南方医科大学学报2026，Vol.46Issue(3)：550-558,9.DOI:10.12122/j.issn.1673-4254.2026.03.09
急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗后30天主要不良心血管事件的列线图预测模型:基于血清GSDMD蛋白表达水平
A nomogram model for predicting MACE risk following primary percutaneous coronary intervention in STEMI patients:an exploratory study based on serum GSDMD
摘要
Abstract
Objective To investigate the value of serum gasdermin D(GSDMD)level for predicting 30-day major adverse cardiovascular events(MACE)in patients following primary percutaneous coronary intervention(PPCI)for acute ST-segment elevation myocardial infarction(STEMI)and construct a predictive nomogram.Methods A total of 100 STEMI patients undergoing PPCI were prospectively enrolled.Serum GSDMD levels of the patients were measured by ELISA before and on the second morning after PPCI and compared using Wilcoxon signed-rank test.The patients were divided into high-GSDMD and low-GSDMD groups based on the optimal cut-off value of postoperative GSDMD levels determined by the Youden index.During the 30-day follow-up,the patients were categorized into MACE group(n=26)and non-MACE group(n=74).The key predictors were selected using univariable and LASSO regression,followed by multivariable logistic regression to identify the independent risk factors.A nomogram was constructed and evaluated by ROC curve analysis,Bootstrap internal validation,Hosmer-Lemeshow test,calibration plots and decision curve analysis(DCA).Results Post-PPCI serum GSDMD levels were significantly elevated relative to the pre-PPCI levels(Z=-4.848,P<0.001).The incidence of 30-day MACE was significantly higher in the high GSDMD group(P=0.01).Post-PPCI GSDMD level was identified as an independent risk factor for short-term MACE.The final nomogram incorporated Killip classification,number of stents,albumin,and post-PPCI GSDMD and demonstrated good predictive performance with an AUC of 0.847(P<0.001,95%CI:0.759-0.936),a sensitivity of 84.6%and a specificity of 79.7%.All the validation analyses confirmed good predictive efficacy and clinical utility of the model.Conclusion Elevated post-PPCI serum GSDMD level is an independent risk factor for 30-day MACE in STEMI patients.The nomogram model based on this biomarker provides a reliable tool for short-term risk stratification of these patients.关键词
Gasdermin D/细胞焦亡/ST段抬高急性心肌梗死/主要不良心血管事件/经皮冠状动脉介入治疗Key words
gasdermin D/pyroptosis/ST-segment elevation acute myocardial infarction/major adverse cardiovascular events/primary percutaneous coronary intervention引用本文复制引用
胡欣怡,王圩健,李慧,陈宗正,周忻,袁俊菲,陈亮..急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗后30天主要不良心血管事件的列线图预测模型:基于血清GSDMD蛋白表达水平[J].南方医科大学学报,2026,46(3):550-558,9.基金项目
国家自然科学基金(82000420) （82000420）
江苏省自然科学基金(BK20211043) （BK20211043）
无锡市科技发展资金"太湖之光"科技攻关项目(Y20232010) （Y20232010）
无锡市"双百"中青年医疗卫生拔尖人才项目(HB2023128)Supported by National Natural Science Foundation of China(82000420). （HB2023128）
