Establishment and evaluation of a risk prediction model for heart failure in patients with severe coronary calcification
-
摘要: 目的 探讨冠状动脉(冠脉)旋磨术对严重冠脉钙化的冠心病患者的治疗效果，建立术后心力衰竭(心衰)风险预测的模型。方法 选取240例患有严重冠脉钙化的老年患者作为研究对象，并根据术后1年随访结果分为心衰组和非心衰组。调查患者接受冠脉旋磨术后1年的心衰风险指标，绘制列线图和临床决策分析(DCA)曲线；计算ROC曲线下面积(AUC)、绘制校准图对列线图进行内部验证。结果 冠脉旋磨术1年后，对所有患者进行随访，心衰组和非心衰组左室射血分数(LVEF)、N末端脑钠肽前体(NT-proBNP)、肌酐、血糖等10个生化指标存在显著性差异。多因素logistic回归模型具有较好的拟合优度(χ2=4.796，P=0.779)，ln(NT-proBNP)、肌酐、血糖、胆固醇、LVEF、术后支架内狭窄及Syntax评分能够作为患者术后心衰发生的独立危险因素(均P < 0.05)。DCA曲线反映列线图预测模型具有良好的临床实用性；预测模型可以准确预测患者预后，AUC为0.890(95%CI：0.840~0.934)，校准曲线1年的预测生存概率与实际生存概率基本一致，平均绝对误差(MAE)为0.038。结论 冠脉旋磨术应用于严重冠脉钙化1年短期内随访预后良好。列线图预测模型具有较高的区分度和一致性，应用简单直观，能够为临床决策提供支持。Abstract: Objective To evaluate the effect of rotational atherectomy in coronary heart disease patients with severe coronary calcification and to establish a model for predicting the risk of postoperative heart failure.Methods A total of 240 elderly patients with severe coronary calcification disease were selected and divided into the heart failure group and the non-heart failure group according to the results of 1-year follow-up. The risk indicators of heart failure 1 year after the rotational atherectomy were investigated. The nomogram and the decision curve analysis(DCA) were drawn and the AUC was calculated, the calibration diagram was drawn for internal verification.Results After 1 year of rotational atherectomy, there were significant differences in left ventricular ejection fraction(LVEF), N-terminal pro-brain natriuretic peptide(NT-proBNP), creatinine, blood glucose, and other 10 biochemical indicators between two groups. Multiple logistic regression model had a good goodness-of-fit(χ2=4.796, P=0.779), 6 indictors including ln(NT-proBNP), creatinine, blood glucose, cholesterol, LVEF, postoperative stent stenosis, and Syntax score could be used as independent risk factors for the occurrence of postoperative heart failure(all P < 0.05). DCA curve showed that the predictive model of nomogram had good practicality. The prediction model could accurately predict the prognosis, the AUC was 0.890(95%CI: 0.840-0.934). The predicted survival probability of the calibrated curve was consistent with the actual survival probability, the mean absolute error(MAE) was 0.038.Conclusion Patients with severe coronary calcification treated with rotational atherectomy have a good prognosis during 1 year of follow-up. The nomogram prediction model has high degree of discrimination and accuracy, the application is simple and intuitive, which can help to make the clinical decision.
-
-
图 1 预测冠脉旋磨术后心衰风险的列线图模型
Figure 1. The nomogram for predicting the risk of heart failure after rotational atherectomy
图 3 列线图模型内部验证后的ROC曲线
Figure 3. ROC curve after internal validation of the nomogram model
图 4 列线图模型内部验证后的校准曲线
Figure 4. Calibration curve after internal validation of the nomogram model
表 1 非心衰组与心衰组临床资料比较
Table 1. Clinical data between the heart failure group and the non-heart failure group
M(P25, P75) 项目 全体(240例) 非心衰组(195例) 心衰组(45例) 统计量 P 性别/例(%) 1.904 0.168 男 138(57.50) 108(55.38) 30(66.67) 女 102(42.50) 87(44.62) 15(33.33) 年龄/岁 72.00(66.75，77.00) 72.00(66.5，76.00) 71.00(67.00，77.00) -0.544 0.587 高血压/例(%) 154(64.17) 131(67.18) 23(51.11) 4.106 0.043 LVEF/% 57.00(47.00，65.00) 59.00(48.00，66.00) 47.00(33.00，60.00) 4.012 < 0.001 术前CK-MB/(U·L-1) 16.00(12.00，23.25) 15.00(12.00，23.50) 17.00(13.00，23.00) -1.724 0.085 术前肌钙蛋白/(U·L-1) 0.10(0.01，0.65) 0.13(0.01，0.65) 0.07(0.01，0.64) -0.072 0.942 NT-proBNP/(pg·mL-1) 1377.50(320.75，2950.50) 1064.00(227.00，2451.00) 