胸痛中心模式下急性ST段抬高型心肌梗死患者预后的预测模型构建与验证  

Construction and validation of prognostic model for patients with acute ST-segment elevation myocardial infarction in central mode of chest pain

作　　者：宋岳涵 张小琼[2] 孙雪 赵小辉 SONG Yuehan;ZHANG Xiaoqiong;SUN Xue;ZHAO Xiaohui(Department of General Practice,the No.2 Hospital of Baoding,Baoding,Hebei,071000,China;Department of Cardiology,the No.2 Hospital of Baoding,Baoding,Hebei,071000,China;Department of Function,the No.2 Hospital of Baoding,Baoding,Hebei,071000,China;Department of Emergency,the No.2 Hospital of Baoding,Baoding,Hebei,071000,China)

机构地区：[1]保定市第二医院全科医学科,河北保定071000 [2]保定市第二医院心血管内二科 [3]保定市第二医院功能科 [4]保定市第二医院急诊科

出　　处：《临床心血管病杂志》2025年第1期67-73,共7页Journal of Clinical Cardiology

基　　金：保定市科技计划项目(No:2441ZF105)。

摘　　要：目的:探讨影响胸痛中心模式下急性ST段抬高型心肌梗死(STEMI)患者预后的因素,构建列线图预测模型,并验证其有效性。方法:选取2020年1月—2024年1月我院收治的胸痛中心模式下的STEMI患者1412例,收集其一般临床资料,根据住院期间是否发生主要不良心血管事件(MACE)分为预后不良组(81例)及预后良好组(1331例)。采用logistic回归分析筛选预后不良的影响因素,构建列线图预测模型。分别采用受试者工作特征(ROC)曲线、校准曲线和决策曲线验证模型的效能。另选取2024年2月—2024年7月173例符合纳入与排除标准的胸痛中心模式下的STEMI患者为验证组(性别、年龄、Killip分级、发病至就诊时间等一般资料与1412例STEMI患者具有可比性),对列线图预测模型进行外部验证。结果:胸痛中心模式下STEMI患者住院期间预后不良率为5.74%(81/1412)。合并糖尿病(OR=4.535,95%CI:2.526~8.143)、Killip分级Ⅲ~Ⅳ级(OR=3.260,95%CI:1.036~10.258)、发病至就诊时间长(OR=1.104,95%CI:1.101~1.108)和高血清YKL-40水平(OR=1.116,95%CI:1.023~1.218)是胸痛中心模式下STEMI患者预后不良的危险因素(均P<0.05);高血红蛋白水平(OR=0.985,95%CI:0.978~0.992)、优化胸痛中心质量管理(OR=0.393,95%CI:0.259~0.595)是胸痛中心模式下STEMI患者预后不良的保护因素(均P<0.05)。内部、外部验证结果显示,列线图模型具有良好预测效能及明显的正向净收益。结论:合并糖尿病、Killip分级、发病至就诊时间、血红蛋白水平、血清YKL-40水平、是否优化胸痛中心质量管理是胸痛中心模式下STEMI患者预后不良的影响因素,所构建的列线图预测模型预测效能、校准度及临床效用良好,可用以指导预后不良的评估及决策制定。Objective To investigate the prognostic factors of acute ST-segment elevation myocardial infarction(STEMI)in the central mode of chest pain,then establish a nomogram prediction model,and verify its effectiveness.Methods A total of 1412 STEMI patients treated under the chest pain center model in our hospital from January 2020 to January 2024 were selected,and their general clinical data were collected.They were divided into the poor prognosis group(n=81)and the good prognosis group(n=1331)according to whether major adverse cardiovascular events(MACE)occurred during hospitalization.The factors influencing poor prognosis were analyzed by logistic regression analysis,and a nomogram prediction model was constructed.The performance of the model was validated using receiver the operating characteristic(ROC)curve,calibration curve,and decision curve.Another 173 STEMI patients who met the inclusion and exclusion criteria under the chest pain center model from February 2024 to July 2024 were selected as the validation group(gender,age,Killip classification,time from onset to treatment,and other general data were comparable to those of the 1412 STEMI patients),and the nomogram prediction model was externally validated in the validation population.Results Under the chest pain center model,the rate of poor prognosis for STEMI patients during hospitalization was 5.74%(81/1412).Combination of diabetes(OR=4.535,95%CI:2.526-8.143),Killip classification ofⅢ-Ⅳ(OR=3.260,95%CI:1.036-10.258),long time from onset to treatment(OR=1.104,95%CI:1.101-1.108),and high serum YKL-40 levels(OR=1.116,95%CI:1.023-1.218)were risk factors for poor prognosis in STEMI patients under the chest pain center model(all P<0.05).Whole high hemoglobin levels(OR=0.985,95%CI:0.978-0.992),and optimized quality management of the chest pain center(OR=0.393,95%CI:0.259-0.595)were protective factors for poor prognosis in STEMI patients under the chest pain center model(both P<0.05).The internal and external validation results showed that the nomogram model had

关 键 词：胸痛中心 急性ST段抬高型心肌梗死 预后 预测模型 LOGISTIC回归分析 

分 类 号：R542.2[医药卫生—心血管疾病]