急性ST段抬高型心肌梗死患者直接PCI术后院内死亡风险预测模型的建立和验证  

Establishment and validation of prediction model of in-hospital mortality risk in patients with acute ST-segment elevation myocardial infarction after primary percutaneous coronary intervention

作　　者：李其华[1] 易秋艳[1] 徐广纳 王晓迪 陈宇[1] 陈见红[1] 韦红卫[1] Li Qihua;Yi Qiuyan;Xu Guangna;Wang Xiaodi;Chen Yu;Chen Jianhong;Wei Hongwei(Department of General Medicine,People's Hospital of Liuzhou City,Guangxi Province,Liuzhou 545006,China;不详)

机构地区：[1]广西柳州市人民医院全科医学科,柳州545006

出　　处：《中国循证心血管医学杂志》2022年第12期1470-1475,共6页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：广西壮族自治区卫生健康委员会自筹经费科研项目(Z20190141)。

摘　　要：目的 探讨急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PCI)术后院内死亡危险因素,建立风险预测模型并进行验证。方法 将2015年1月至2018年4月于柳州市人民医院心血管内科诊断STEMI并行直接PCI的480例患者进行回顾性分析(建模组),记录相关临床资料,包括年龄、性别、吸烟史、高血压病史、糖尿病史、血脂异常史、冠心病史、陈旧性心肌梗死(OMI)病史、PCI史、脑血管病史、肾功能不全病史、入院收缩压、舒张压、脉压差、心率、梗死部位、恶性室性心动过速或心室颤动发生情况、入院Killip功能分级、再灌注时间、严重冠状动脉(冠脉)病变支数、慢复流/无复流发生情况、支架内血栓发生情况、心肌钙蛋白Ⅰ(cTnI)、肌酸激酶同工酶(CK-MB)、入院血糖、空腹血糖、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油(TG)、超敏C反应蛋白(hs-CRP)、N末端脑钠肽前体(NT-proBNP)、血肌酐(Cr)、白细胞计数(WBC)、血红蛋白(Hb),以及是否发生院内死亡。通过单因素和多因素回归分析筛选出与发生死亡相关的独立危险因素,建立风险预测模型,采用Hosmer-Lemeshow(H-L)拟合优度检验和受试者工作特征(ROC)曲线对该模型进行评估。另收集2018年4月至2019年6月于柳州市人民医院心血管内科诊断STEMI并行直接PCI的108例患者临床资料(验模组),验证本模型的预测价值。结果 建模组患者院内死亡16例(3.3%),生存464例(96.7%),将建模组患者分为院内死亡组和存活组,单因素分析结果显示,院内死亡组患者年龄大于存活组,恶性室性心动过速或心室颤动发生率、入院Killip泵功能分级≥3级发生率、3支严重冠脉病变发生率、支架内血栓发生率、入院cTnI、CK-MB、入院血糖、空腹血糖、hsCRP、NT-pro BNP、Cr高于存活组,脉压差、TG、Hb低于存活组,差异有统计学意义(Objective To investigate the risk factors of in-hospital mortality in patients with acute STsegment elevation myocardial infarction(STEMI) after primary percutaneous coronary intervention(pPCI), establish and validate the risk prediction model. Methods STEMI patients undergone pPCI(n=480) were chosen into modeling group from Department of Cardiovascular Medicine in People’s Hospital of Liuzhou City from Jan. 2015to Apr. 2018. The clinical materials were recorded, including age, gender, histories of smoking, hypertension,diabetes, dyslipidemia, coronary heart disease(CHD), old myocardial infarction(OMI), PCI, cerebrovascular diseases and renal insufficiency, hospitalized systolic blood pressure(SBP), diastolic blood pressure(DBP), pulse pressure(PP), heart rate(HR), infarction sites, malignant ventricular tachycardia(VT) or ventricular fibrillation(VF), Killip classification, reperfusion time, number of severe coronary lesion vessels, slow/no reflow, in-stent thrombosis, cardiac troponin I(cTnI), creatine kinase isoenzyme(CK-MB), blood sugar, fasting plasma glucose(FPG), total cholesterol(TC), low-density lipoprotein-cholesterol(LDL-C), high-density lipoprotein-cholesterol(HDL-C), triglyceride(TG), high-sensitivity C-reactive protein(hs-CRP), N-terminal pro-brain natriuretic peptide(NT-proBNP), serum creatinine(SCr), white blood cell count(WBC), hemoglobin(Hb), and whether in-hospital mortality occurred or not. The independent risk factors related to death were screened by using single-factor and multi-factor regression analysis, and the risk prediction model was established. The model was evaluated by using Hosmer-Lemeshow(H-L) goodness-of-fit test and receiver operating characteristic(ROC) curve. In addition, the clinical materials were collected from STEMI patients undergone pPCI(validation group, n=108) from Department of Cardiovascular Medicine in People’s Hospital of Liuzhou City from Apr. 2018 to June 2019. Results There were 16 patients(3.3%) died in hospital and 464 patients(96.7%) survived in modelin

关 键 词：急性ST段抬高型心肌梗死 直接经皮冠状动脉介入 院内死亡 风险预测模型 

分 类 号：R542.22[医药卫生—心血管疾病]