摘要
目的探讨基于超声心动图和临床电子病历信息构建老年稳定型冠状动脉粥样硬化性心脏病(冠心病)临界病变患者中预测远期主要不良心血管事件(MACEs)的风险预测模型。方法本研究纳入2018年1月至2020年12月于武汉大学人民医院心内科住院的老年稳定型冠心病临界病变患者。应用LASSO回归和多因素Cox回归分析筛选特征变量并构建列线图。利用曲线下面积(AUC)、校准曲线和决策曲线分析来对预测模型进行性能的评估。结果总共纳入345例,按照7:3的比例随机分为训练组(n=241)和验证组(n=104)。糖尿病、既往心肌梗死、脂蛋白(a)和左室舒张期后壁厚度(LVPWD)与MACEs有显著相关性,并基于这四项指标构建列线图。在预测训练组患者出院后2年和3年分别发生MACEs的AUC为0.717(95%CI:0.622~0.812)和0.72(95%CI:0.638~0.802),在验证组患者2年和3年分别发生MACEs的AUC分别为0.668(95%CI:0.527~0.809)和0.691(95%CI:0.552~0.83)。在训练组以及验证组校准曲线均表现出预测模型具有良好的一致性。在训练组以及验证组中决策曲线分析显示出预测模型很大的正向收益率。结论基于糖尿病、既往心肌梗死、脂蛋白(a)和LVPWD构建的列线图可以有效预测老年稳定型冠心病临界病变患者出院后2年和3年的发生MACEs的风险。
Objective To investigate the construction of predictive model for long-term risk of major adverse cardiovascular events(MACEs)based on echocardiogram and data of clinical electronic medical record(EMR)in elderly patients with coronary intermediate lesion of stable coronary heart disease(CHD).Methods The elderly patients with coronary intermediate lesion of CHD were chosen from Department of Cardiology in Renmin Hospital of Wuhan University from Jan.2018 to Dec.2020.The characteristic variables were screened and a nomogram was constructed by using LASSO regression and multi-factor Cox regression analyses.The performanceof the predictive model was assessed by using analyses of area under curve(AUC),calibration curve and decision curve.Results There were totally 345 cases included,and they were randomly divided,in a ratio of 7:3,into training group(n=241)and validation group(n=104).There was a significant correlation among diabetes,previous myocardial infarction,lipoprotein(a)[LP(a)],left ventricular posterior wall thickness at end diastole(LVPWTD)and MACEs,and a nomogram was constructed based on above 4 indexes.In predicting MACEs occurrence in training group,AUC was 0.717(95%CI:0.622~0.812)after discharged for 2 y,and AUC was 0.72(95%CI:0.638~0.802)after discharged for 3 y.In predicting MACEs occurrence in validation group,AUC was 0.668(95%CI:0.527~0.809)after discharged for 2 y,and AUC was 0.691(95%CI:0.552~0.83)after discharged for 3 y.The performance of calibration curve showed a good consistency of predictive model in 2 groups.The performance of decision curveshowed a positive yield of predictive model in 2 groups.Conclusion The nomogram constructed based on diabetes,previous myocardial infarction,LP(a)and LVPWTD can effectively predict MACEs risk in elderly CHD patients with coronary intermediate lesion after discharged for 2 y and 3 y.
作者
王代娇
宋宏宁
陈金玲
Wang Daijiao;Song Hongning;Chen Jinling(Department of Ultrasonography,Renmin Hospital,Wuhan University,Wuhan 430060,China;不详)
出处
《中国循证心血管医学杂志》
2024年第9期1034-1038,共5页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
国家自然科学基金(82102046)。
关键词
稳定型冠心病
冠状动脉临界病变
超声心动图
Stable coronary heart disease
Coronary intermediate lesion
Echocardiogram
作者简介
通讯作者:陈金玲,E-mail:77810848@qq.com。
