择期PCI术后发生PCI相关心肌损伤的危险因素及其列线图模型

Risk factors and a nomogram model for predicting periprocedural myocardial injury in patients undergoing elective PCI

目的:分析择期行经皮冠状动脉介入(PCI)的冠心病患者术后发生PCI相关心肌损伤的危险因素,构建并验证列线图模型。方法:纳入2017年1月—2021年12月连云港市第一人民医院和南京市第一医院行择期PCI的冠心病患者428例为研究对象。终点事件为PCI相关心肌损伤,定义为PCI术后24 h内肌钙蛋白峰值超过正常值5倍以上。将患者分为PCI相关心肌损伤组(207例)和非PCI相关心肌损伤组(221例),采用多因素logistic分析探讨影响患者发生PCI相关心肌损伤的危险因素,构建列线图模型并进行验证。结果:PCI相关心肌损伤组患者年龄、植入支架数量和脂质斑块体积均高于非PCI相关心肌损伤组,最小管腔面积小于非PCI相关心肌损伤组(均P<0.05)。多因素logistic回归分析显示,年龄(OR=1.039,95%CI:1.015~1.064,P=0.001)、支架数量(OR=1.792,95%CI:1.285~2.499,P=0.001)、最小管腔面积(OR=0.747,95%CI:0.580~0.962,P=0.024)和脂质斑块体积(OR=1.007,95%CI:1.000~1.014,P=0.049)为发生PCI相关心肌损伤的危险因素。基于logistic回归分析结果构建列线图模型,该列线图模型预测发生PCI相关心肌损伤的C指数为0.711。校准曲线显示,该列线图模型预测建模组、验证组患者发生PCI相关心肌损伤发生率与本组PCI相关心肌损伤实际发生率基本一致。结论:年龄、支架数量、最小管腔面积和脂质斑块体积是发生PCI相关心肌损伤的独立危险因素。本研究建立的列线图模型有较好的预测效能和区分度,可预测择期行PCI的冠心病患者术后PCI相关心肌损伤的发生。

Objective:To analyze risk factors predicting periprocedural myocardial injury in coronary heart disease patients undergoing elective PCI,and subsequently establish and validate a nomogram prediction model.Methods:A total of 428 coronary heart disease patients who underwent elective PCI at the First People's Hospital of Lianyungang and the First Hospital of Nanjing from January 2017 to December 2021 were enrolled as study subjects.The endpoint event was periprocedural myocardial injury,defined as the peak value of cardiac troponin exceeding the normal value by more than 5 times within 24 hours after PCI.Patients were divided into the periprocedural myocardial injury group(n=207) and the non-periprocedural myocardial injury group(n=221).Multivariate logistic analysis was employed to explore the risk factors affecting the occurrence of periprocedural myocardial injury,and a nomogram model was constructed and validated.Results:Patients in the periprocedural myocardial injury group were older and had more stents implanted,larger lipid plaque volume,and smaller minimum lumen area compared to the non-periprocedural myocardial injury group(all P<0.05).Multivariate logistic regression analysis showed that age(OR=1.039,95%CI:1.015-1.064,P=0.001),number of stents(OR=1.792,95%CI:1.285-2.499,P=0.001),minimum lumen area(OR=0.747,95%CI:0.580-0.962,P=0.024),and lipid plaque volume(OR=1.007,95%CI:1.000-1.014,P=0.049) were risk factors for periprocedural myocardial injury.Based on the results of logistic regression analysis,a nomogram model was constructed,which the area under the ROC(AUC) was 0.711 for predicting periprocedural myocardial injury.The calibration curve showed that the incidence of periprocedural myocardial injury in the modeling and validation groups was basically consistent with the actual incidence.Conclusion:Age,stent numbers,minimum lumen area,and lipid plaque volume are independent risk factors for periprocedural myocardial injury.The nomogram model based on these four factors demonstrates good prediction efficiency and consistency,providing an effective tool for clinical decision-making in patients undergoing elective PCI.