中国全科医学2025，Vol.28Issue(30)：3779-3786,8.DOI:10.12114/j.issn.1007-9572.2025.0027
老年急性ST段抬高型心肌梗死经皮冠状动脉介入治疗术后心绞痛复发风险预测模型构建和验证:基于CYP2C19相关基因检测
Construction and Validation of a Risk Prediction Model for Recurrent Angina after Percutaneous Coronary Intervention in Elderly Patients with Acute ST-segment Elevation Myocardial Infarction:Based on CYP2C19-related Genetic Testing
摘要
Abstract
Background Acute ST-segment elevation myocardial infarction(STEMI)has a high mortality and disability rate.Percutaneous coronary intervention(PCI)is an important revascularization method that can improve prognosis.However,some patients experience recurrent angina after PCI,which affects their quality of life and long-term prognosis.Drug-metabolizing enzyme gene polymorphisms influence drug efficacy and adverse reactions.Cytochrome P450 2C19(CYP2C19)is involved in the metabolism of multiple drugs,and its gene polymorphisms can alter enzyme activity and affect drug metabolism.The correlation between different CYP2C19 metabolic levels and recurrent angina after PCI in STEMI patients is worth exploring.Objective To investigate the correlation between different CYP2C19 metabolic levels and recurrent angina after PCI in STEMI patients.Methods A total of 128 patients who underwent emergency PCI for acute coronary occlusion at the Chest Pain Center of the First Affiliated Hospital of Inner Mongolia Medical University in 2022 were selected as the study subjects.The patients'medical records and CYP2C19 gene test results were collected.Follow-up was conducted via telephone or outpatient visits at 1,3,6,and 12 months after PCI,with the follow-up ending on December 31,2023.The endpoint event was angina attack.Lasso regression analysis was used to screen variables related to angina attacks,followed by the construction of a predictive model using multivariate Logistic regression analysis and the development of a nomogram.Bootstrap resampling was used for internal model validation.The training and validation sets were evaluated using receiver operating characteristic(ROC)curves,goodness-of-fit tests,calibration curves,and decision curve analysis(DCA)to construct a risk prediction model for recurrent angina after PCI in elderly STEMI patients.Results A total of 128 patients were included,with 92 males(71.9%)and 36 females(28.1%),and a median age of 63.5(61.0,66.0)years.During follow-up,45 patients(35.2%)experienced recurrent angina,while 83 patients(64.8%)did not.There were statistically significant differences in gender,low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),and CYP2C19 genotype between patients with and without recurrent angina(P<0.05).Lasso regression analysis identified 7 independent predictive variables,including gender,LDL-C,HDL-C,homocysteine(Hcy),apolipoprotein B(ApoB),D-dimer,and CYP2C19 genotype.Multivariate Logistic regression analysis showed that female gender(OR=3.492 9,95%CI=1.288 8-10.010 1),elevated LDL-C(OR=3.123 7,95%CI=1.685 9-6.348 4),and elevated Hcy(OR=1.061 4,95%CI=1.028 8-1.103 6)were risk factors for recurrent angina after STEMI intervention,while elevated HDL-C(OR=0.016 7,95%CI=0.000 9-0.209 1),intermediate CYP2C19 metabolism(OR=0.273 4,95%CI=0.0747-0.923 7),and normal CYP2C19 metabolism(OR=0.086 7,95%CI=0.025 5-0.256 1)were protective factors against recurrent angina after PCI in STEMI patients(P<0.05).The model was internally validated using Bootstrap resampling with 1 000 replications,and the Hosmer-Lemeshow calibration curve showed good model fit.ROC curves were plotted for the training and validation sets,with areas under the ROC curve(AUC)of 0.869(95%CI=0.796-0.943)and 0.789(95%CI=0.701-0.877),respectively,indicating good discrimination in both the modeling and validation populations.Further DCA showed that the model had good clinical utility.Conclusion Intermediate and normal CYP2C19 metabolic types are protective factors against recurrent angina after STEMI intervention.This study established a risk prediction model for recurrent angina after PCI in STEMI patients that includes five clinical indicators:female gender,LDL-C,Hcy,HDL-C,and CYP2C19.The model can be used to predict the risk of recurrent angina in patients for early screening and has good fit,discrimination,and clinical application value.关键词
ST段抬高型心肌梗死/心绞痛/细胞色素P450 2C19/经皮冠状动脉介入治疗/预测模型/列线图Key words
ST-segment elevation myocardial infarction/Angina pectoris/CYP2C19/Percutaneous coronary intervention/Prediction model/Nomogram分类
医药卫生引用本文复制引用
贾高鹏,陈秋雨..老年急性ST段抬高型心肌梗死经皮冠状动脉介入治疗术后心绞痛复发风险预测模型构建和验证:基于CYP2C19相关基因检测[J].中国全科医学,2025,28(30):3779-3786,8.基金项目
内蒙古自治区自然科学基金资助项目(2024LHMS08011) （2024LHMS08011）
内蒙古医科大学面上项目(YKD2022MS069) （YKD2022MS069）
内蒙古医科大学创客培育项目(101322024031) （101322024031）
