Objective To establish a nomogram prediction model for in-hospital heart failure in elderly patients with acute ST-segment elevation myocardial infarction(STEMI).Methods The clinical data of 139 elderly patients with a-cute STEM I admitted to hospital from September 2021 to September 2023 were retrospectively analyzed and divided in-to training set(n=111)and validation set(n=28)according to 8∶2 law.The senile acute STEMI patients were divided into the occurrence group and the non-occurrence group according to the occurrence or non-occurrence of heart failure after percutaneous coronary intervention(PCI).The clinical data of the occurrence group and the non-occurrence group of the training set were compared,the influencing factors of the occurrence of nosocomial heart failure in elderly acute STEMI patients were analyzed,and the nomogram prediction model of nosocomial heart failure in elderly acute STEMI patients was constructed and verified.Results Among 111 patients in the training set,35 cases of heart failure occurred in hospital.In the verification set of 28 patients,9 cases of hospital heart failure occurred.In the training group,the pro-portion of Killip grade ≥ grade 3 cases,the number of diseased vessels,N-terminal brain natriuretic peptide precursor(NT-proBNP),white blood cell count,neutrophil to lymphocyte ratio(NLR),neutrophil to high density lipoprotein cholesterol ratio(NHR),modified shock index(MSI),the time from onset to admission,and Global Register of Acute Coronary Events(GRACE)score at admission in the occurrence group were higher than that in the non-occurrence group(P＜0.05),and the left ventricular ejection fraction(LVEF)in the occurrence group was lower than that in the non-occurrence group(P＜0.05).Logistic regression analysis showed that NT-proBNP(OR=4.272,95％CI:1.878～9.717),NLR(OR=4.764,95％CI:2.094～10.836),NHR(OR=3.888,95％CI:1.709～8.845)and MSI(OR=3.597,95％CI:1.581～8.182)were the influential factors for nosocomial heart failure in elderly patients with acute STEMI(P＜0.05).The sensitivity of the predictive model for predicting in-hospital heart failure in elderly acute STE-MI patients based on the training sets line chart was 88.57％(95％CI:0.723～0.963),with a specificity of 89.47％(95％CI:0.798～0.950),and an area under the curve of 0.903(95％CI:0.856～0.967).The sensitivity of the valida-tion set's line chart predictive model for predicting in-hospital heart failure in elderly acute STEM I patients was 88.88％(95％CI:0.507～0.994),with a specificity of 84.21％(95％CI:0.595～0.958),and an area under the curve of 0.894(95％CI:0.834～0.952).Conclusion NT-proBNP,NLR,NHR and MSI are related to the occurrence of nosoco-mial heart failure in elderly patients with acute STEMI,and the construction of a nomogram prediction model is helpful for early screening of the risk of nosocomial heart failure in elderly patients with acute STEMI.
关键词
老年/急性ST段抬高型心肌梗死/院内心衰/影响因素/列线图预测模型
Key words
elderly patients/acute ST elevation myocardial infarction/heart failure in hospital/influencing factors/nomogram prediction model
维普
万方数据