临床误诊误治2026，Vol.39Issue(8)：36-42,66,8.DOI:10.3969/j.issn.1002-3429.2026.08.007
优化综合急救流程下急性ST段抬高型心肌梗死患者行PCI的救治效果及影响因素预测模型构建
Rescue efficacy of PCI in patients with acute ST segment elevation myocardial infarction under optimized comprehensive emergency procedures and construction of prediction model of influencing factors
摘要
Abstract
Objective To investigate the rescue efficacy of percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI)under the optimized comprehensive emergency procedure,and to construct a prediction model of influencing factors for the rescue efficacy of PCI in patients with acute STEMI.Methods A total of 673 patients with acute STEMI who underwent PCI from January 2018 to February 2024 were selected.Among them,232 patients with acute STEMI who underwent PCI from January 2018 to December 2020 received routine emergency procedures and were included in the routine emergency procedure group.From January 2021 to February 2024,441 patients with acute STEMI who underwent PCI were included in the optimized comprehensive emergency procedure group.The rescue efficacy of the two groups were compared.In the meantime,the general clinical data of all patients with acute STEMI were collected,and the patients were divided into poor rescue efficacy group and good rescue efficacy group according to the treatment outcome at 30 d after operation.Univariate and multivariate logistic regression analyses were used to analyze the influencing factors of poor rescue efficacy,and a nomogram prediction model was constructed.The receiver operating characteristic(ROC)curve,calibration curve and decision curve analysis(DCA)were used to verify the effectiveness of the model.Results The rate of poor rescue efficacy at 30 d after operation was 14.56％(98/673).The rate of poor rescue efficacy in the optimized comprehensive emergency procedure group[9.98％(44/441)]was lower than that in the routine emergency procedure group[23.28％(54/232)](P＜0.05).Age(OR=1.029,95％CI:1.023,1.035),pre-hospital initial assessment time(OR=1.024,95％CI:1.021,1.028),pre-hospital vital signs assessment time(OR=1.007,95％CI:1.005,1.010),pre-hospital emergency response time(OR=1.105,95％CI:1.102,1.108),total ischemia time(OR=1.059,95％CI:1.052,1.067),first medical contact to balloon dilatation(FMC2B)time(OR=1.040,95％CI:1.028,1.053),modified early warning score(MEWS)(OR=1.045,95％CI:1.018,1.073),receiving optimized comprehensive emergency protocol(OR=0.363,95％CI:0.252,0.523),cardiac troponin Ⅰ(cTnI)(OR=1.099,95％CI:1.078,1.120)were influencing factors for poor outcomes in patients with acute STEMI undergoing PCI(P＜0.0 1).The ROC curve of the nomogram prediction model for acute STEMI patients with poor PCI treatment showed that the area under the curve was 0.907(95％CI:0.871,0.942).The calibration curve showed that the prediction probability of the model was basically consistent with the actual observation results,and DCA suggested that there was a high clinical positive net benefit in the range of 0.19-0.78 threshold probability.Conclusion Optimized comprehensive emergency procedure can improve the rescue efficacy of PCI in patients with acute STEMI.Age,pre-hospital initial assessment time,pre-hospital vital sign assessment time,pre-hospital emergency response time,total ischemia time,FMC2 B time,MEWS,receiving optimized comprehensive emergency protocol,cTnI are the influencing factors of poor rescue efficacy of PCI in patients with acute STEMI.The nomogram risk prediction model has good prediction efficiency,calibration and clinical utility,which can be used to guide the clinical formulation of targeted risk protection measures.关键词
急性ST段抬高型心肌梗死/经皮冠状动脉介入/优化综合急救流程/救治效果/肌钙蛋白Ⅰ/改良早期预警系统/预测模型Key words
acute ST-segment elevation myocardial infarction/percutaneous coronary intervention/optimized comprehensive emergency protocol/rescue efficacy/cardiac troponin Ⅰ/modified early warning score/prediction model引用本文复制引用
黄雯,景晓,侯静,琅哲,梁喜凤..优化综合急救流程下急性ST段抬高型心肌梗死患者行PCI的救治效果及影响因素预测模型构建[J].临床误诊误治,2026,39(8):36-42,66,8.基金项目
河北省2024年度医学科学研究课题计划(20240558) （20240558）
