60岁、多支病变血管、前壁梗死、Gensini评分>40分、高血压、糖尿病、入院时左室射血分数(LVEF)<45%、心肌肌钙蛋白I(cTnI)≥2.0ng/ml、肌酸激酶同工酶(CK-MB)≥50U/L、氨基末端B型脑钠肽前体(NT-proBNP)≥1800ng/L、高敏C反应蛋白(hsCRP)≥15.00mg/L、血运重建不完全及室壁运动幅度丧失均是AMI患者PCI术后并发心衰的独立危险因素(OR=2.593~7.622,P<0.05或<0.01);基于以上独立危险因素构建AMI患者PCI术后并发心衰的列线图模型,预测发生率与实际发生率基本一致,模型内部验证曲线下面积(AUC)为0.856时,敏感度为87.10%,特异度为76.03%。结论:根据AMI患者PCI后并发心衰的危险因素构建的列线图模型对其术后并发心衰具有较好的预测效能。Objective:To explore risk factors of heart failure(HF)after percutaneous coronary intervention(PCI)in acute myocardial infarction(AMI),and establish a nomogram prediction model.Methods:A total of 208 AMI patients undergoing emergency PCI in our hospital were selected.According to occurrence of HF within 12 months after PCI or not,they were divided into HF group(n=62)and no HF group(n=146).Multivariate Logistic regression was used to analyze influencing factors of HF after PCI in AMI patients,and nomogram prediction model was established.Results:Multivariate Logistic regression analysis indicated that age>60 years,multi-vessel coronary disease,anterior wall infarction,Gensini score>40 scores,hypertension,diabetes mellitus,LVEF<45%,cardiac troponin I(cTnI)≥2.0ng/ml,creatine kinase isozyme(CK-MB)≥50U/L,amino terminal pro B-type brain natriuretic peptide(NT-proBNP)≥1800ng/L,high sensitive C reactive protein(hsCRP)≥15.00mg/L at hospitalization,incomplete revascularization and loss of ventricular wall motion amplitude were independent risk factors for HF after PCI in AMI patients(OR=2.593~7.622,P<0.05 or<0.01).Nomogram model of HF after PCI in AMI patients was established based on the above independent risk factors,and its predicted incidence rate was basically consistent with the actual incidence rate,and the area under the internal validation curve(AUC)of the model was 0.856,sensitivity was 87.10%and specificity was 76.03%.Conclusion:Nomogram model established based on risk factors of HF after PCI in AMI patients possesses good predictive efficacy for HF in these patients.

关 键 词：心肌梗死 血管成形术 气囊 冠状动脉 心力衰竭 

分 类 号：R542.22[医药卫生—心血管疾病]