严重冠状动脉钙化病变患者行冠状动脉旋磨术后远期预后预测模型建立与评价  

To establish and evaluate a long-term prognosis prediction model for patients with severe coronary artery calcification after rotational atherectomy

作　　者：王仁辉 于子翔[1] 程琦 娜孜拉·亚利钦 李晓梅[1] 马依彤[1] WANG Ren-hui;YU Zi-xiang;CHENG Qi;Nazira YALIQIN;LI Xiao-mei;MA Yi-tong(First Department of Coronary heart Disease,Heart Center,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院心脏中心冠心病一科,新疆维吾尔自治区乌鲁木齐市830054

出　　处：《中国心血管病研究》2024年第5期433-440,共8页Chinese Journal of Cardiovascular Research

基　　金：新疆维吾尔自治区天山英才计划项目(TSYC202301B010);新疆维吾尔自治区天山英才领军计划项目(2022TSYCLJ0001)。

摘　　要：目的探讨严重冠状动脉钙化(CAC)病变患者在行冠状动脉旋磨术(RA)后远期主要心脑血管不良事件(MACCE)发生的危险因素,据此构建严重CAC病变患者行RA后远期MACCE发生的预测模型。方法回顾性分析2012年7月至2022年8月在新疆医科大学第一附属医院接受RA的严重CAC病变的冠心病患者共245例,中位随访时间49(28.0,70.5)个月,根据随访期间是否发生MACCE将研究对象分为MACCE组(61例)和非MACCE组(184例)。采用Lasso回归和多因素Cox回归分析确定严重CAC病变患者RA后远期MACCE发生的独立危险因素,在此基础上构建预测模型并对模型进行评价。结果Cox回归分析结果表明,发生院内MACCE、糖化血红蛋白和N末端B型利钠肽原(NT-proBNP)是严重CAC病变患者行RA后远期MACCE发生的独立危险因素。建立Nomogram模型,模型的C-index为0.697,术后3年、4年和5年的接受者操作特性曲线(ROC)下面积分别为0.698、0.730和0.703,表明模型的预测准确性较好。校准图结果表明该模型预测风险与实际发生风险的一致性较好。临床决策曲线分析(DCA)结果显示,列线图模型具有较好的临床适用性。结论本研究建立的预测模型可以较好地评估严重CAC病变患者行RA后远期MACCE发生的危险程度,可以帮助临床医师筛选高危患者,制定个体化治疗,改善患者预后。Objective To investigate the efficacy of Rotational Atherectomy in patients with severe coronary artery calcification(CAC)lesions.The risk factors of long-term major adverse cardiovascular and cerebrovascular events(MACCE)in patients with severe CAC lesions after RA were analyzed,and the prediction model of long-term MACCE in patients with severe CAC lesions after RA was constructed.Methods A total of 245 patients with severe CAC lesions who underwent RA in the First Affiliated Hospital of Xinjiang Medical University from July 2012 to August 2022 were retrospectively analyzed.The median follow-up time was 49(28.0,70.5)months.The patients were divided into the MACCE group(61 cases)and the non-MACCE group(184 cases)according to whether MACCE occurred during the follow-up period.Lasso regression and multivariate Cox regression analysis were used to determine the independent risk factors for long-term MACCE after RA in patients with severe CAC lesions,and the prediction model was constructed and evaluated on this basis.Result The results of Cox regression analysis showed that the incidence of in-hospital MACCE,glycosylated hemoglobin and N-terminal B-type brain natriuretic peptide(NT-proBNP)is an independent risk factor for long-term MACCE in patients with severe CAC lesions after RA.The C-index of Nomogram model was 0.697,and the Receiver Operating Characteristic curve of 3,4 and 5 years after operation was calculated.The area under the receiver operating characteristic(ROC)was 0.698,0.730 and 0.703,respectively,indicating that the prediction accuracy of the model was good.The calibration chart results showed that the predicted risk of the model was in good agreement with the actual risk.Decision Curve Analysis(DCA)showed that the nomogram model had good clinical applicability.Conclusions The predictive model established in this study can effectively evaluate the risk of long-term MACCE in patients with severe CAC lesions after RA,which can help clinicians to screen high-risk patients and formulate individualized tr

关 键 词：冠状动脉斑块旋磨术 冠状动脉钙化 主要心脑血管不良事件 预测模型 

分 类 号：R541.4[医药卫生—心血管疾病]