目的:探讨经皮冠状动脉介入治疗(Percutaneous Coronary Intervention,PCI)的老年ST段抬高型心肌梗死(ST elevation myocardial infarction,STEMI)患者在术后发生左心室重构的风险因素,并基于该风险因素构建PCI术后发生左心室重构的风险预测模型.方法:回顾性采集 2020 年1 月-2023年 6 月期间信阳市中心医院心血管内科完成PCI手术治疗的 162 例老年STEMI患者的临床资料.根据患者PCI后左心室重构发生情况分为发生组(46例)与未发生组(116 例).分析比较发生组与未发生组患者的基线资料,经回归分析检验老年STEMI患者PCI后左心室重构发生的风险因素,并基于风险因素构建列线图风险预测模型.结果:发生组的血清微小 RNA-503(Micro RNA-503,miR-503)、氨基末端脑钠肽前体(N terminal pro B type natriuretic peptide,NT-proBNP)、同型半胱氨酸(Homocystine,Hcy)、粘附斑激酶(Focal Adhesion Kinase,FAK)水平均显著高于未发生组,Apelin-13 水平显著低于未发生组(P＜0.05);其它基线资料组间比较无显著差异(P＞0.05).构建多元Logistic回归分析模型,结果显示,miR-503、NT-proBNP、Hcy、FAK、Apelin-13 水平异常均可能是老年STEMI患者经PCI手术后左心室重构发生的风险因素(P＜0.05).基于风险因素构建列线图预测模型,采用Bootstrap法对模型进行内部验证,结果显示,内部校正曲线与理想曲线的拟合反映良好,经ROC曲线检验整体模型的评估价值显示,AUC为 0.964(95%CI为 0.940-0.989),模型预测的精确度良好.结论:老年STEMI患者miR-503、NT-proBNP、Hcy、FAK、Apelin-13 水平异常可能是PCI后左心室重构的风险因素,以此构建列线图风险预测模型,模型预测评估精确度良好.
Construction of a risk prediction model for left ventricular remodeling in elderly patients with ST segment elevation myocardial infarction after PCI
Objective:To investigate the effects of Percutaneous Coronary Intervention(PCI)on elderly patients with ST elevation myocardial infarction(STEMI)risk factors for postoperative left ventricular remodeling in patients,and based on these risk factors,a risk prediction model for postoperative left ventricular remodeling after PCI was constructed.Methods:The clinical data of 162 elderly STEMI patients who underwent PCI surgery in the cardiovascular Department of Xinyang Central Hospital from January 2020 to June 2023 were retrospectively collected.According to the occurrence of left ventricular remodeling after PCI,patients were divided into occurrence group(46 cases)and non-occurrence group(116 cases).The baseline data of patients in the occurrence group and the non-occurrence group were analyzed and compared.The risk factors of left ventricular remodeling after PCI in elderly STEMI patients were examined by regression analysis,and the risk prediction model was built based on the risk factors.Result:The levels of Serum MicroRNA-503(miR-503),N terminal pro B type natriuretic peptide(NT-proBNP),homocystine(Hcy)and Focal Adhesion Kinase(FAK)were significantly higher than those of the non-developing group,and the level of Apelin-13 was significantly lower than that of the non-developing group(P<0.05).There were no significant differences among other baseline data groups(P>0.05).Multivariate Logistic regression analysis model was constructed,and the results showed that abnormal levels of miR-503,NT-proBNP,Hcy,FAK and Apelin-13 may be risk factors for left ventricular remodeling after PCI in elderly STEMI patients(P<0.05).A nomogram prediction model was built based on risk factors,and the model was internally verified by Bootstrap method.The results showed that the internal correction curve fit well with the ideal curve,and the evaluated value of the overall model was 0.964(95%CI 0.940-0.989)after ROC curve test.The accuracy of the model prediction is good.Conclusion:Abnormal levels of miR-503,NT-proBNP,Hcy,FAK and Apelin-13 in elderly STEMI patients may be a risk factor for left ventricular remodeling after PCI,and a nomogram risk prediction model was constructed with good prediction accuracy.
ST-segment elevation myocardial infarctionCoronary interventionElderly patientsLeft ventricular remodelingPrediction model
NETL
NSTL
万方数据
