急性冠状动脉综合征合并糖尿病患者经皮冠状动脉介入术后临床结局风险预测模型的建立与验证  

Establishment and validation of a risk prediction model for clinical outcomes after percutaneous coronary intervention in patients with acute coronary syndrome and diabetes

作　　者：孙红言 朱莉 孙兆青[1] 张贺[1] 汤蕙霞 SUN Hong-yan;ZHU Li;SUN Zhao-qing;ZHANG He;TANG Hui-xia(Rehabilitation Medicine Centre,Shengjing Hospital,China Medical University,Shenyang 110022,China)

机构地区：[1]中国医科大学附属盛京医院康复医学中心,辽宁省沈阳市110022

出　　处：《中国心血管病研究》2024年第2期161-166,共6页Chinese Journal of Cardiovascular Research

基　　金：国家重点研发计划项目资助(2018YFC1311600);中国医科大学附属盛京医院主任基金项目(M0079)。

摘　　要：目的建立一个风险预估模型用于预测接受经皮冠状动脉介入治疗的急性冠状动脉综合征合并糖尿病患者的主要不良心血管事件(MACE)发生风险。方法回顾性选取2018年5月至2020年12月期间中国医科大学附属盛京医院心血管内科收治的672例急性冠状动脉综合征合并糖尿病患者,采用系统抽样法将患者分为建模组(75%)及验证组(25%),通过LASSO回归分析来确定潜在的危险因素,通过逻辑回归分析以确定独立危险因素,从而建立预测模型。受试者工作特征曲线下面积用于评估模型的判别能力,校准曲线用于模型的校准,另外通过决策曲线分析用于评估模型的临床有效性。结果122例患者(18.15%)发生了MACE,其中建模组和验证组分别为82例(16.27%)和40例(23.81%)。最后,确定了年龄、左心室射血分数、支架置入枚数、甘油三酯-葡萄糖指数和冠状动脉病变支数五个变量来构建模型,建模组和验证组的受试者工作特征曲线下面积值分别为0.812和0.803,表明该模型具有很好的区分能力。此外,校准和决策曲线分析表明,该模型分别具有较高的准确性和临床价值。结论年龄、左心室射血分数、支架置入枚数、甘油三酯-葡萄糖指数和冠状动脉病变支数是与接受冠状动脉介入术的急性冠状动脉综合征合并糖尿病患者发生不良心血管事件相关的独立危险因素。该模型可指导此类患者的精准治疗,并有助于临床早期干预,从而预防不良心血管事件的发生进而改善患者预后。Objective To develop a risk prediction model for predicting the occurrence of the major adverse cardiovascular events(MACE)in patients with acute coronary syndrome and diabetes after percutaneous coronary intervention.Methods A total of 672 patients with acute coronary syndrome and diabetes admitted to the Cardiovascular Department of Shengjing Hospital,China Medical University between May 2018 and December 2020 were selected and divided into modeling group(75%)and validation group(25%)with systematic sampling method.Clinical data were collected retrospectively.The clinical characteristics and serum biomarkers were used for further analyses by LASSO regression analysis to identify the potential risk factors and by logistic regression analysis to identify the independent risk factors for the predictive modelling.The area under the subject operating characteristic curve was used to assess the discriminatory power of the model;calibration curves were used for calibration of the model;and decision curve analysis was used to assess the clinical validity of the model.Results MACE occurred in 122 patients(18.15%),including 82(16.27%)and 40(23.81%)in the modelling and validation group,respectively.Five variables,including the age,left ventricular ejection fraction,stent placement,triglyceride-glucose index and vessel stenosis,number were identified to construct the model,and the values of the area under the curve of the working characteristics of the subjects in the modelling and validation group were 0.812 and 0.803,respectively,which demonstrated that the model had a very good discriminatory power.In addition,calibration and decision curve analyses indicated that the model had high accuracy and clinical value,respectively.Conclusions Age,left ventricular ejection fraction,stent placement,triglyceride-glucose index,and vessel stenosis are independent risk factors associated with adverse cardiovascular events in patients with acute coronary syndromes combined with diabetes who undergo coronary intervention.This model may

关 键 词：经皮冠状动脉介入治疗 急性冠状动脉综合征 糖尿病 不良心血管事件 风险模型 

分 类 号：R541.4[医药卫生—心血管疾病]