冠心病多支血管病变患者不完全血运重建预后不良预测模型的建立  

Development of a predictive model for poor prognosis of multivessel coronary artery disease patients with incomplete revascularization

作　　者：连欢 赵卓妍 王艳芳 张皓然[1] 丁振江[1] 张英[1] LIAN Huan;ZHAO Zhuo-yan;WANG Yan-fang;ZHANG Hao-ran;DING Zhen-jiang;ZHANG Ying(Department of Cardiology,the Affiliated Hospital of Chengde Medical College,Chengde 067000,China)

机构地区：[1]承德医学院附属医院心脏内科,河北承德067000

出　　处：《中国介入心脏病学杂志》2023年第2期95-103,共9页Chinese Journal of Interventional Cardiology

摘　　要：目的构建冠心病(CHD)多支血管病变(MVD)患者不完全血运重建(ICR)术后预后不良的预测模型。方法回顾性收集2020年1月至2021年5月在承德医学院附属医院行冠状动脉造影示MVD且经皮冠状动脉介入治疗(PCI)术后ICR患者的临床资料,按照出院时间顺序,将符合入选条件的受试者757例分为训练集530例(70.0%)与验证集227例(30.0%),纳入单因素Logistic回归分析中P<0.2的变量进行多因素Logistic回归分析,按照赤池信息准则(AIC)选取最优Logistic回归模型构建MVD患者ICR术后预后不良的预测模型。采用受试者工作特征(ROC)曲线下面积(AUC)验证及评估该模型的区分能力,并绘制校准曲线和决策曲线分析(DCA)曲线对该模型的校准度、临床净获益及实用性进行评估。结果用于预测MVD患者ICR术后预后不良预测模型的预测因子包括:尿酸、女性、年龄、PCI术前罪犯血管心肌梗死溶栓治疗试验血流分级、糖耐量异常、非结合胆红素。训练集与验证集的ROC的AUC分别为0.645、0.690。训练集与验证集校准曲线的Hosmer-Lemeshow检验的统计值分别为8.97(P=0.535)、16.45(P=0.087)。DCA曲线显示当主要不良心血管事件的风险阈值在0.10~0.70时本模型临床适用。结论本研究构建了用于预测MVD患者ICR术后预后不良的预测模型,该预测模型的预测能力、校准能力和临床净获益良好,能够作为临床早期预测MVD患者ICR术后预后不良的有效工具。Objective To construct a predictive model in coronary heart disease(CHD)patients with multivessel coronary artery disease(MVD)after incomplete revascularization(ICR)for poor prognosis.Methods The clinical data were retrospectively collected from January 2020 to May 2021 underwent coronary angiography and ICR after percutaneous coronary intervention(PCI)in the Affiliated Hospital of Chengde Medical College.According to inclusion criteria,757 subjects were included and were divided into validation set(30.0%,n=227)and training set(70.0%,n=530)according to the discharge time sequence,the interfering factors with P<0.2 in univariate Logistic analysis were included in multivariate Logistic regression for analysis.The optimal logistic regression model was selected according to the Akaike information criterion(AIC)to construct the predictive model of poor prognosis of ICR in patients with MVD.Using area under the receiver operating characteristic(AUROC)to verify and evaluate the discriminatory power of the model,and calibration curve and decision curve analysis(DCA)were drawn to estimate the calibration degree,clinical net income and practicability of the model.Results The predictive factors used to predict the poor prognosis of patients with MVD after ICR included uric acid,female,age,TIMI blood flow classification of criminal vessels before PCI,impaired glucose toleranceand,and unconjugated bilirubin.The AUROC of training set was 0.645,and validation set was 0.690.The statistical value of HosmerLemeshow test of calibration curve of training set and validation set were 8.97(P=0.535)and 16.45(P=0.087)respectively.DCA curve showed that this model was clinically applicable when the predictive probability value of MACE is between 0.10 and 0.70.Conclusions In this study,a predictive model for predicting the poor prognosis of patients with MVD after ICR was constructed.The predictive model has good predictive ability,calibration ability,and clinical net benefit.It can be used to predict the poor prognosis of patients with MVD

关 键 词：冠心病 经皮冠状动脉介入治疗 多支血管病变 不完全血运重建 预测模型 

分 类 号：R541[医药卫生—心血管疾病]