建立老年急性心梗患者1年内全因死亡风险的预后预测模型

A Prognostic Prediction Model for the Risk of All-cause Mortality within 1 Year in Elderly Patients with Acute Heart Attack

目的本研究旨在构建与验证了一个预测老年急性心肌梗死(acute myocardial infarction,AMI)患者1年内全因死亡风险的预后预测模型。方法本研究为一项回顾性队列研究,将911例研究对象随机分为建模队列与验证队列。应用多因素Logistic回归分析分析老年AMI患者1年内全因死亡的独立危险因素。应用R软件(3.5.3版)构建预测老年AMI患者1年内全因死亡风险的列线图模型,并对该模型进行验证。结果多因素回归分析结果显示,年龄、BNP、心率、Killip分级、GNRI评分、STEMI、PCI、心肌梗死病史、糖尿病病史和心脏骤停史是老年AMI患者1年内死亡的独立危险因素。对该模型进行内部和外部的验证,建模队列中AUC值为0.784(95%CI:0.761~0.807);验证队列中AUC值为0.782(95%CI:0.759~0.805)。Hosmer-Lemeshow检验结果提示该预测模型具有良好稳定性。结论本研究中简单、易用的列线图模型可以有效地预测老年AMI患者1年内全因死亡的个体化风险。

Objective To construct and validate a prognostic model for predicting the risk of all-cause death within one year in elderly patients with acute myocardial infarction(AMI).Methods This is a retrospective cohort study in which 911 subjects were randomly divided into a modelling cohort and a validation cohort.Independent risk factors for all-cause mortality within 1 year in elderly patients with AMI were analyzed using multifactorial Logistic regression analysis.R software(version 3.5.3)was applied to construct a column line graph model to predict the risk of all-cause death within 1 year in elderly AMI patients,and the model was validated.Results The results of multivariate regression analysis showed that age,BNP,heart rate,Killip grade,GNRI score,STEMI,PCI,history of myocardial infarction,history of diabetes and history of cardiac arrest were the independent risk factors for death within one year in elderly patients with AMI.The AUC of the model was 0.784(95%CI:0.761-0.807)in the modeling queue and 0.782(95%CI:0.759-0.805)in the validation queue.The results of Hosmer-Leme showed test indicate that the prediction model has good stability.Conclusion The simple and easy-to-use nomogram model in this study can effectively predict the individualized risk of all-cause death in elderly patients with AMI within one year.