弥散性冠状动脉病变患者冠状动脉内膜剥脱术后发生围术期心肌梗死的预测模型

Risk factors for myocardial infarction after coronary endarterectomy in patients with diffuse coronary artery disease and construct a predictive model

目的:分析弥散性冠状动脉病变(diffused coronary artery disease,DCAD)患者冠状动脉内膜剥脱术(coronary endarterectomy,CE)后发生围术期心肌梗死(perioperative myocardial infarction,PMI)的危险因素并构建预测模型。方法:回顾性选择2021年8月至2023年8月山东第一医科大学附属职业病医院收治的350例行CE治疗的DCAD患者临床资料作为研究对象,以简单随机抽样法分为建模组与验证组(7:3)。并根据患者术后48h内PMI发生情况进行分组,将发生PMI患者临床资料纳入PMI组,将未发生PMI患者临床资料纳入无PMI组。采用二元Logistics回归分析造成DCAD患者CE术后PMI发生的危险因素并构建列线图,以验证组数据对列线图模型进行外部验证。结果:建模组发生PMI 64例(26.1%),验证组发生PMI 25例(23.8%)(χ^(2)=0.207,P=0.649);PMI组Syntax评分、LVEDD、hs-CRP水平及合并糖尿病患者占比高于无PMI组,LVEF、肌酐清除率低于无PMI组(P<0.05);Syntax评分、LVEDD、hs-CRP高水平,合并糖尿病是DCAD患者CE术后PMI发生的危险因素(OR>1,P<0.05),LVEF、肌酐清除率高水平是患者术后PMI发生的保护因素(OR<1,P<0.05);建模组AUC为0.960(95%CI:0.928~0.992,P<0.001),验证组AUC为0.953(95%CI:0.917~0.988,P<0.001)。结论:Syntax评分、LVEDD、hs-CRP、合并糖尿病、LVEF、肌酐清除率高水平是DCAD患者CE术后PMI发生的独立因素,根据其构建模型预测效能较好。

Objective:To analyze the risk factors of myocardial infarction (PMI) after coronary endarterectomy (CE) in patients with diffuse coronary artery disease (DCAD) and to construct a predictive model.Methods:A retrospective study was conducted to select the clinical data of 350 patients with DCAD who underwent CE treatment in Shandong Provincial Medical College/First Affiliated Hospital of Shandong Provincial Medical College from August 2021 to August 2023 as the research objects.They were divided into modeling group and verification group (7:3 ratio) by simple random sampling method.The clinical data of patients with PMI were included in the PMI group,and the clinical data of patients without PMI were included in the non-PMI group.Baseline data of patients were collected.Binary logistic regression analysis was used to analyze the risk factors of PMI after CE in DCAD patients and construct a nomogram to verify the nomogram model.Results:PMI occurred in 64 cases (26.1%) in the modeling group and 25 cases (23.8%) in the validation group (χ~2=0.207,P=0.649);The Syntax score,LVEDD,hs-CRP level and proportion of patients with diabetes mellitus in the PMI group were higher than those in the non-PMI group,while LVEF and creatinine clearance rate were lower than those in the non-PMI group (P<0.05);The high levels of Syntax score,LVEDD,hs-CRP and diabetes mellitus were the risk factors of PMI after CE in DCAD patients (OR>1,P<0.05),and high levels of LVEF and creatinine clearance rate were protective factors for PMI after patients (OR<1,P<0.05);The AUC of the modeling group was 0.960 (95%CI:0.928-0.992,P<0.001),and the AUC of the validation group was 0.953 (95%CI:0.917-0.988,P<0.001).Conclusion:Syntax score,LVEDD,hs-CRP,diabetes mellitus,LVEF and high creatinine clearance rate are independent factors for PMI after CE in DCAD patients,and the prediction efficiency of the model constructed according to them is better.