冠状动脉旁路移植术后主动脉内球囊反搏应用的危险因素分析及预测模型的构建

Analysis of risk factors of intra-aortic balloon pump application after coronary artery bypass grafting and establish a prediction model

目的:探讨冠状动脉旁路移植术(coronary artery bypass grafting,CABG)后应用主动脉内球囊反搏(intra-aortic balloon pump,IABP)的危险因素,构建预测CABG术后应用IABP风险的列线图模型。方法:回顾性收集2020年3月至2022年9月,在河南省人民医院心脏中心行CABG手术的161例冠心病患者的临床资料,根据CABG术后是否应用IABP将患者分为IABP组(58例)和非IABP组(103例)。通过单因素及多因素Logistic回归分析筛选影响CABG术后应用IABP的危险因素,应用R软件建立预测IABP应用风险的列线图模型,利用ROC曲线下面积(AUC)、校准曲线和Hosmer-Lemeshow拟合优度检验评估列线图预测模型。结果:多因素Logistic回归分析显示:术前NT-proBNP(OR=1.288,95%CI:1.063~1.560,P=0.010)升高、术前肌钙蛋白T(TnT)(OR=2.460,95%CI:1.079~5.383,P=0.032)升高、术前LVEF(OR=0.873,95%CI:0.830~0.919,P<0.01)降低及术后肺动脉搏动指数(pulmonary artery pulsatility index,PAPI)(OR=0.136,95%CI:0.053~0.351,P<0.01)降低是CABG术后应用IABP的危险因素。基于上述指标构建列线图模型,训练集AUC为0.898(95%CI:0.842~0.955),验证集AUC为0.834(95%CI:699~0.969),说明该模型具有很高的区分度。校正曲线和Hosmer-Lemeshow拟合优度检验(P=0.729)均提示预测值和实际值间具备较好的一致性。结论:术前NT-proBNP、TnT、LVEF及术后PAPI是CABG术后应用IABP的预测因素,构建的列线图模型可评估CABG术后应用IABP的风险,为早期筛选CABG术后高风险患者并及时干预提供了理论依据。

Objective:To investigate the independent risk factors of intra-aortic balloon pump(IABP)application after coronary artery bypass grafting(CABG)and establish a nomogram prediction model for predicting the risk of IABP application after CABG.Methods:The clinical data of 161 patients with coronary heart disease undergoing CABG in the Heart Center of Henan Provincial People’s Hospital from March 2020 to September 2022 were retrospectively collected.According to whether the patients received IABP application after CABG,they were divided into the IABP group(n=58)and non-IABP group(n=103).Univariate and multivariate logistic regression analysis was performed to explore the independent risk factors.The R software was used to establish a nomogram prediction model for predicting the risk of IABP application.The area under the ROC curve(AUC),calibration curve and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the nomogram prediction model.Results:Multivariate Logistic regression analysis showed that increased preoperative NT-proBNP(OR=1.288,95%CI:1.063~1.560,P=0.010)and troponin T(TnT)(OR=2.460,95%CI:1.079-5.383,P=0.032),reduced preoperative LVEF(OR=0.873,95%CI:0.830-0.919,P<0.01)and postoperative pulmonary artery pulsatility index(PAPI)(OR=0.136,95%CI:0.053~0.351,P<0.01)were independent risk factors for IABP application after CABG.Using the risk factors to construct a nomogram prediction model,the ACUs in the training set and validation set were 0.898(95%CI:0.842-0.955)and 0.834(95%CI:0.699-0.969),respectively,which showed that the nomogram model had a good discrimination ability.The calibration curve and the Hosmer-Lemeshow goodness-of-fit test(P=0.729)indicated that the predicted probability of the nomogram model was consistent with the actual probability.Conclusions:Preoperative NTproBNP,TnT,LVEF and postoperative PAPI are independent influencing factor for the IABP application after CABG.The nomogram model established in this study can evaluated the risk of IABP application after CABG and provide a theoretical basis for early screening of high-risk patients after CABG and timely intervention.