急性ST段抬高型心肌梗死经皮冠状动脉介入术后患者发生心肌微循环灌注障碍的影响因素分析及风险预测模型的构建
Analysis of influencing factors and construction of risk prediction model for myocardial microcirculation perfusion disorders in patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention
王静 1刘树凯 2张丽 1凡艳儒 1王海山1
作者信息
- 1. 063000 河北省唐山市,唐山市妇幼保健院120中心
- 2. 063000 河北省唐山市,唐山市妇幼保健院内科
- 折叠
摘要
目的 分析急性ST段抬高型心肌梗死(STEMI)经皮冠状动脉介入术(PCI)后患者发生心肌微循环灌注障碍的影响因素,并构建风险预测模型.方法 回顾2020年5月～2024年1月于唐山市妇幼保健院行PCI的384例STEMI患者的临床资料,并采用随机数字表法分为建模组(n=269)和验证组(n=115).根据建模组患者术后TIMI心肌灌注分级(TMPG)分为障碍组(n=61)和正常组(n=208).STEMI患者PCI后心肌微循环障碍的影响因素采用多因素logistic回归分析;构建预测STEMI患者PCI后心肌微循环障碍的列线图预测模型,绘制校准曲线和ROC曲线评估模型预测效能.结果 与正常组比较,障碍组左心室射血分数(LVEF)较低,糖尿病、高血压、症状-首次医疗接触(FMC)＞4h、FMC-肝素给予(H)＞4h、冠状动脉慢血流的占比较高(P＜0.05).多因素logistic回归分析显示,LVEF(OR=0.875)、糖尿病(OR=2.284)、高血压(OR=2.417)、症状-FMC 时间(OR=3.200)、FMC-H 时间(OR=2.185)、冠状动脉慢血流(OR=2.416)均为 STEMI 患者PCI后心肌微循环灌注障碍的影响因素(P＜0.05).建模组ROC曲线下面积为0.820(95％CI 0.761～0.880),敏感度为72.13％,特异度为80.77％;验证组ROC曲线下面积为0.899(95％CI 0.814～0.984),敏感度为90.00％,特异度为 80.00％.Hosmer-Lemeshow拟合度检验中,建模组x2=11.877,P=0.157,验证组x2=10.438,P=0.236.结论 STEMI患者PCI后心肌微循环灌注障碍的发生与LVEF、糖尿病、高血压、症状-FMC时间、FMC-H时间、冠状动脉慢血流密切相关,基于这些因素构建的风险预测模型区分度较佳.
Abstract
Objective To analyze the influencing factors of myocardial microcirculation perfusion disorders in patients with acute ST segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI)and to construct a risk prediction model.Methods The clinical data of 384 STEMI patients who underwent PCI in Tangshan Maternal and Child Health Hospital from May 2020 to January 2024 were reviewed and divided into the modeling group(n=269)and verification group(n=1 15)by random number table method.According to the postoperative TIMI myocardial perfusion grading(TMPG)of patients in the modeling group,they were separated into the obstacle group(n=61)and the normal group(n=208).The influencing factors of myocardial microcirculation disturbance after PCI in STEMI patients were analyzed by multivariate logistic regression.A nematographic prediction model for predicting myocardial microcirculation disturbance in STEMI patients after PCI was constructed,and the calibration curve and ROC curve were drawn to evaluate the prediction efficiency of the model.Results Compared with the normal group,the left ventricular ejection fraction(LVEF)in the obstacle group was lower but the proportions of diabetes,hypertension,symptom first medical contact(FMC)＞4 h,FMC heparin(H)＞4 h,and coronary slow flow were higher(P＜0.05).Multivariate logistic regression found that LVEF(OR=0.875),diabetes(OR=2.284),hypertension(OR=2.417),symptom-FMC time(0R=3.200),FMC-H time(OR=2.185)and coronary slow flow(OR=2.416)were all the influencing factors of myocardial microcirculation perfusion obstruction in STEMI patients after PCI(P＜0.05).The area under the ROC curve of the modeling group was 0.820(95％CI 0.761-0.880),with a sensitivity of 72.13％and a specificity of 80.77％;the area under the ROC curve of the validation group was 0.899(95％CI 0.814-0.984),with a sensitivity of 90.00％and a specificity of 80.00％.In the Hosmer-Lemeshow fit test,the modeling group x2=11.877,P=0.157,and the validation group x2=10.438,P=0.236.Conclusion The occurrence of myocardial microcirculation perfusion disorder in STEMI patients after PCI is closely related to LVEF,diabetes,hypertension,symptom-FMC time,FMC-H time and coronary slow flow;the distinction of risk prediction model based on these factors is better.
关键词
急性ST段抬高型心肌梗死/经皮冠状动脉介入术/心肌微循环灌注障碍/影响因素/预测模型Key words
Acute ST segment elevation myocardial infarction/Percutaneous coronary intervention/Myocardial microcirculation perfusion disorders/Influencing factors/Prediction model引用本文复制引用
基金项目
河北省医学科学研究重点课题计划项目(20221765)
出版年
2024
NETL
NSTL
万方数据