摘要
目的探讨老年冠心病患者冠状动脉血运重建术后主要不良心血管事件(MACE)的危险因素及干预模式的有效性,建立并验证风险预测模型。方法采用区组随机化法,将200例接受冠状动脉血运重建术的冠心病患者分为干预组100例和对照组100例,所有患者均由专科医生提供诊治方案并随访2年,同时干预组患者实施综合管理。实际完成研究的患者共196例,其中干预组99例,对照组97例。根据是否发生MACE,将196例患者分为MACE组39例和非MACE组157例,比较MACE组和非MACE组患者随诊2年后的临床资料。采用多因素logistic回归分析评估老年冠心病患者冠状动脉血运重建术后MACE的危险因素,并建立列线图预测模型。结果MACE组和非MACE组患者随诊2年后年龄、吸烟、高血压病、糖尿病、糖化血红蛋白(HbA1c)控制达标、低密度脂蛋白胆固醇(LDL-C)控制达标、左心室射血分数(LVEF)、肾功能不全、Gensini积分、综合干预方面比较差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,年龄>65岁、吸烟、高HbA1c、高LDL-C、低LVEF、高Genisi积分是老年冠心病患者冠状动脉血运重建术后MACE的独立危险因素,而综合干预为其保护因素(P<0.05)。列线图预测的老年冠心病患者冠状动脉血运重建术后MACE发生率与MACE实际发生率基本一致,一致性指数(C-index)为0.865(95%CI 0.821~0.925)。结论综合管理的干预模式有助于降低老年冠心病患者冠状动脉血运重建术后MACE的发生率;年龄越大,术后发生MACE的危险性越大;吸烟、高HbA1c和高LDL-C显著提高MACE的发生率;高Gensini积分为发生MACE的重要预测因素。列线图预测模型对MACE的发生有精准的预测能力和辨识度,在临床中需对上述危险因素进行重点关注,并积极干预,减低MACE的发生率。
Objective To explore the risk factors of major adverse cardiovascular events(MACE)after coronary artery revascularization and the effectiveness of intervention models in elderly patients with coronary artery disease,and to establish and verify the risk prediction model.Methods A total of 200 patients with coronary artery disease undergoing coronary artery revascularization were divided into intervention group(100 cases)and control group(100 cases)by a simple randomized grouping method.All patients were provided with diagnostic and treatment plans by specialist doctors,and followed up for 2 years.At the same time,patients in intervention group were managed comprehensively.196 patients actually completed the study,including 99 patients in intervention group and 97 patients in control group.According to whether MACE occurred,196 patients were divided into MACE group(39 cases)and non-MACE group(157 cases).Clinical data of patients in MACE group and non-MACE group after 2 years of follow-up were compared.Risk factors of MACE after coronary artery revascularization in elderly patients with coronary artery disease were analyzed by multivariate logistic regression,and nomogram prediction model was established.ResultsThere were statistically significant differences of age,smoking,hypertension,diabetes mellitus,glycosylated hemoglobin(HbA1c),low density lipoprotein cholesterin(LDL-C),left ventricular ejection fraction(LVEF),renal dysfunction,Gensini score,comprehensive intervention between MACE group and non-MACE group after 2 years of follow-up(P<0.05).Multivariate logistic regression analysis showed that age>65 years old,smoking,high HbA1c,high LDL-C,low LVEF,high Gensini score were independent risk factors for MACE after coronary artery revascularization in elderly patients with coronary heart disease,while comprehensive intervention was protective factor(P<0.05).The incidence rate of MACE after coronary artery revascularization predicted by nomogram was basically consistent with the actual incidence rate of MACE in elderly patients with coronary heart disease,and the consistency index(C-index)was 0.865(95%CI 0.821~0.925).Conclusion The intervention mode of comprehensive management is helpful to reduce the incidence of MACE after coronary revascularization in elderly patients with coronary heart disease.The older the patient is,the greater the risk of postperative MACE is;Smoking,high HbA1c and high LDL-C significantly increase the incidence of MACE;High Gensini score is an important predictor of MACE.The nomogram prediction model has accurate prediction ability and discrimination for the occurrence of MACE.In clinical practice,it is necessary to focus on above risk factors and actively intervene to reduce the incidence of MACE.
作者
杨明
刘敏
聂斌
程波
徐亚宁
姚峰
刘建华
Yang Ming;Liu Min;Nie Bin;Cheng Bo;Xu Yaning;Yao Feng;Liu Jianhua(Department of Comprehensiveness,Wuhan Sixth Hosipital,Wuhan 430015,China)
出处
《临床内科杂志》
CAS
2022年第11期740-744,共5页
Journal of Clinical Internal Medicine
关键词
老年患者
冠心病
冠状动脉血运重建术
主要不良心血管事件
风险预测模型
列线图
Elderly patients
Coronary artery disease
Coronary artery revascularization
Major adverse cardiovascular events
Risk model
Nomogram
作者简介
通讯作者:刘建华,E-mail:ljianhua1101@163.com
