Establishment And Validation Of A Clinical Prediction Model For Chronic Coronary Syndrome Based On The Theory Of “internal Movement Of Collateral Wind??

Background:There are about 11.39 million people with coronary heart disease(coronary heart disease,CHD)in China,and the mortality rate has been on the rise since 2012.Frequent occurrence of acute coronary syndrome(acute coronary syndrome,ACS)is the main cause of increased mortality in CHD.Acute myocardial infarction(acute myocardial infarction,AMI)is the main cause of death in patients with CHD.About 2.5%of AMI patients have recurrent myocardial infarction within 1 year after discharge,and the fatality rate within 1 year is 28%.The mortality of recurrent myocardial infarction is as high as 32.1%,so it is effective to prevent chronic coronary syndrome(chronic coronary syndrome).The transformation from CCS to ACS is of great social and economic significance.Objective and significance:The purpose of this study is to establish a clinical predictive model of CCS based on the combination of traditional Chinese and western medicine.First of all,the number of emergency AMI patients and solar terms and meteorological factors were analyzed to explore the impact of solar terms and meteorological factors on the incidence of AMI,and to find possible independent risk meteorological factors.Secondly,through a prospective cohort study,followup of patients with CCS within one year,combined with common risk factors,TCM symptoms,TCM syndrome,tongue and pulse and other indicators to explore the impact of internal movement of collaterals and wind on the prognosis of CCS patients.Finally,according to the results of study 1 and 2,with the help of Logistic regression,combined with meteorological factors,internal movement of collaterals and other independent risk factor indicators,the establishment of acute cardiovascular adverse events(major adverse cardiovascular events,MACE)as the outcome of the integrated traditional Chinese and western medicine CCS clinical prediction model,and internal verification of the model,hoping that the model can help early identification of high-risk CCS patients from multiple dimensions,and give more accurate prevention and treatment measures.Methods:1.The daily meteorological elements(maximum wind speed,mean wind speed,maximum wind speed,maximum pressure,mean pressure,minimum pressure,maximum temperature,average temperature,minimum temperature,minimum relative humidity,precipitation)provided by Beijing Meteorological Observatory during the emergency diagnosis of AMI in all hospitals in Beijing from January 20,2015 to January 19,2019 were collected.The time series analysis,Spearman correlation analysis,Poisson model analysis and lag effect analysis were carried out to explore the time-onset relationship model between the incidence of AMI and meteorological elements.2.This study is a prospective cohort study.According to the diagnosis and discharge criteria of CCS,the items of internal movement of collaterals were selected as exposure factors.The score of internal movement of collaterals was divided into exposure group with score greater than or equal to 3 and control group with score less than 3.The subjects were followed up.The followup period is not less than 180 days.The end point was the occurrence of major adverse cardiovascular events,including cardiogenic death,non-fatal myocardial infarction,hospitalization for unstable angina pectoris,hospitalization for heart failure,and a compound endpoint for stroke.Univariate and multivariate Logistic regression was used to analyze the influence of internal movement of collaterals on the prognosis of patients with CCS,and the prognostic value of this item was evaluated by Kmurm survival curve.3.Based on the results of study 1 and study 2,the prediction variables of study 1 data are selected,and the model is established by Logistic regression.The model is evaluated from the point of view of AIC,differentiation,C statistics and shown in the form of line chart.Results:1.A total of 38134 patients were enrolled in the study,including 26521 males and 11613 females,with a proportion of 2.28 AMI.The age stratification of AMI patients is shown in the table,the minimum age is 18 years old,the maximum age is 107 years old,the average age is(67.18±14.08)years old.According to the 24 solar terms frequency analysis of all AMI frequencies,the top four solar terms were Lesser Cold(1924,5.05%),the Beginning of Spring(1767,4.63%),Cold Dew(1760,4.62%),and the Beginning of Winter(1740,4.56%).According to the frequency of visiting doctors,the luck analysis of all AMI patients showed that the distribution of main transport from high to low was the first transportation>the final transportation>the fourth transportation>the second transportation>the third transportation.The distribution of passenger transport from high to low is too hot>less soil>too gold>less wood>less water>too water>Taimu>less gold.The distribution of main qi from high to low is final qi>five qi>primary qi>second qi>fourth qi>three qi,and the distribution of politeness from high to low is Shaoyin monarch fire>Jueyin wind wood>Taiyin wet soil>Shaoyang phase fire>Yangming dry gold>sun cold water.Statistical analysis of all AMI frequencies and meteorological elements shows that mean wind speed and average temperature are negatively correlated with AMI frequency,and mean wind speed and average temperature are independent risk factors for AMI.Divided by 24 solar terms,in the period of Greater Cold,the relative humidity was negatively correlated with the number of AMI;in the period of the Beginning of Spring,the relative humidity was positively correlated with the number of AMI;in the period of Rain Water,the average air pressure was negatively correlated with the number of AMI;in the period of the Spring Equinox,the average wind speed was negatively correlated with the number of AMI;and in