老年急性ST段抬高型心肌梗死患者院内心衰的危险因素分析及列线图预测模型的构建

Analysis of risk factors and nomogram prediction model for in-hospital heart failure in elderly patients with acute ST segment elevation myocardial infarction(STEMI)

目的探讨老年急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者发生院内心衰的危险因素,并构建列线图预测模型,为心衰的预测评估提供参考工具。方法选取北京市大兴区人民医院急诊科2022年6月至2024年6月收治的老年急性STEMI患者的临床资料进行回顾性分析,共计278例,参照2∶8定律分为验证集(n=56)和训练集(n=222),根据老年急性STEMI患者PCI术后有无院内心衰分为心衰组与非心衰组。比较心衰组与非心衰组的一般资料,经Logistic法回归分析老年STEMI患者院内发生心衰的危险因素,并构建、验证相关列线图预测模型。结果训练集222例患者共74例住院期间发生心衰,验证集56例患者共21例住院期间发生心衰。与非心衰组比较,心衰组中性粒细胞与淋巴细胞比值(NLR)、心功能Killip分级≥3级率、病变血管数、修正休克指数(MSI)、发病至入院间隔、入院时急性冠脉事件全球注册(GRACE)评分、白细胞计数、N末端脑钠肽前体(NT-proBNP)、中性粒细胞与高密度脂蛋白胆固醇比值(NHR)升高,左心室射血分数(LVEF)降低,差异有统计学意义(P<0.05)。Logistic回归分析表明NLR、MSI、NT-proBNP、NHR是老年急性STEMI患者住院期间心衰发病的重要危险因素(P<0.05)。训练集列线图预测模型对老年急性STEMI患者住院期间心衰发病的预测灵敏度、特异度分别为89.19%、92.59%,ROC曲线下面积为0.897。验证集列线图预测模型对老年急性STEMI患者住院期间心衰发病的预测灵敏度、特异度分别为85.71%、89.47%,ROC曲线下面积为0.883。结论老年急性STEMI患者住院期间发生心衰与NT-proBNP、NLR、NHR、MSI具有密切关联性,据此构建的列线图在院内心衰发病风险预测中具有较高价值。

Objective To investigate the risk factors of nosocomial heart failure in elderly patients with acute ST-segment elevation myocardial infarction(STEMI),and to construct a prediction model of nomogram to provide a reference tool for prediction and evaluation of heart failure.Methods Clinical data of elderly patients with acute STEMI admitted to the hospital from June 2022 to June 2024 were retrospec-tively analyzed.A total of 278 cases were divided into validation set(n=56)and training set(n=222)ac-cording to the 2∶8 rule.According to the occurrence of nosocomial heart failure after percutaneous coro-nary intervention(PCI),elderly acute STEMI patients were divided into heart failure group and non-heart failure group.The general status of the heart failure group and the non-heart failure group was compared,the risk factors of heart failure in the hospital of elderly STEMI patients were analyzed by Logistic regres-sion,and the correlation nomogram prediction model was constructed and verified.Results A total of 74 of 222 patients in the training set experienced heart failure during hospitalization,while 21 out of 56 pa-tients in the validation set experienced heart failure during hospitalization.Compared with non heart fail-ure group,the heart failure group showed an increase in neutrophil to lymphocyte ratio(NLR),heart function Killip grade≥3 rate,number of diseased vessels,modified shock index(MSI),interval between onset and admission,global registry of acute coronary events(GRACE)score at admission,white blood cell count,N-terminal pro brain natriuretic peptide(NT proBNP),neutrophil to high-density lipoprotein cholesterol ratio(NHR),and a decrease in left ventricular ejection fraction(LVEF),with statistically sig-nificant differences(P<0.05).Logistic confirmed that NLR,MSI,NT-proBNP and NHR were impor-tant risk factors for heart failure in elderly acute STEMI patients during hospitalization(P<0.05).The sensitivity and specificity of the model for predicting the incidence of heart failure in elderly acute STEMI patients during hospitalization were 89.19%and 92.59%,respectively,and the area under the curve was 0.897.The sensitivity and specificity of the model were 85.71%and 89.47%,respectively,and the area under the curve was 0.883.Conclusion NT-proBNP,NLR,NHR and MSI are closely related to the oc-currence of heart failure in elderly acute STEMI patients during hospitalization,and the nomogram con-structed based on this is of high value in predicting the risk of heart failure in hospital.