摘要
目的探究老年冠心病患者经皮冠状动脉介入治疗(PCI)术后1年内再入院治疗的影响因素,建立并验证其个体化预测的列线图模型。方法选取2017年4月至2019年4月期间行PCI术的423例老年冠心病(CHD)患者作为模型组,选取2019年5月至2019年12月期间行PCI术的108例老年CHD患者作为验证组。收集患者的临床资料和1年随访记录;单因素、多因素Logistic回归分析再入院的危险因素;采用R软件建立预测术后1年内患者再入院治疗风险的列线图模型,并进行验证。结果年龄≥70岁(OR=1.020,95%CI 0.703~1.481)、高血压(OR=1.175,95%CI 0.792~1.742)、高血脂(OR=1.507,95%CI 1.059~2.144)、糖尿病(OR=1.828,95%CI 1.162~2.874)、脑血管病(OR=1.682,95%CI 1.356~2.087)、左心衰竭(OR=1.828,95%CI 1.442~2.317)、三支病变(OR=1.190,95%CI 0.770~1.839)、左主干病变(OR=1.294,95%CI 0.970~1.727)和支架数量≥3枚(OR=1.249,95%CI 0.911~1.712)为影响患者治疗后1年再入院的独立危险因素。成功建立个体化预测列线图模型,模型组和验证组的一致性指数分别为0.841和0.819,校准曲线显示该模型具有良好的区分度和精确度;ROC曲线显示该模型预测模型组和验证组患者治疗后1年内再次入院治疗风险的AUC分别为0.828(95%CI 0.795~0.861)和0.805(95%CI 0.759~0.839)。结论年龄(≥70岁)、高血压、高血脂、糖尿病、脑血管病、左心衰竭、三支病变、左主干病变和支架数量≥3枚是影响CHD患者PCI术后1年内再次入院的独立危险因素;以这些因素构建的列线图预测模型对预测PCI术后1年内再入院具有较好价值。
Objective To determine the factors influencing readmission within 1 year after percutaneous coronary intervention(PCI)in elderly patients with coronary heart disease(CHD),and to establish and verify a nomogram model for individual prediction.Methods A total of 423 CHD patients admitted to our hospital who underwent PCI from April 2017 to April 2019 were selected as the model group,and 108 CHD patients who underwent PCI from May 2019 to December 2019 as the verification group.Clinical data and 1-year follow-up record were collected in all patients.The risk factors for readmission were assessed by univariate and multivariate logistic regression analysis.R software was used to establish and verify the nomogram model for predicting the risk of readmission within 1 year after surgery.Results The independent risk factors for readmission within 1 year after PCI included age≥70 years old(OR=1.020,95%CI 0.703-1.481),hypertension(OR=1.175,95%CI 0.792-1.742),hyperlipidemia(OR=1.507,95%CI 1.059-2.144),diabetes(OR=1.828,95%CI 1.162-2.874),cerebrovascular disease(OR=1.682,95%CI 1.356-2.087),left heart failure(OR=1.828,95%CI 1.442-2.317),triple vessel lesion(OR=1.190,95%CI 0.770-1.839),left main coronary arterial lesion(OR=1.294,95%CI 0.970-1.727),and stent number≥3(OR=1.249,95%CI 0.911-1.712).The nomogram model for individual prediction was established successfully.The concordance indexes were 0.841 and 0.819 in the model group and the verification group,respectively.The calibration curve indicated that the model had good discrimination and accuracy.The ROC curve revealed that the AUC was 0.828(95%CI 0.795-0.861)in the model group and 0.805(95%CI 0.759-0.839)in the verification group for predicting the risk of readmission within 1 year after PCI.Conclusion The age(≥70 years old),hypertension,hyperlipidemia,diabetes mellitus,cerebrovascular disease,left heart failure,triple vessel lesion,left main coronary arterial lesion and stent number≥3 are independent risk factors for readmission of CHD patients within 1 year after PCI.The nomogram model constructed according to these risk factors has good value in predicting readmission within 1 year after PCI.
作者
张丽
左蕾
ZHANG Li;ZUO Lei(Department of Cardiology,Xingtai Third Hospital,Xingtai 054000,China)
出处
《南昌大学学报（医学版）》
2022年第4期75-80,共6页
Journal of Nanchang University：Medical Sciences
基金
河北省医学会基金课题(162658-5-2)。
关键词
冠心病
经皮冠状动脉介入治疗
危险因素
再入院
列线图
老年人
coronary heart disease
percutaneous coronary intervention
risk factors
readmission
nomogram
elderly
作者简介
张丽(1982-),女,本科,主管护师,主要从事心内科的急救及术后管理方面的研究;通信作者:左蕾,主治医师,E-mail:aivod63@126.com。
