摘要
目的 建立并验证老年冠心病急诊患者行经皮冠状动脉介入治疗(PCI)后心肌内出血的风险因素预测模型。方法 选择南京医科大学第一附属医院2022年收治的54例行PCI的急诊老年冠心病患者作为研究对象,同期选择50例行PCI的急诊老年冠心病患者作为验证组;以心脏磁共振成像作为诊断和评估心肌内出血的金标准,采用多因素logistic回归模型构建心肌内出血风险因素的预测模型,绘制ROC曲线分析预测模型的应用价值。结果 心肌内无出血者29例(无出血组),出血者28例(出血组)。出血组心肌梗死部位、病变支数、开通时间、肾功能不全比较,差异均有统计学意义(P<0.05);多因素logistic分析,结果显示心肌梗死部位为前壁、病变支数为多支、开通时间>45 min、肾功能不全是影响患者术后心肌内出血的独立危险因素(P<0.05),其联合预测模型为logit(P)=0.695×心肌梗死部位+0.756×病变支数+0.678×开通时间+0.702×肾功能不全;该预测模型预测急诊老年冠心病患者PCI后心肌内出血的曲线下面积为0.870(95%CI:0.769~0.972,P<0.001);在验证组中采用预测模型的灵敏度为89.47%,特异度为90.32%,阳性预测值为85.00%,阴性预测值为93.33%,准确率为90.00%,具有较高的应用价值。结论 通过心肌梗死部位、病变支数、开通时间、肾功能不全构建的预测急诊老年冠心病患者PCI后心肌内出血的模型具有较高的应用价值。
Objective To establish and validate a risk prediction model for myocardial hemorrhage after percutaneous coronary intervention(PCI)in elderly patients with acute coronary syndrome.Methods 54 elderly patients with acute coronary syndrome(ACS)who received percutaneous coronary intervention(PCI)at the First Affiliated Hospital of Nanjing Medical University in 2022 were selected as the study group,and 50 elderly patients with ACS who received PCI during the same period were selected as the validation group.Cardiac magnetic resonance imaging was used as the gold standard for diagnosing and evaluating myocardial hemorrhage,and a multiple logistic regression model was used to construct a risk prediction model for myocardial hemorrhage.ROC curve analysis was performed to evaluate the predictive value of the model.Results A total of 29 patients(the non-hemorrhage group)had no myocardial bleeding,while 28 patients(the hemorrhage group)developed myocardial hemorrhage after PCI.The differences in infarct location,number of diseased vessels,time to revascularization,and renal dysfunction were statistically significant between the two groups(P<0.05).Multivariate logistic analysis demonstrated that infarct location in the anterior wall,multiple diseased vessels,time to revascularization>45 min,and renal dysfunction were independent risk factors for postoperative myocardial hemorrhage(P<0.05).The combined prediction model determined by logistic regression analysis was logit(P)=0.695×infarct location+0.756×number of diseased vessels+0.678×time to revascularization+0.702×renal dysfunction.The AUC of the prediction model for elderly emergency patients with ACS after PCI-related myocardial hemorrhage was 0.870(95%CI:0.769-0.972,P<0.001).In the validation cohort,the sensitivity of the prediction model was 89.47%,the specificity was 90.32%,the positive predictive value was 85.00%,the negative predictive value was 93.33%,and the accuracy was 90.00%.The prediction model had high application value.Conclusion The risk prediction model
作者
魏群
孟浩宇
张敏
耿益
Wei Qun;Meng Haoyu;Zhang Min;Geng Yi(Department of Cardiovascular Medicine,the First Afiliated Hospital with Nanjing Medical University,Nanjing 210029)
出处
《国际老年医学杂志》
2023年第5期524-527,共4页
International Journal of Geriatrics
基金
江苏省基础研究计划(自然科学基金)-青年基金项目(BK20210966)。
关键词
老年冠心病
经皮冠状动脉介入治疗
心肌内出血
风险因素
预测模型
Elderly coronary heart disease
Percutaneous coronary intervention
Myocardial hemorrhage
Risk factors
Prediction model
