高龄冠心病患者PCI术后主要心脑血管不良事件风险评估模型验证与分析研究

Verification and analysis study of the risk assessment model for major adverse cardiovascular and cerebrovascular events in elderly patients with coronary heart disease after percutaneous coronary intervention

目的验证上海长海医院建立的高龄冠心病患者经皮冠状动脉介入治疗(PCI)后院内主要心脑血管不良事件(MACCE)风险评估模型,探讨其对术后院内MACCE预测价值。方法连续入选长海医院2015年1月至2015年9月确诊为冠心病并接受PCI治疗的≥75岁高龄患者344例。对患者临床资料进行全面收集、整理和统计分析,采用高龄冠心病患者PCI风险评估模型对患者危险因素进行评分,验证其预测术后院内MACCE能力及拟合校正性能。结果完成随访344例,院内发生MACCE15例(4.36%)。高龄冠心病患者PCI风险评估模型对术后院内MACCE发生具有良好预测及拟合性能(ROC曲线下面积为0.747,P=0.001;Hosmer-Lemeshow拟合优度检验χ~2=2.731,P=0.909)。生存分析结果表明,高龄冠心病患者PCI风险评分评价低危、中危、高危组患者术后MACCE发生率分别为2.77%(7/253)、6.67%(5/75)、18.75%(3/16),差异有显著统计学意义(χ~2=11.708,P=0.003)。Cox回归模型单因素和多因素分析表明,高龄冠心病患者PCI风险评分是影响术后院内MACCE发生率的独立预测因子(HR=1.560,95%CI=1.253～1.944,P<0.001)。结论高龄冠心病患者PCI风险评分是高龄冠心病患者PCI术后院内MACCE发生的独立预测因子。该PCI风险评估模型对术后院内MACCE发生率具有良好的预测性能。

Objective To test and verify the risk assessment model, which is created by Shanghai Changhai Hospital of China and is designed for prediction of the occurrence of major adverse cardiovascular and cerebrovascular events （MACCE） in elderly patients with coronary heart disease （CHD） after percutaneous coronary intervention （PCI）, and to discuss its clinical value in predicting the occurrence of MACCE during hospitalization after PCI. Methods A total of 344 consecutive elderly patients （age ≥75） with confirmed CHD, who were admitted to Shanghai Changhai Hospital of China during the period from January 2015 to September 2015 to receive PCI, were enrolled in this study. The clinical data of patients were comprehensively collected, organized and statistically analyzed. By using PCI risk assessment model for elderly patients with CHD, the risk factors of patients were evaluated. The predictive ability of the model in predicting the occurrence of MACCE during hospitalization and its fitting correction performance were tested and verified. Results All the 344 patients were followed up. During hospitalization period MACCE occurred in 15 patients （4.36%）. PCI risk assessment model for elderly patients with CHD had excellent prediction ability and fitting performance for the occurrence of MACCE in postoperative hospitalization period （the area under ROC curve=0.747, P=0.001; Hosmer-Lemeshow goodness of fit test χ2=2.731, P=0.909）. Survival analysis indicated that the incidences of MACCE in low risk group, moderate risk group and high risk group, which were classified by risk assessment model, were 2.77% （7/253）, 6.67% （5/75） and 18.75% （3/16） respectively; the differences between each other among the three groups were statistically significant （χ2= 11.708, P=0.003）. Univariate and multivariate Cox regression analysis revealed that PCI risk score in elderly CHD patients was an independent predictive factor that affected the incidence of MACCE during hospitalization （HR=1.560,95% CI=1.255-1.944, P〈0.001 ）. Conclusion The PCI risk score of the elderly CHD patients is an independent factor that can predict the incidence of MACCE during hospitalization in elderly CHD patients after receiving PCI. The PCI risk scoring model has a good predictive performance for the occurrence of MACCE during postoperative hospitalization period.