心肌梗死患者药物洗脱支架植入术后院内心力衰竭风险预测模型构建  

A prediction model for in-hospital heart failure in patients with myocardial infarction after drug-eluting stent implantation

作　　者：刘艳[1] 陈姚 孙爱娇[1] 黄晶晶 余子琪 Liu Yan;Chen Yao;Sun Aijiao;Huang Jingjing;Yu Ziqi(Department of Cardiology,Anqing Municipal Hospital,Anhui Province,Anqing 246003,China;不详)

机构地区：[1]安徽安庆市立医院心内科,安庆246003

出　　处：《中国循证心血管医学杂志》2025年第1期111-114,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨心肌梗死患者药物洗脱冠状动脉支架植入术后并发院内心力衰竭的危险因素,并建立列线图模型。方法回顾性分析2021年1月至2022年6月于安徽安庆市立医院行药物洗脱支架植入术治疗的106例急性心肌梗死患者,收集患者的临床资料,根据术后是否发生心力衰竭分为心力衰竭组(n=39)和非心力衰竭组(n=67)。采用多因素Logistic回归分析法筛选急性心肌梗死术后并发院内心力衰竭的危险因素,运用R语言建立急性心肌梗死术后并发院内心力衰竭的列线图模型,验证急性心肌梗死术后并发院内心力衰竭列线图模型的预测效能。结果心力衰竭组和非心力衰竭组患者年龄、合并高血压、合并糖尿病、心肌梗死史、Gensini分级、病变支数等资料比较,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,年龄≥60岁、合并高血压、合并糖尿病、心肌梗死史、Gensini分级Ⅲ~Ⅳ级、多支病变是心肌梗死患者术后并发院内心力衰竭的危险因素(P<0.05);心肌梗死患者术后并发院内心力衰竭的列线图模型C-index为0.869;校正曲线的预测值和实际值基本吻合;模型内部验证的ROC值为0.847;决策曲线阈值概率在41%~100%时预测心肌梗死患者术后并发院内心力衰竭的净获益值较高,说明本研究构建的列线图模型具有较好的风险预测效能。结论年龄、合并高血压、合并糖尿病、心肌梗死病史、Gensini分级、病变支数均是心肌梗死患者支架植入术后并发院内心力衰竭的影响因素。Objective To discuss the risk factors for in-hospital heart failure(HF)in patients with acute myocardial infarction(AMI)after implantation of drug-eluting stent(DES),and establish a nomogram model.Methods AMI patients(n=106)undergone DES implantation were retrospectively analyzed in Anqing Municipal Hospital of Anhui Province from Jan.2021 to June 2022.The clinical materials were collected from patients.All patients were divided,according to whether HF occurrence or not,into HF group(n=39)and non-HF group(n=67).The risk factors for in-hospital HF were screened by using multi-factor Logistic regression analysis.A nomogram model of AMI complicated by postoperative in-hospital HF was established by using R language,and predictive efficacy of the model was verified by using Bootstrap method.Results The comparison in age,complicated hypertension,complicated diabetes,AMI history,Gensini grades and number of diseased vessels had statistical differences between 2 groups(P<0.05).The results of multi-factor Logistic regression analysis showed that age≥60,complicated hypertension,complicated diabetes,AMI history,grades III and IV of Gensini grades,and multiple diseased vessels were risk factors for AMI complicated by postoperative in-hospital HF(P<0.05).The C-index of nomogram model was 0.869,predicted value of correction curve was basically consistent with actual value,and ROC value was 0.847 verified by the model internally.When the threshold probability of decision curve was 41%-100%,the net benefit value was higher in predicting AMI complicated by postoperative in-hospital HF,which indicated that nomogram model had a higher risk predictive efficiency.Conclusion age,complicated hypertension,complicated diabetes,AMI history,Gensini grades and number of diseased vessels were influence factors in patients with AMI complicated by postoperative in-hospital HF.

关 键 词：心肌梗死 药物洗脱支架植入术 心力衰竭 预测模型 列线图 

分 类 号：R542.22[医药卫生—心血管疾病]