the period of the Summer Solstice,the relative humidity was positively correlated with the number of AMI.In the period of Lesser Heat,the relative humidity was positively correlated with the number of AMI,the minimum humidity was negatively correlated with the number of AMI,and the daily precipitation was negatively correlated with the number of AMI;in the period of Greater Heat,the relative humidity was negatively correlated with the number of AMI;in the period of the Beginning of Autumn,the average air pressure was positively correlated with the number of AMI;in the period of the End of Heat,the minimum humidity was positively correlated with the number of AMl;and in the period of White Dew,the daily precipitation was negatively correlated with the number of AMI.During the period of Frosts Descent,the average wind speed was negatively correlated with the number of AMI;in the period of heavy snow,the relative humidity was negatively correlated with the number of AMI;and in the period of the Winter Solstice,the average wind speed was negatively correlated with the number of AMI.2.The study began on January 1,2022 and ended on January 20,2023.A total of 653 patients were followed up,including 325 patients in the exposure group and 328 patients in the control group.There was no significant difference in baseline data and vital signs between the two groups(P>0.05).At the end of follow-up,a total of 73 patients in both groups had MACE events.There was significant difference in the number of MACE events between the two groups.According to the statistics of the scores of patients with MACE events in the two groups,there was significant difference between the patients with MACE events and those without MACE events in the exposure group.According to the classification of tongue color frequency,in the exposure group,the tongue was the most dark(85 cases,13.02%),and in the control group,the tongue was the most reddish(94 cases,14.40%).According to the classification of other tongue images,the toothed tongue and tongue pulse stasis were the most in the exposure group(all 20 cases,3.06%),and the cracked tongue was the most in the control group(20 cases,3.06%).According to the classification of tongue coating,the most thin white fur was found in both groups,167 cases(25.57%)in the exposure group and 152 cases(23.28%)in the control group.According to the statistics of the pulse frequency of the two groups,the chord pulse was the most in both groups(119 cases,18.22%).According to the statistical analysis of T CM syndromes of the two groups,the syndrome of qi deficiency and blood stasis was the most in both groups,107 cases(16.39%)in the exposure group and 90 cases(13.78%)in the control group.According to the statistics of the frequency of TCM syndrome elements in the two groups,the kidney was the most in both groups,167 cases(25.57%)in the exposure group and 195 cases(29.86%)in the control group.Among the disease syndrome elements,the two groups showed the most "qi deficiency",211 cases(32.31%)in the exposure group and 203 cases(31.09%)in the control group.The univariate regression results showed that male,body mass index(Body mass index,BMI)and the score of internal movement of collaterals were positively correlated with the occurrence of MACE,while the family history of coronary heart disease,smoking and drinking history were negatively correlated with MACE.Multivariate regression analysis showed that gender,smoking history,family history of coronary heart disease,BMI and internal movement of collaterals were independent risk factors for MACE in patients with CCS.Kmurm survival curve was used to evaluate the effect of internal movement of collaterals on the prognosis of patients with CCS for 1 year.The results showed that there was a significant difference between the two groups at a follow-up of about 10 months.3.This study included all the patients in study 1,and the data set was randomly divided into training set and verification set according to the proportion of 7:3.There were 207 males in the training group(22.21%),with an average age of 65.80±8.25 years old,and 95 males in the control group(27.57%),with an average age of 67.79±7.26 years old.there was no significant difference in basic characteristic data between the two groups(P>0.05).The formula of Logistic model in this study is Logit(p)=-8.474+1.226×smoking history(yes/no)+2.692×family history of coronary heart disease(yes/no)+0.147×BMI+0.496×internal movement of collaterals-1.258×male(yes/no).If yes,the assignment is 1,otherwise the assignment is 0,and the variables are not collinear.The verification set is substituted into the model for internal verification,the C index of the model training set is 0.898(0.843-0.953),and the C index of the verification set is 0.896(0.836-0.957).The model is tested by AIC,differentiation and so on,and the test results are good,and the model is shown in the form of a line chart.Conclusions:1.Mean air temperature and mean wind speed may be independent factors affecting the incidence of AMI,which may be the core meteorological factors affecting AMI caused by external wind.From the point of view of meteorological elements,this paper expounds the rationality of "external wind causing internal wind" in the theory of "internal movement of collateral wind".2.The integral of internal movement of collateral wind is positively correlated with the occurrence of MACE in patients with CCS,which provides evidence for the prevention and treatment of CHD and reduction of the occurrence of MACE from the theory of "internal movement of collateral wind".3.The preliminary construction of the clinical prediction model of CCS based on the combination of traditional Chinese and western medicine shows that the items of internal movement of collateral wind based on the theory of "internal movement of collateral wind" can help to identify patients with middle and high risk of CCS.