ST段抬高型心肌梗死患者PCI术后1年内发生主要不良心血管事件危险因素及列线图预测模型构建  

Risk factors of major adverse cardiovascular events within one year in patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention and establishment of nomogram predictive model

作　　者：孙阳[1] 黎敬锋 李银[1] Sun Yang;Li Jingfeng;Li Yin(Department of Cardiovascular Medicine,First People's Hospital of Chuzhou City,Chuzhou 239000,China;不详)

机构地区：[1]滁州市第一人民医院心血管内科,滁州239000

出　　处：《中国循证心血管医学杂志》2024年第11期1330-1334,1340,共6页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：安徽省滁州市科技计划项目(2021ZD004)。

摘　　要：目的探讨ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术后1年内发生术后主要不良心血管事件(MACE)危险因素及列线图预测模型构建。方法本研究为回顾性研究,选择2022年6月至2024年6月于滁州市第一人民医院完成1年随访的52例行急诊PCI术后发生MACE的STEMI患者作为MACE组。另选取同期52例随访期间未发生MACE患者作为非MACE组。统计并比较两组患者的基线资料。采用Cox回归分析协变量调整前后血常规指标及血清基质金属蛋白酶-9(MMP-9)水平对STEMI急诊PCI术后MACE发生的影响程度,并构建列线图预测模型;采用受试者工作特征(ROC)曲线检验列线图预测模型对STEMI患者急诊PCI术后MACE发生的预测价值。结果MACE组患者平均MACE发生时间为(7.50±2.43)个月。MACE组Gensini评分、术前Killip分级为Ⅲ级、合并高血压、吸烟占比、血清白细胞计数(WBC)、中性粒细胞计数(NEUT)、中性粒细胞/淋巴细胞比值(NLR)、血小板与淋巴细胞比率(PLR)、MMP-9水平高于非MACE组(P<0.05)。通过LASSO回归模型的三折交叉验证确定最佳惩罚项系数λ,最终筛选出8个潜在的相关因素,分别为Gensini评分、术前Killip分级、合并高血压、吸烟、NEUT、NLR、PLR、MMP-9。Cox回归分析结果显示,血清NLR、PLR、MMP-9高表达是STEMI患者急诊PCI术后MACE发生的危险因素(HR=1.818、1.032、1.004,P<0.05)。使用Bootstrap内部验证法对列线图预测模型进行验证,C-index值0.932。绘制ROC曲线检验列线图预测STEMI患者急诊PCI术后MACE发生的价值,AUC为0.932(95%CI:0.887~0.976),敏感度为0.865,特异度为0.885,约登指数0.750。绘制决策曲线,结果显示,在阈值0.005~1.000范围内,血清NLR、PLR、MMP-9联合预测STEMI急诊PCI术后MACE发生的净收益率优于单独的净收益率。结论血常规指标NLR、PLR及血清MMP-9与STEMI急诊PCI术后MACE发生密切相关,构建列线图预测模型对预测STEMI患者�Objective To investigate the risk factors for occurrence of major adverse cardiovascular events(MACE)within one year in patients with ST-segment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI),and to establish a nomogram predictive model.Methods This study was a retrospective one.STEMI patients(n=52)with MACE after emergency PCI during 1-y follow-up were chosen into MACE group,and patients without MACE during 1-y follow-up were chosen into non-MACE group from the First People’s Hospital of Chuzhou City from June 2022 to June 2024.The baseline materials were statistical analyzed and compared between 2 groups.The influence of blood routine indexes and level of serum matrix metalloproteinase-9(MMP-9)on MACE occurrence after emergency PCI by using Cox regression analysis before and after covariate adjustment,and a nomogram predictive model was established.The predictive value of nomogram predictive model to MACE occurrence by using ROC curve in STEMI patients after emergency PCI.Results The average occurrence time of MACE was(7.50±2.43)months in MACE group.Gensini scores,gradeⅢof Killip classification,complicated hypertension,smoking percentage,white blood cell count(WBC),neutrophil count(NEUT),neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR)and MMP-9 level were higher in MACE group than those in Non-MACE group(P<0.05).The optimal penalty coefficient(λ)was determined by using three-fold cross-validation of LASSO regression model,and finally 8 potential relative factor were screened including Gensini scores,preoperative Killip classification,complicated hypertension,smoking,NEUT,NLR,PLR and MMP-9.The results of Cox regression analysis showed that the higher expressions of NLR,PLR and MMP-9 were risk factors for MACE occurrence(HR=1.818,HR=1.032,HR=1.004,P<0.05)in STEMI patients after emergency PCI.The nomogram predictive model was verified by using Bootstrap internal verification method and C-index value was 0.932.The predictive value of nomogram

关 键 词：ST段抬高型心肌梗死 主要不良心血管事件 急诊经皮冠状动脉介入 基质金属蛋白酶-9 列线图预测模型 

分 类 号：R542.22[医药卫生—心血管疾病]