心肺运动试验结果参数对冠心病PCI术后焦虑患者转归的预测价值

Predictive value of result parameters of cardiopulmonary exercise testing to outcomes in anxiety patients with coronary heart disease after PCI

目的探讨心肺运动试验结果参数对冠状动脉粥样硬化性心脏病(冠心病)经皮冠状动脉介入治疗(PCI)术后焦虑患者转归的预测价值。方法选择2016年1月至2018年12月于河南大学淮河医院接受PCI的冠心病患者847例的数据资料进行回顾性分析。描述全部患者术后5年内的随访情况以及死亡情况。冠心病PCI术后焦虑患者术后5年死亡的单因素分析、多因素分析。冠心病PCI术后焦虑患者术后5年死亡的预测模型构建和预测效能分析。结果全部患者接受了1427(827,1634)d的PCI术后随访。全部纳入研究的患者之中,术后5年共有68例死亡,779例生存。单因素分析结果显示,术后5年内死亡患者以及生存患者的用力肺活量占预测百分比(FVC%)、二氧化碳通气当量最小值(VE/VCO_(2))、运动后3 min内心率恢复(HRR)的数据差异有统计学意义(P<0.05)。多因素分析结果显示,FVC%、VE/VCO_(2)、HRR是冠心病PCI术后焦虑患者术后5年死亡的独立影响因素(P<0.05)。依据多因素分析所筛选出来的变量构建列线图风险模型,C-index为0.723。利用Bootstrap自抽样法进行内部验证,重复自抽样1000次,获得校准曲线,平均绝对误差为0.008,决策分析曲线分析结果显示,在综合风险阈值概率11%~51%,净获益率>0。利用回归模型的独立影响因素以及P值预测概率对冠心病PCI术后焦虑患者术后5年死亡进行ROC曲线的预测,约登指数分别为33.14%、34.82%、39.61%、53.06%。结论冠心病PCI术后焦虑患者转归同FVC%、VE/VCO_(2)、HRR三种心肺运动试验结果参数有关;而基于各影响因素的预测模型能够较为良好地预测患者的转归。

Objective To discuss the predictive value of result parameters of cardiopulmonary exercise testing(CPET)to outcomes in anxiety patients with coronary heart disease(CHD)after PCI.Methods The clinical data of CHD patients received PCI(n=847)were retrospectively analyzed in Huaihe Hospital of Henan University from Jan.2016 to Dec.2018.The information of follow-up and death were described in all patients within 5 y after PCI.The death information was given single-factor and multi-factor analyses in CHD patients with anxiety within 5 y after PCI.A predictive model was established and its predictive effectiveness on death was analyzed in CHD patients with anxiety after PCI.Results All patients were followed up for 1427 d after PCI.Among all patients included the study,there were 68 died patients and 779 survival ones after PCI for 5 y.The results of single-factor analysis showed that differences in predicted percentage of forced vital capacity(FVC%),minimum carbon dioxide ventilation equivalent(VE/VCO_(2))and 3 min post-exercise heart rate recovery(HRR)had statistical significance between died patients and survival ones within 5 y after PCI.The results of multi-factor analysis showed that FVC%,VE/VCO_(2)and HRR were independent influence factors for death in CHD patients with anxiety after PCI for 5 y(P<0.05).A nomogram risk model was established based on the variables screened by multi-factor analysis,and C-index was 0.723.Bootstrap self-sampling method was used for internal verification,and self-sampling was repeated for 1000 times to obtained a calibration curve with an average absolute error of 0.008.The results of decision analysis curve showed that the probability of comprehensive risk threshold was 11%-51%,and net benefit rate was>0.The independent influence factors in regression model and P-value prediction probability were used to predict the death in ROC curve in CHD patients with anxiety after PCI for 5 y,and Youden index was,respectively,33.14%,34.82%,39.61%and 53.06%.Conclusion The outcomes of CHD patients with postoperative anxiety are correlated to CPET parameters of FVC%,VE/VCO_(2)and HRR,and the predictive model based on various influence factors can predict well patients’outcomes.