急性STEMI患者pPCI术后6个月内MACE的影响因素分析及风险预测Nomogram模型构建

Analysis of the influencing factors of MACE within 6 months after pPCI in acute STEMI patients and construction of risk prediction Nomogram model

目的分析急性ST段抬高型心肌梗死(ST segment elevation myocardial infarction,STEMI)患者直接经皮冠状动脉介入治疗(primary percutaneous coronary intervention,pPCI)术后6个月内主要不良心血管事件(major adverse cardiovascular events,MACE)的影响因素,并构建风险预测Nomogram模型。方法回顾性分析2020年6月至2022年12月安阳市人民医院收治的519例行pPCI术的急性STEMI患者的临床资料,将其按照2∶1的比例随机分为模型组(n=346)和验证组(n=173)。根据pPCI术后6个月内MACE的发生情况,将模型组患者分为发生组和未发生组,采用Logistic回归分析筛选急性STEMI患者pPCI术后6个月内MACE的影响因素,构建风险预测Nomogram模型并对其进行验证。结果Killip心功能III/IV级、术后TIMI分级≤2级、术后无复流、N末端B型钠尿肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、左心室射血分数(left ventricular ejection fraction,LVEF)、碎裂QRS波(fragmented QRS wave,fQRS波)、超敏C反应蛋白(high-sensitivity C reactive protein,hs-CRP)是急性STEMI患者pPCI术后6个月内MACE的影响因素(P<0.05)。模型组和验证组的校准曲线显示,Nomogram模型校准曲线和理想曲线的一致性良好,两组Hosmer-Lemeshow检验结果分别为χ^(2)=2.135、P=0.977,χ^(2)=3.756、P=0.878;受试者工作特征曲线显示,该模型预测模型组和验证组患者pPCI术后6个月内MACE的曲线下面积分别为0.827、0.811;决策曲线显示,急性STEMI患者根据该模型预测pPCI术后6个月内MACE发生风险的净收益较高。结论Killip心功能III/IV级、术后TIMI分级≤2级、术后无复流、NT-proBNP、LVEF、fQRS波及hs-CRP是急性STEMI患者pPCI术后6个月内MACE的影响因素,以此构建的风险预测Nomogram模型的预测效能及适用性较好,可用于预测急性STEMI患者预后。

Objective To analyze the influencing factors of major adverse cardiovascular events(MACE)within 6 months after primary percutaneous coronary intervention(pPCI)in patients with acute ST segment elevation myocardial infarction(STEMI),and to build a risk prediction Nomogram model.Methods The clinical data of 519 patients with acute STEMI who underwent pPCI admitted to The People's Hospital of Anyang City from June 2020 to December 2022 were retrospectively analyzed,and they were divided into a model group(n=346)and a validation group(n=173)according to the ratio of 2∶1.The model group patients were divided into the occurrence group and the non-occurrence group based on the occurrence of MACE within 6 months after pPCI.The influencing factors of MACE within 6 months after pPCI in acute STEMI patients were screened through logistic regression analysis,and the risk prediction Nomogram model was constructed and validated.Results Killip's cardiac function class III/IV,postoperative TIMI grade≤2 grade,no-reflow after surgery,N-terminal pro-brain natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),fragmented QRS wave(fQRS wave)and high-sensitivity C reactive protein(hs-CRP)were the influencing factors of MACE within 6 months after pPCI in acute STEMI patients(P<0.05).The calibration curve of the model group and the validation group showed good consistency between the calibration curve and ideal curve of the Nomogram model,and the Hosmer-Lemeshow test results for both groups wereχ^(2)=2.135,P=0.977 andχ^(2)=3.756,P=0.878.The receiver operating characteristic showed that the area under the curve of the model group and validation group patients with MACE within 6 months after pPCI by the model were 0.827 and 0.811 respectively.The decision curve analysis showed that acute STEMI patients had higher net return on predicting the risk of MACE within 6 months after pPCI based on this model.Conclusion Killip's cardiac function class III/IV,postoperative TIMI grade≤2 grade,no-reflow after surgery,NT-proBNP,LVEF,fQRS wave and hs-CRP are influencing factors for MACE within 6 months after pPCI in acute STEMI patients,and the risk prediction Nomogram model constructed based on them has good predictive efficiency and applicability,and it can be used to predict the prognosis of acute STEMI patients.