冠状动脉旁路移植术后住院期间主要心脏不良事件的危险因素分析和列线图模型构建  

Risk factors and nomogram model establishment of major adverse cardiac events during hospitalization after coronary artery bypass grafting

作　　者：李佳馨 程虎[1] 王江[1] LI Jiaxin;CHENG Hu;WANG Jiang(Department of Anesthesiology,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麻醉科,乌鲁木齐市830054

出　　处：《临床麻醉学杂志》2025年第1期12-18,共7页Journal of Clinical Anesthesiology

基　　金：青年科研启航专项基金项目(2023YFY-QKQN-38)。

摘　　要：目的探讨非心肺转流下冠状动脉旁路移植术(OPCABG)患者术后住院期间主要心脏不良事件(MACE)的危险因素,并构建列线图模型。方法回顾性收集2021年1月至2023年12月555例接受OPCABG患者的一般资料、术前实验室检查、术中指标以及术后住院期间MACE的发生情况,男388例,女167例,年龄>45岁,BMI<28.0 kg/m 2,ASAⅢ或Ⅳ级。根据术后住院期间是否发生MACE将患者分为两组:MACE组和非MACE组。将筛选出的变量纳入多因素Logistic回归分析,并建立OPCABG患者术后住院期间发生MACE的列线图模型。绘制受试者工作特征(ROC)曲线、校准曲线、决策曲线分析(DCA)对列线图模型进行验证。结果共有33例(5.9%)患者术后住院期间发生MACE。多因素Logistic回归分析显示,年龄增长、C-反应蛋白(CRP)、空腹血糖(FPG)、总胆红素(TBil)、血尿素氮(BUN)、白蛋白校正阴离子间隙(ACAG)升高是OPCABG患者术后住院期间发生MACE的危险因素(P<0.05)。基于上述危险因素构建OPCABG患者术后住院期间发生MACE的列线图模型,该模型曲线下面积(AUC)为0.948(95%CI 0.913~0.983),敏感性为81.8%,特异性为95.8%。校准曲线结果显示,列线图模型预测曲线与实测曲线基本吻合。DCA结果显示,该列线图模型在预测OPCABG患者术后住院期间MACE方面能产生良好的临床效益。结论年龄增长、CRP、FPG、TBil、BUN、ACAG升高是OPCABG患者术后住院期间发生MACE的危险因素,基于此构建的列线图模型对OPCABG患者术后住院期间MACE具有较高的预测效能及临床获益。Objective To investigate the risk factors for major adverse cardiac events(MACE)during hospitalization after off-pump coronary artery bypass grafting(OPCABG)and construct a nomogram model.Methods A total of 555 patients,388 males and 167 females,aged>45 years,with BMI<28.0 kg/m 2,and ASA physical status Ⅲ or Ⅳ,who underwent OPCABG from January 2021 to December 2023 were retrospectively collected.General data,preoperative laboratory tests,intraoperative indicators,and the occurrence of MACE during hospitalization after surgery were recorded.The patients were divided into two groups based on whether MACE occurred:the MACE group and the non-MACE group.The selected variables were included in a multivariable logistic regression analysis to develop a nomogram model for predicting postoperative MACE during hospitalization in patients after OPCABG.The nomogram model was validated using receiver operating characteristic(ROC)curves,calibration curves,and decision curve analysis(DCA).Results Thirty-three patients(5.9%)experienced MACE during hospitalization after surgery.Multivariable logistic regression analysis showed that increased age,elevated levels of C-reactive protein(CRP),fasting plasma glucose(FPG),total bilirubin(TBil),blood urea nitrogen(BUN),and albumin-corrected anion gap(ACAG)were risk factors for the occurrence of MACE during hospitalization after OPCABG(P<0.05).A nomogram model was developed based on these risk factors to predict MACE during hospitalization in patients after OPCABG.The area under the curve(AUC)was 0.948(95%CI 0.913-0.983),with a sensitivity of 81.8%and a specificity of 95.8%.The calibration curve results indicated that the predicted curve of the nomogram model closely matched the observed outcomes.Decision curve analysis(DCA)showed that the nomogram model provided good clinical benefit in predicting MACE during hospitalization in patients after OPCABG.Conclusion Increased age,elevated levels of CRP,FPG,TBil,BUN,and ACAG are risk factors for the occurrence of MACE during hospitalization

关 键 词：冠状动脉旁路移植术 短期预后 主要心脏不良事件 白蛋白校正阴离子间隙 列线图 

分 类 号：R54[医药卫生—心血管疾病]