基于非梗死区心肌全壁运动指数建立主要不良心血管事件发生风险评估模型  

Establishment of a risk assessment model for long-term MACE based on global wall motion index

作　　者：王有鹏[1] 潘轶斌[1] Wang Youpeng;Pan Yibin(Second Ward of Department of Cardiovascular Medicine,Jinhua Central Hospital,Jinhua 321000,Zhejiang Province,China)

机构地区：[1]金华市中心医院心血管内科二区,321000

出　　处：《中华老年心脑血管病杂志》2024年第6期624-627,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：金华市科技计划项目(2023C22447);浙江省基础公益研究计划(LGF21H020003)。

摘　　要：目的研究基于非梗死区心肌全壁运动指数(GWMI)建立急性心肌梗死经皮冠状动脉介入治疗(PCI)术后远期主要不良心血管事件(MACE)发生风险评估模型。方法选取2019年5月至2021年5月金华市中心医院心血管内科二区收治的急性心肌梗死行PCI患者350例,根据随访结果分为MACE组82例和非MACE组268例。采用logistic回归分析远期危险因素,并构建危险因素的回归方程模型,采用ROC曲线分析风险评估模型、全球急性冠状动脉事件注册(GRACE)评分对远期MACE的预测效能。结果MACE组GRACE评分、B型钠尿肽、GWMI明显高于非MACE组,淋巴细胞、血红蛋白及血运重建比例明显低于非MACE组,差异有统计学意义(P<0.05,P<0.01)。ROC曲线分析显示,GWMI预测MACE的截断值为1.04,曲线下面积为0.747(95%CI:0.678~0.815)。多因素logistic回归分析显示,B型钠尿肽、GWMI为MACE发生的危险因素,淋巴细胞、血红蛋白、血运重建为MACE发生的保护因素(P<0.05,P<0.01)。建立风险评估模型的回归方程,结果显示,风险评估模型、GRACE评分预测MACE的曲线下面积分别为0.903(95%CI:0.862~0.952)、0.757(95%CI:0.692~0.822)。结论非梗死区GWMI是急性心肌梗死PCI术后远期MACE的影响因素,基于非梗死区GWMI建立的风险评估模型可有效预测远期MACE发生风险。Objective To construct a risk assessment model for long-term MACE after PCI in acute myocardial infarction(AMI)patients based on global wall motion index(GWMI).Methods A total of 350 AMI patients undergoing PCI in our hospital from May 2019 to May 2021 were enrolled,and according to whether MACE occurred during follow-up period,they were divided into MACE group(82 cases)and non-MACE group(268 cases).Logistic regression analysis was used to identify the long-term risk factors,and a regression model of risk factors was constructed.Receiver operating characteristic(ROC)curve analysis was applied to evaluate and compare the predictive efficacy of our risk assessment model and Global Registry of Acute Coronary Events(GRACE)score for long-term MACE.Results The MACE group had significantly higher GRACE score,GWMI and B-type natriuretic peptide(BNP)level,and lower lymphocyte count,hemoglobin level and revascularization ratio than the non-MACE group(P<0.05,P<0.01).ROC curve analysis showed that the cutoff value of GWMI for predicting MACE was 1.04,and the AUC value was 0.747(95%CI:0.678-0.815).Multivariate logistic regression analysis indicated that BNP and GWMI were risk factors for MACE,while lymphocyte count,hemoglobin,and revascularization were protective factors for MACE(P<0.05,P<0.01).The regression equation for risk assessment model revealed that the AUC value in predicting MACE was 0.903(95%CI:0.862-0.952)for our risk assessment model and 0.757(95%CI:0.692-0.822)for GRACE score.Conclusion GWMI is an influencing factor for long-term MACE after PCI in AMI patients.A risk assessment model based on GWMI can effectively predict the risk of long-term MACE.

关 键 词：心肌梗死 经皮冠状动脉介入治疗 风险评估与减低 室壁运动异常指数 主要不良心血管事件 

分 类 号：R542.22[医药卫生—心血管疾病]