Construction of nomogram model to predict reperfusion injury after carotid artery stenting
Objective To analyze the influencing factors of reperfusion injury after carotid artery stenting in patients with ischemic stroke caused by carotid artery stenosis,to construct a nomogram model of reperfusion injury after carotid artery stenting,and to intestigate its predictive value.Methods From December 2016 to May 2021,310 patients with ischemic stroke underwent carotid artery stenting in Nanyang Central Hospital,among whom 36 patients developed postoperative reperfusion injury(reperfusion injury group)and 274 patients developed no reperfusion injury(non-reperfusion injury group).The body mass index(BMI),comorbidities(hypertension,diabetes,coronary heart disease),smoking habits,alcohol consumptions,carotid artery stenosis site and degree,collateral circulation,and serum levels of total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),S-100β,and neuron-specific enolase(NSE)on admission were compared between two groups.The risk factors of reperfusion injury after carotid artery stenting were analyzed by multivariate logistic regression,and the R software 4.0 was used to analyze the results of reperfusion injury according to the risk factors.Based on the risk factors,R language software 4.0"rms"package was used to construct a nomogram model of reperfusion injury after carotid artery stenting in ischemic stroke patients,the performance of the model was evaluated by C index and calibration curve,and the net benefit of the model was assessed by decision curve.Results(1)The rates of hypertension,coronary heart disease,poor collateral circulation and severe carotid artery stenosis,and the levels of serum S-100β and NSE were higher in reperfusion injury group[83.33％,27.78％,47.22％,25.00％,(88.36±4.52)ng/L,(10.80±1.36)μg/L]than those in non-reperfusion injury group[65.33％,6.93％,17.15％,5.11％,(82.90±4.08)ng/L,(9.55±1.06)μg/L](P＜0.05),and there were no significant differences in the gender ratio,age,smoking habits,alcohol consumptions,diabetes mellitus,carotid artery stenosis site,serum levels of TC,TG,LDL-C and HDL-C levels between two groups(P＞0.05).(2)Coronary heart disease(OR=8.033,95％CI:4.326-25.663,P＜0.001),poor collateral circulation(OR=3.686,95％CJ:1.121-12.118,P=0.032),severe carotid artery stenosis(OR=7.087,95％CI:1.636-30.697,P=0.009),and S-100β ≥84.9 ng/L(OR=15.448,95％CI:3.976-60.016,P＜0.001)were the risk factors of reperfusion injury after carotid artery stenting in patients with ischemic stroke.(3)The results of internal validation showed that the C index of the constructed nomogram model was 0.766(95％CI:0.719-0.786),and the calibration curve was basically close to the ideal curve with a good agreement;the decision curve was far away from the horizontal and vertical coordinates,and the risk threshold for predicting reperfusion injury after carotid artery stenting was＞0.03.Conclusion Coronary artery disease,poor collateral circulation,severe carotid artery stenosis,and S-100βlevel≥84.9 ng/L are the risk factors of reperfusion injury after carotid artery stenting in patients with ischemic stroke caused by carotid artery stenosis,and the nomogram model can effectively predict the risk of reperfusion injury.
ischemic strokecarotid artery stenosiscarotid artery stentingreperfusion injurynomogram model
NETL
NSTL
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