摘要
目的构建单中心急性非ST段抬高型心肌梗死(NSTEMI)患者预后评估模型。方法收集2017年1月—2019年9月入院诊断为NSTEMI的患者497例为研究对象。随访(26.86±11.89)个月,终点为主要不良心血管事件(MACE)。分析NSTEMI患者院外MACE发生的危险因素,构建预测评分系统。结果将研究人群分为训练集和外部验证集。以终点事件为因变量对训练集人群进行分析,显示性别、年龄、吸烟、Killip>2级、GRACE评分、GRACE评分高危及极高危、袢利尿剂、射血分数、白蛋白、尿酸、磷、血红蛋白、院内介入均为相关影响因素。通过单因素、多因素Cox分析等多种统计学方法得到NSTEMI患者1年、2年无MACE事件发生的9个影响因素,建立相应的列线图(C-index=0.711)。与GRACE评分相比,本预测模型的AUC 1年(0.719 vs.0.736)、2年(0.702 vs.0.743)均较高,C-index同样优于GRACE评分(0.582 vs.0.711)。结论性别、年龄、院内介入、肌酐、射血分数、血钾、高密度脂蛋白、尿酸、Killip>2级是院外MACE事件的独立影响因素。基于上述9项影响因素,本研究建立的生存预测模型拥有较好的预测效能及一致性。列线图预测模型具有良好的区分度且较GRACE评分预测价值高,可为NSTEMI患者临床决策及预后预测提供个体化的有效预测工具。
Objective To build a single-center prognosis-predicting model of acute non ST-segment elevation myocardial infarction(NSTEMI),Methods A total of 497 patients who were definitely diagnosed with NSTEMI in our hospital from January 2017 to September 2019 were enrolled.The follow-up was(26.86±11.89)months,and the endpoints were major adverse cardiovascular events(MACE).The risk factors of out-of-hospital MACE in NSTEMI patients were analyzed,and a predictive scoring system was built.Results All included patients were divided into the training set and the external validation set.Taking the end-point event as the dependent variable,the analysis of patients in the training set showed that sex,age,smoking,Killip>2,GRACE score,high-risk and extremely high-risk,loop diuretics,ejection fraction,albumin,uric acid,phosphorus,hemoglobin,and in-hospital intervention were all relevant influencing factors.Nine influencing factors of NSTEMI patients without MACE in 1 year and 2 years were screened by univariate and multivariate Cox analysis,and the nomogram was established(C-index=0.711).Compared with GRACE score,the AUC of the nomogram was higher in 1 year(0.719 vs.0.736)and 2 years(0.702 vs.0.743),and the C-index was also better than GRACEscore(0.582 vs.0.711).Conclusion Sex,age,in-hospital interventioni,creatinine,ejection fraction,serum potassium,high density lipoprotein,uric acid,and Killip>2 were independent influencing factors for out-of-hospital MACE.The survival prediction model based on the above nine factors has good prediction efficiency and consistency.The nomogram prediction model has good differentiation and higher prediction value than GRACE score,which can provide an individualized and effective prediction tool for clinical decision-making and prognosis in NSTEMI patients.
作者
吕晓
黄继良
晋芹
但汉良
高鹏
白玉豪
苑智慧
李树仁
郝萧
LV Xiao;HUAGN Jiliang;JIN Qin;DAN Hanliang;GAO Peng;BAI Yuhao;YUAN Zhihui;LI Shuren;HAO Xiao(Department of Cardiology,People's Hospital of Dongxihu District,Wuhan,430040,China;Graduate School,North China University of Science and Technology;Graduate College,Hebei Medical University;Department of Cardiology,Hebei General Hospital)
出处
《临床心血管病杂志》
CAS
北大核心
2022年第12期967-974,共8页
Journal of Clinical Cardiology
