中国现代医学杂志2023，Vol.33Issue(24)：87-93,7.DOI:10.3969/j.issn.1005-8982.2023.24.015
急性ST段抬高型心肌梗死患者PCI后左心室壁瘤形成的影响因素分析及预测模型的初步构建
Analysis of factors affecting left ventricular aneurysm formation after PCI in patients with acute ST-segment elevation myocardial infarction and preliminary development of a prediction model
摘要
Abstract
Objective To explore the factors affecting left ventricular aneurysm(LVA)formation in patients with acute ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI),based on which to preliminarily develop a prediction model.Methods The clinical data of 110 STEMI patients admitted to our hospital from January 2020 to January 2023 were retrospectively analyzed.According to whether LVA occurred after PCI,they were divided into LVA-free group(76 cases)and LVA group(34 cases).Univariable analysis and multivariable Logistic regression analysis were performed to screen factors affecting LVA formation in STEMI patients after PCI.With the results of multivariable analysis,the prediction model for LVA formation in STEMI patients after PCI was preliminarily developed,and the performance of the prediction model was evaluated via the receiver operating characteristic(ROC)curve.Results The proportion of female patients,rate of alcohol consumption and levels of CRP,BNP and MMP-9 in the LVA group were higher than those in the LVA-free group(P＜0.05).The LVEF in the LVA group was lower than that in the LVA-free group(P＜0.05).The ROC curve analysis demonstrated that areas under curves(AUCs)of LVEF,CRP,BNP,and MMP-9 in predicting LVA formation in STEMI patients after PCI were 0.836,0.860,0.868,and 0.803(P＜0.05),with the cut-off values being 49.478％,27.905 mg/L,389.798 pg/mL,and 279.807 pg/mL,respectively.The multivariable Logistic regression analysis showed that female[(OR)=3.589(95％CI:1.428,7.25)],alcohol consumption[(OR)=2.694(95％CI:1.437,5.482)],LVEF(≤ 49.478％)[(OR)=3.978(95％CI:0.537,1.176)],and levels of CRP(≥ 27.905 mg/L)[(OR)=4.959(95％CI:2.003,19.350)],BNP(≥ 389.798 pg/mL)[(OR)=2.739(95％CI:1.455,5.712)]and MMP-9(≥ 279.807 pg/mL)[(OR)=5.105(95％CI:1.684,14.178)]were risk factors for LVA formation in STEMI patients after PCI(P＜0.05).Based on the results of multivariable Logistic regression analysis,relevant clinical indicators including LVEF,CRP,BNP,and MMP-9 were included in the prediction model,which was established as Logit(P)=-31.584+1.381XLVEF+1.601XCRP+1.007XBNP+1.630XMMP-9.The ROC curve analysis indicated that the cut-off value of the prediction model for LVA formation in STEMI patients after PCI was 31.580,with an AUC of 0.941,a sensitivity of 92.1％(95％CI:84.6％,98.8％),and a specificity of 88.2％(95％CI:75.4％,93.4％).The sensitivity of the prediction model was higher than that of each indicators alone for predicting LVA formation after PCI in STEMI patients.Conclusions Female,alcohol consumption,and high LVEF and levels of CRP,BNP,and MMP-9 are risk factors for the formation of LVA in STEMI patients after PCI.Clinical follow-up should be conducted on patients with risk factors for a long time to early detect the occurrence of LVA and to facilitate early treatment.关键词
ST段抬高型心肌梗死/经皮冠状动脉介入治疗/左心室壁瘤/危险因素/预测模型Key words
ST-segment elevation myocardial infarction/percutaneous coronary intervention/left ventricular aneurysm/risk factor/prediction model分类
医药卫生引用本文复制引用
李楠,郭永梅,蔡雄,张上仕,邹金荣..急性ST段抬高型心肌梗死患者PCI后左心室壁瘤形成的影响因素分析及预测模型的初步构建[J].中国现代医学杂志,2023,33(24):87-93,7.基金项目
江西省自然科学基金(No:20202BAB206004) （No:20202BAB206004）
江西省卫生健康委科技计划项目(No:202140916) （No:202140916）
