基于fQRS波构建的列线图模型对急性前壁ST段抬高型心肌梗死PCI术后近期MACE的预测价值  

Predictive Value of fQRS Based Nomogram Model for Short-term MACE after PCI in Acute Anterior ST-segment Elevation Myocardial Infarction

作　　者：孙慧荣[1] 柯志强[2] 王艺烨 王欢 王曲解 SUN Huirong;KE Zhiqiang;WANG Yiye;WANG Huan;WANG Qujie(Xianning Central Hospital,First Affiliated Hospital of Hubei University of Science and Technology,Xianning 437100,Hube,China)

机构地区：[1]湖北科技学院附属第一医院,咸宁市中心医院,湖北咸宁437100 [2]湖北科技学院医学部医药研究院,糖尿病与心脑血管病变湖北省重点实验室,湖北咸宁437100

出　　处：《中西医结合心脑血管病杂志》2023年第7期1255-1260,共6页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：湖北省教育厅科学研究计划指导性项目(No.B2021224);咸宁市中心医院,湖北科技学院附属第一医院科研基金资助项目(No.2020XYB005)。

摘　　要：目的:构建基于体表心电图的碎裂QRS(fQRS)波列线图模型,评估该模型对急性前壁ST段抬高型心肌梗死行经皮冠状动脉介入治疗(PCI)术病人近期发生主要心脑血管不良事件(MACE)的预测价值。方法:回顾性选取2017年8月—2020年7月于湖北科技学院附属第一医院急诊行PCI术的急性前壁ST段抬高型心肌梗死病人218例的临床资料。根据入院时心电图是否存在fQRS波分为fQRS波组(69例)和非fQRS波组(149例);根据病人PCI术后12个月内是否发生MACE事件分为MACE组(98例)和非MACE组(120例)。采用LASSO与多因素Logistic回归分析法分析fQRS波与急性前壁ST段抬高型心肌梗死PCI术后病人12个月内发生MACE的相关性,并评估其独立危险因素,通过R语言构建基于fQRS波的列线图模型并对该模型进行验证。结果:fQRS波组MACE发生情况较非fQRS波组高(P<0.05)。单因素分析结果显示,MACE组与非MACE组左心室舒张末期内径(LVEDD)、左室射血分数(LVEF)、左心室收缩末期内径(LVESD)及氨基末端脑利钠肽前体(NT-proBNP)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油、心肌肌钙蛋白I(cTnI)比较,差异均有统计学意义(P<0.05)。LASSO结合多因素Logistics回归分析显示,血红蛋白浓度、LVEF与MACE发生呈负相关(P<0.05),NT-proBNP、fQRS波、白细胞计数、三酰甘油与MACE发生呈正相关(P<0.05)。受试者工作特征(ROC)曲线显示,列线图预测MACE发生风险的曲线下面积(AUC)为0.85,95%CI(0.73,0.91);采用Bootstrap方法重复抽样1000次验证列线图,校准曲线的平均绝对误差为0.019,说明校准曲线与理想曲线贴合良好;且临床决策曲线显示,当MACE的发生阈值为0.08~0.88时该模型图的适用性佳。结论:基于体表心电图的碎裂QRS波构建的列线图模型能较好地预测急性前壁ST段抬高型心肌梗死行PCI术治疗病人近期发生MACE的风险,具有较好的临床适用性。Objective:To construct the fragmented QRS complex(fQRS complex)nomogram model based on body surface electrocardiogram,and evaluate the prediction value of this model for the short-term major cardiovascular and cerebrovascular adverse events(MACE)in patients with acute anterior ST-segment elevation myocardial infarction after percutaneous coronary intervention(PCI).Methods:Clinical data of 218 patients with acute anterior ST-segment elevation myocardial infarction were retrospectively selected and divided into fQRS group(69 cases)and non-FQRs group(149 cases)according to the presence or absence of fQRS in ECG at admission.Patients were divided into MACE group(98 cases)and non-MACE group(120 cases)according to the occurrence of MACE events within 12 months after PCI.LASSO and multivariate Logistic analysis were used to analyze the correlation between fQRS complex and MACE in patients with acute anterior ST-segment elevation myocardial infarction within 12 months after PCI,and to evaluate its independent risk factors.A nomogram model based on fQRS wave was constructed by R language,and the model was verified.Results:The incidence of MACE in fQRS group was more than that in non-FQRS group(P<0.05).The left ventricular end-diastolic inner diameter(LVEDD),left ventricular ejection fraction(LVEF),left ventricular end-systolic inner diameter(LVESD),amino terminal natriuretic peptide precursor(NT-proBNP),high density lipoprotein,triacylglycerol,and cardiac troponin I(cTnI)between the MACE group and the non-MACE group were statistically significant differences(P<0.05).LASSO analysis combined with multivariate Logistics regression analysis showed that hemoglobin concentration and LVEF were negatively correlated with the occurrence of MACE(P<0.05),while NT-proBNP,fQRS wave,white blood cell count and triacylglycerol were positively correlated with the MACE(P<0.05).ROC curve showed that the graph had a strong ability to predict the risk of MACE,and the area under ROC curve(AUC)was 0.85,95%CI(0.73,0.91).The average absolute erro

关 键 词：急性ST段抬高型心肌梗死 心电图 碎裂QRS波 主要心血管不良事件 预后 

分 类 号：R542.22[医药卫生—心血管疾病]