3534.00(1897.00，6987.00) -5.604 < 0.001 肌酐/(μmol·L-1) 74.00(62.00，92.00) 73.00(60.00，89.55) 90.00(72.00，136.00) -4.285 < 0.001 血糖/(μmol·L-1) 5.49(4.79，7.09) 5.39(4.74，6.82) 7.02(5.20，8.96) -3.531 < 0.001 糖化血红蛋白/% 6.80(5.90，7.93) 6.80(5.90，7.84) 6.75(5.80，8.53) -0.604 0.546 血红蛋白/(g·L-1) 121.00(110.00，131.00) 122.00(111.00，131.50) 113.00(108.00，130.00) 1.312 0.190 TC/(mmol·L-1) 3.80(3.11，4.52) 3.71(3.09，4.39) 4.39(3.32，6.37) -3.135 0.002 TG/(mmol·L-1) 1.23(0.97，1.63) 1.19(0.96，1.58) 1.42(1.09，2.26) -2.026 0.043 LDL-C/(mmol·L-1) 1.91(1.50，2.48) 1.88(1.49，2.40) 2.13(1.58，2.82) -2.120 0.034 VLDL/(mmol·L-1) 0.84(0.68，1.01) 0.83(0.66，1.00) 0.88(0.76，1.06) -1.743 0.081 术后支架内再狭窄/例(%) 13(5.42) 4(2.05) 9(20) 22.991 < 0.001 注：CK-MB：肌酸激酶同工酶；VLDL：极低密度脂蛋白。 
下载: 导出CSV
表 2 冠脉旋磨术后心衰发生风险的多因素logistic回归分析结果
Table 2. The risk of heart failure after rotational atherectomy analyzed by multivariate logistic regression analysis
指标 B SE Wald χ2 P OR(95%CI) 常量 -4.224 1.271 11.038 0.001 0.015 LVEF -0.057 0.018 10.431 0.001 1.945(1.713~2.978) ln(NT-proBNP) 0.004 0.001 12.107 0.005 1.000(1.000~1.009) 肌酐 0.005 0.001 11.181 0.001 1.005(1.002~1.008) 血糖 0.221 0.079 7.912 0.005 1.248(1.069~1.456) 胆固醇 0.751 0.180 17.388 0.000 2.119(1.489~3.016) 术后支架内再狭窄 2.564 0.817 9.860 0.002 12.992(2.621~64.394) Syntax评分 0.452 0.053 7.624 0.012 1.012(1.000~1.027)
下载: 导出CSV
-
[1] 马军伟, 王伟. 冠状动脉血管内碎石术研究进展[J]. 临床心血管病杂志, 2021, 37(5): 402-405. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXB202105003.htm
[2] 关晓楠, 李艳兵, 马宁, 等. 血管内超声指导冠状动脉旋磨对比切割球囊在左主干钙化病变单支架术式中应用1年的随访疗效分析[J]. 临床心血管病杂志, 2021, 37(6): 520-525. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXB202106006.htm
[3] 何贵均, 周骐. 冠状动脉钙化研究的新进展[J]. 中国心血管杂志, 2019, 24(6): 579-582. https://www.cnki.com.cn/Article/CJFDTOTAL-XIXG201906026.htm
[4] 宋倩, 陈韬, 郭军. 冠状动脉内旋磨术缺血并发症影响因素分析[J]. 临床军医杂志, 2020, 48(5): 609-610. https://www.cnki.com.cn/Article/CJFDTOTAL-JYGZ202005039.htm
[5] Uetani T, Amano T. Current status of rotational atherectomy in the drug-eluting stent era[J]. Circ J, 2018, 82(4): 946-947. doi: 10.1253/circj.CJ-18-0170
[6] 刘继纯, 凌洋, 范群, 等. 冠状动脉钙化的研究进展[J]. 牡丹江医学院学报, 2020, 41(4): 110-113. https://www.cnki.com.cn/Article/CJFDTOTAL-MDJB202004030.htm
[7] 中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志, 2018, 46(10): 760-789. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLYS201904009.htm
[8] 白云锋, 武向阳. 急性心肌梗死心力衰竭与冠脉病变严重程度的相关性及临床特点[J]. 世界最新医学信息文摘, 2019, 19(72): 125+127. https://www.cnki.com.cn/Article/CJFDTOTAL-WMIA201972087.htm
[9] 陈挺阳, 王喜泰. NT-proBNP及APACHE评分在老年慢性心力衰竭预后评估中的应用[J]. 临床合理用药杂志, 2020, 13(35): 175-177. https://www.cnki.com.cn/Article/CJFDTOTAL-PLHY202035084.htm
[10] 顾怡钰, 杨昕宇, 张铭炀, 等. 心房颤动射频消融术后复发不同预测评分的比较及Nomogram模型的构建[J]. 临床心血管病杂志, 2021, 37(12): 1126-1132. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXB202112012.htm
[11] 黄静和, 陈思敏, 许研, 等. 空间QRS-T夹角与冠状动脉病变的关系及主要不良心脏事件的预测价值[J]. 实用医学杂志, 2020, 36(22): 3130-3134. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ202022020.htm
[12] 刘同祥, 邱炳华, 台培春, 等. 冠脉旋磨术在冠状动脉钙化病变患者PCI治疗中的应用价值[J]. 心血管康复医学杂志, 2020, 29(2): 168-171. https://www.cnki.com.cn/Article/CJFDTOTAL-XXGK202002013.htm
[13] 江海燕. 冠状动脉旋磨术治疗冠状动脉严重钙化病变的护理支持[J]. 当代护士(下旬刊), 2020, 27(3): 122-124. https://www.cnki.com.cn/Article/CJFDTOTAL-DDHZ202003056.htm
[14] 韩煜, 刘忠龙, 祝奉硕, 等. 预测放射性下颌骨坏死术后复发的列线图模型建立[J]. 精准医学杂志, 2020, 35(5): 394-399. https://www.cnki.com.cn/Article/CJFDTOTAL-SPAN202005004.htm
[15] Paolo R, Nikolaos A. Coronary artery plaque burden nomograms: are they ready for use?[J]. Circ Cardiovasc Imaging, 2017, 10(3).
-
图(4)
表(2)
计量
- 文章访问数: 1132
- PDF下载数: 662
- 施引文献: 0