表观生物年龄加速预测老年重度冠状动脉钙化患者行冠状动脉旋磨术后主要不良心血管事件的研究  

Association Between Epigenetic Age Acceleration and Major Adverse Cardiovascular Events in Elderly Patients with Severe Coronary Artery Calcification After Rotational Atherectomy

作　　者：李瑞婷 马月 马锐 张荣秀 刘占文 LI Ruiting;MA Yue;MA Rui;ZHANG Rongxiu;LIU Zhanwen(Cardiovascular Medicine Department,The Third People’s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830000,Xinjiang,China)

机构地区：[1]新疆维吾尔自治区第三人民医院心血管内科,新疆乌鲁木齐830000

出　　处：《心血管病学进展》2025年第4期362-370,共9页Advances in Cardiovascular Diseases

基　　金：新疆维吾尔自治区第三人民医院基金(2024QSYYK11)。

摘　　要：目的探讨表观生物年龄加速(EAA)与老年严重冠状动脉钙化(CAC)患者行冠状动脉旋磨术(RA)后发生主要不良心血管事件(MACE)之间的关系。方法回顾性选取2013年7月—2023年8月在新疆维吾尔自治区第三人民医院接受RA的老年严重CAC患者共206例。终点事件为发生MACE,中位随访时间为49.0个月。通过计算EAA,将患者分为EAA+组(表观年龄>实际年龄)与EAA-组(表观年龄<实际年龄),探究EAA与老年严重CAC患者行RA后发生MACE之间的关系。采用Kaplan-Meier生存分析探究EAA与老年严重CAC患者行RA后发生MACE之间的相关性。采用单因素Cox回归分析MACE发生的危险因素,将结果进一步纳入多因素Cox回归分析,并构建术后发生MACE的列线图;采用ROC曲线、决策曲线分析(DCA)和校准曲线分析EAA对MACE发生的预测价值。结果Kaplan-Meier生存分析发现,EAA-组的无MACE累计生存率更高(P=0.007)。Cox回归分析发现在模型调整后EAA+仍与MACE的发生具有显著相关性(P<0.05)。限制性立方样条(RCS)曲线显示EAA与MACE的发生呈线性相关(P的非线性值=0.619)。ROC曲线显示,在1、3、5和8年内AUC分别为0.72、0.76、0.78和0.75;DCA结果也表明EAA对MACE的发生具有良好的预测作用;校准曲线显示EAA具有较高准确度。列线图可视化预测患者的MACE发生风险。结论EAA与老年严重CAC患者行RA后发生MACE之间存在相关性,可帮助医护人员识别高危患者并改善患者的不良预后。Objective To investigate the relationship between epigenetic age acceleration(EAA)and the occurrence of major adverse cardiovascular events(MACE)after rotational atherectomy(RA)in elderly patients with severe coronary artery calcification(CAC).Methods A retrospective study was conducted on a total of 206 elderly patients with severe CAC who underwent RA at The Third People’s Hospital of Xinjiang Uygur Autonomous Region from July 2013 to August 2023.The patients were categorized into EAA+group(PhenoAge>actual age)and EAA-group(PhenoAge<actual age)based on their calculated phenotypic age(PhenoAge).The association between EAA and the occurrence of MACE after RA in elderly patients with severe CAC was explored using Kaplan-Meier survival analysis.Cox proportional hazards regression models were used to identify risk factors for MACE occurrence,and these results were further included in a multivariable Cox regression analysis.ROC curve,decision curve analysis(DCA),and calibration curve were used to examine the predictive value of EAA for MACE occurrence.Results Kaplan-Meier survival analysis revealed a higher cumulative survival rate without MACE in the EAA-group(P=0.007).Cox regression analysis found that EAA+was still significantly associated with the occurrence of MACE after model adjustment(P<0.05).The restricted cubic spline(RCS)curve showed a linear correlation between EAA and MACE occurrence(P for nonlinear=0.619).The AUC values for the ROC curve at 1,3,5,and 8 years were 0.72,0.76,0.78,and 0.75,respectively.DCA results also demonstrated the good predictive value of EAA for MACE,while the calibration curve indicated a high model accuracy.The nomogram visualized the risk of MACE occurrence in patients.Conclusion There is a relationship between EAA and the occurrence of MACE after RA in elderly patients with severe CAC,which can help healthcare providers identify high-risk patients and improve patient outcomes.

关 键 词：表观生物年龄加速 冠状动脉钙化 老年患者 冠状动脉旋磨术 主要不良心血管事件 

分 类 号：R541.4[医药卫生—心血管疾病]