| Objective: To study the independent risk factors of major adverse cardiovascular events（Major adverse cardiovascular events,MACE）in patients with acute myocardial infarction（Acute myocardial infarction,AMI）within 2 years after percutaneous coronary intervention（Percutaneous coronary intervention,PCI）,and to construct a nomogram that can better predict the risk of MACE in patients with AMI within 2 years after PCI.The application of nomogram is helpful to improve clinical decision-making ability and improve the prognosis of patients.Methods: Collect the information of 491 inpatients with AMI and percutaneous coronary intervention from january2017 to june2019.All included patients were asked about their medical history,comprehensive physical examination and improved relevant examinations.According to the occurrence of MACE within 2 years after PCI,the patients were divided into MACE（+）group and MACE（-）group.There were 137 cases in MACE（+）group and 354 cases in MACE（-）group.The risk factors of MACE within2 years after PCI were analyzed.All subjects were randomly divided into modeling group and validation group at the ratio of 7:3,including 345 cases in modeling group and 146 cases in validation group.The independent risk factors of MACE risk in AMI patients within 2 years after PCI were analyzed by univariate analysis and multivariate logistic regression analysis,and the nomogram of MACE risk in AMI patients within 2 years after PCI was constructed and verified.Results:（1）The risk factors of MACE in AMI patients within 2 years after PCI included age,myoglobin,NT-pro BNP,Ratio of neutrophils to lymphocytes（Neutrophilto-lymphocyte ratio,NLR）,creatinine,e GFR,Gensini score,f QRS wave,the number of coronary branches and the degree of coronary stenosis.The age of MACE（+）group（≥65 years old accounted for 71.5% vs 52%,P < 0.001）and myoglobin（median 306.80（ng/ml）vs 250.15（ng/ml）,P=0.036）,NT-pro BNP（median 1248（ng·L-1）vs 577（ng·L-1）,P < 0.001）,NLR（median 7.57 vs 6.22,P = 0.042）,creatinine（median 78（μmol·L-1）vs70（μMol·L-1）,P < 0.001）,Gensini score（median 88 vs 72.50,P < 0.001）,f QRS wave（56.9% vs 34.5%,P <0.001）,number of diseased coronary branches（≥ 3 branches accounted for 38% vs 24.6%,P = 0.012）,degree of main diseased coronary stenosis（stenosis ≥ 99% accounted for 73% vs 57.3%,P = 0.004）were significantly higher than those in MACE（-）group,and e GFR（89.92（ml / min）vs 102 38（ml / min）,P < 0.001）was significantly lower than that in MACE（-）group.（2）According to the risk factors affecting the risk of MACE in AMI patients within 2 years after PCI,univariate analysis,multivariate logistic regression and R language found that the independent risk factors used to establish the risk prediction model of MACE within 2 years were age,f QRS wave,Gensini score,NLR.All the subjects were randomly divided into the modeling group and the validation group in the ratio of 7:3.The areas under ROC curve of the modeling group and the validation group were 0.743 and 0.720 respectively.The nomogram of MACE risk in AMI patients within 2 years after PCI was established.It was verified that the nomogram has great discrimination and consistency.Conclusion:（1）Age,myoglobin,NT-pro BNP,NLR,creatinine,e GFR,f QRS wave,number of coronary branches,degree of coronary stenosis and Gensini score are the main risk factors for MACE in AMI patients within 2 years after PCI.（2）Through univariate analysis and multivariate logistic regression analysis,it was found that age,f QRS wave,Gensini score,NLR were independent risk factors for MACE in AMI patients within 2years after PCI.（3）Based on the four independent risk factors of age,f QRS wave,Gensini score,NLR,the nomogram of the risk of MACE in AMI patients within 2 years after PCI is established,which has a good prediction ability for MACE in AMI patients within 2years after PCI,helps to identify the high-risk factors of MACE and distinguish high-risk patients,and strengthen the management of risk factors to improve the quality of life. |
PDF Full Text Request