Abstract
Objective To establish an integrated Chinese and Western medicine clinical prediction model for the risk of major adverse cardiovascular events(MACEs)following percutaneous coronary intervention(PCI)in patients with coronary heart disease(CHD),and offer a reference for the early screening and diagnosis of high-risk patients.Methods A total of 1 137 patients of CHD after PCI from September 2019 to March 2022 in China-Japan Friendship Hospital were enrolled and assigned to the derivation set(956 cases)and validation set(181 cases)with a ratio of 5:1.Survival analysis was conducted by Kaplan-Meier method.The least absolute shrinkage and selection operator(Lasso)regression analysis was used to screen for predictors,and multivariate Logistic regression analysis was conducted to establish an integrated Chinese and Western medicine clinical prediction model for MACEs risk after PCI in patients with CHD.The Hosmer-Lemeshow test,calibration curve,area under curve(AUC)of receiver operating characteristic(ROC),net reclassification index(NRI),and clinical impact curve(CIC)were conducted to comprehensively evaluate the prediction ability of the model.Results Kaplan-Meier survival analysis suggested the median survival time of patients was 21.44 months and 18.87 months(P=0.950),respectively.A total of 20 variables were preliminarily identified of MACEs risk after PCI through Lasso-Logistic regression analysis.Higher levels of hemoglobin(Hb),high left ventricular ejection fraction(LVEF)and high activity of daily living(ADL)score,combined treatment of Chinese and Western medicine,and history of aspirin medication were the protective factors;however,female,elevated age,heart rate(HR),body mass index(BMI),neutrophil-lymphocyte ratio(NLR),serum creatinine(SCr),fasting blood-glucose(FBG)and homocysteine(HCY),history of old myocardial infarction,family history of cardiovascular and cerebrovascular disease,the number of stents implanted,and Chinese medicine syndrome elements including blood stasis,qi stagnation,phlegm turbidity and qi deficiency were risk factors.Thereinto,age,HR,BMI,FBG,HCY,LVEF,history of old myocardial infarction,family history of cardiovascular and cerebrovascular disease,the number of stent implantation,and Chinese medicine syndrome elements including blood stasis,qi stagnation,phlegm turbidity and qi deficiency were independent factors(P＜0.05).The Hosmer-Lemeshow test(x2=7.703,P=0.463),calibration curve,and ROC analysis(AUC=0.908)indicated that the model had favorable goodness-of-fit and discrimination performance,and the comprehensive ability for MACEs identification was improved by 11.8％(NRI=0.118,95％CI:0.041-0.187,P=0.002).CIC showed that when the risk threshold was equal to or greater than 60％,the estimated MACEs positive number was more in line with the actual number of individuals.Conclusions The integrated Chinese and Western medicine clinical prediction model for MACEs risk after PCI in CHD patients exhibits ideal clinical prediction ability and is expected to assist in early warning of high-risk individuals and guiding clinical decision-making.关键词
心血管疾病/冠状动脉粥样硬化性心脏病/经皮冠状动脉介入术/临床预测模型/主要不良心血管事件/中西医结合Key words
cardiovascular disease/coronary heart disease/percutaneous coronary intervention/clinical prediction model/major adverse cardiovascular events/integrative medicine
