STEMI患者PCI术后发生院内主要不良心血管事件的预测模型构建

李幸; 赵倩; 马依彤; 杨毅宁

doi:10.12125/j.chj.202211057

STEMI患者PCI术后发生院内主要不良心血管事件的预测模型构建

Predictive model of in-hospital major adverse cardiovascular events in patients with ST-segment elevation myocardial infarction after PCI in Xinjiang

摘要

摘要:
目的探讨新疆地区急性ST段抬高型心肌梗死患者经皮冠状动脉介入（PCI）术后院内主要不良心血管事件（MACE）发生的独立危险因素，并构建风险预测模型。
方法选取2017年11月～2022年6月在新疆医科大学第一附属医院心脏中心就诊的615例急性ST段抬高型心肌梗死（STEMI）患者，依据是否发生院内 MACE事件分为 MACE 组（n=77 ）和无MACE组（n=538）。对变量进行拟合多因素Logistic回归分析，筛选出发生院内MACE的独立影响因素，并构建列线图预测模型。
结果与无事件组相比，发生院内MACE组患者的年龄高（P<0.05），白细胞水平增加（P<0.01），肾功能指标血肌酐（P<0.01）和尿素氮（P<0.01）水平升高，总胆红素水平增加（P<0.01），LVEF降低（P<0.01），冠脉狭窄数量增加（P<0.01）。两组患者住院治疗情况相似，但院内MACE组患者氯吡格雷和他汀类药物的使用比例降低（均P<0.01）；单因素Logistic回归分析的结果显示，年龄（OR=1.024，95% CI：1.004～1.045， P<0.05）、LVEF（OR=0.944，95% CI：0.915～0.974，P<0.01）、Killip IV分级（OR=10.421，95% CI：1.218～89.126， P<0.05）、总胆红素（OR=1.131，95% CI：1.084～1.180，P<0.01）、白细胞（OR=1.290，95% CI：1.194～1.393，P<0.01）、尿素氮（OR=1.384，95% CI：1.232～1.554，P<0.01）、肌酐（OR=1.020，95% CI：1.008～1.031， P<0.05）以及冠脉狭窄数量（OR=1.275，95% CI：1.062～1.531， P<0.01）是院内MACE的影响因素；多因素Logistic回归分析显示LVEF、总胆红素、白细胞及尿素氮是院内MACE的独立影响因素，并将4个独立影响因素用于构建列线图模型。
结论 LVEF、总胆红素、白细胞及尿素氮是院内MACE的独立影响因素。

Abstract:
AIM To investigate the independent risk factors of in-hospital major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction in Xinjiang based on LASSO regression and build a risk prediction model.
METHODS 615 patients with acute ST segment elevation myocardial infarction (STEMI) who were treated at the Heart Center of the First Affiliated Hospital of Xinjiang Medical University from November 2017 to June 2022 were selected. They were divided into the MACE group (n=77) and the non MACE group (n=538) based on whether there were any MACE events in the hospital. Multiple logistic regression analysis was conducted to fit the variables, identify the independent influencing factors of hospital MACE, and construct a column chart prediction model.
RESULTS Compared with the non event group, patients in the hospital MACE group had a higher age (P<0.05), increased white blood cell levels (P<0.01), increased levels of renal function indicators such as creatinine (P<0.01) and urea nitrogen (P<0.01), increased total bilirubin levels (P<0.01), decreased LVEF (P<0.01), and increased number of coronary artery stenosis (P<0.01). The hospitalization treatment status of the two groups of patients was similar, but the proportion of clopidogrel and statins used in the MACE group decreased (both P<0.01); The results of univariate logistic regression analysis showed that age (OR=1.024, 95% CI: 1.004-1.045, P<0.05), LVEF (OR=0.944, 95% CI: 0.915-0.974, P<0.01), Killip IV grade (OR=10.421, 95% CI: 1.218-89.126, P<0.05), total bilirubin (OR=1.131, 95% CI: 1.084-1.180, P<0.01), white blood cells (OR=1.290, 95% CI: 1.194-1.393, P<0.01), urea nitrogen (OR=1.384, 95% CI: 1.232-1.554, P<0.01) Creatinine (OR=1.020, 95% CI: 1.008-1.031, P<0.05) and the number of coronary artery stenosis (OR=1.275, 95% CI: 1.062-1.531, P<0.01) are influencing factors for in-hospital MACE; Multivariate logistic regression analysis showed that LVEF, total bilirubin, white blood cells, and urea nitrogen were independent influencing factors for hospital MACE, and four independent influencing factors were used to construct a column chart model.
CONCLUSION LVEF, total bilirubin, white blood cells, and urea nitrogen are independent influencing factors for hospital MACE.

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