Establishment A Prediction Model Of Major Adverse Cardiovascular Events In Female Patients With Acute Coronary Syndrome After PCI

ObjectivesBased on literature analysis,this study investigated the influencing factors of Major Adverse Cardiovascular Events(MACE)one year after Percutaneous Coronary Intervention(PCI)in female patients with Acute Coronary Syndrome(ACS),and formed a questionnaire.A risk nomogram prediction model based on parameter integration was constructed through investigating incidence of MACE after PCI in female ACS patients and analyzing influence factors of postoperative MACE to provide data support for the prognosis of patients after interventional cardiovascular medicine.MethodsThe risk factors for MACE after PCI in female ACS patients were extracted by reviewing relevant studies systematically with evidence-based literature research methods and screening the literature strictly according to the inclusion and exclusion criteria.There are 702 female ACS patients altogether who underwent PCI for the first time in the cardiovascular medicine department of a tertiary hospital in Henan Province from November 2019 to September 2020 were included.The clinical information such as general clinical data,blood test data and cardiac imaging data of the patients were collected based on evidence-based risk factors.The patients were followed up for one year and divided into MACE group and non-MACE group according to whether MACE occurred after PCI.The database was established using Epidata 3.1 and used for statistical analysis using R software(R3.5.5).The clinical data of female ACS patients were statistically described by means±standard deviation,frequency and percentage.Comparison of clinical data of female ACS patients between two groups using t-test,X~2 test,or Fisher’s exact probability method.Least Absolute Shrinkage and Selection Operator(Lasso)regression was used to screen the independent variables that best predict the occurrence of MACE in female ACS patients after PCI,and the variables were then incorporated into logistic regression for fitting and modeling so that a nomogram model was drawn.The model were internally validated using the Bootstrap method with 1000 replicates and evaluated by the C-index of concordance(C-index),receiver operating characteristic curve(ROC)and calibration curve for the discrimination and prediction accuracy.Decision Curve Analysis(DCA)was used to analyze the clinical utility.All p values were 2-sided,and statistical significance was defined as p<0.05.ResultsThere are 17 literatures were screened according to the inclusion and exclusion criteria by reviewing relevant literature.After quality evaluation of the literature,46 factors affecting the occurrence of MACE after PCI in female ACS patients were identified.There are 646 cases were finally included compared with702 cases initially in that the 56 cases were excluded due to loss to follow-up and incomplete data.There are 98 cases(15.17%)developed MACE one year after PCI and all-cause deaths accounted for 1.86%,heart failure patients accounted for 2.48%,angina recurrence accounted for 5.57%,non-fatal myocardial infarction patients accounted for 1.86%,severe arrhythmia patients accounted for 2.17%,and revascularization patients accounted for 1.24%.The results of univariate analysis showed:body mass index,number of live births,time of amenorrhea,diabetes,hysterectomy,self-care ability score,deep vein thrombosis risk score,creatinine,brain natriuretic peptide,C-reactive protein,D-dimer,muscle Acid kinase,troponin I,aspartate aminotransferase,nutritional risk index,left ventricular ejection fraction,number of lesions,total length of stents,and total number of stents were associated with MACE after PCI in female ACS patients(p<0.05).The results of Lasso-logistic regression analysis showed:time of amenorrhea,diastolic blood pressure,diabetes,self-care ability score,creatinine,brain natriuretic peptide,D-dimer,aspartate aminotransferase,left ventricular ejection fraction,number of lesions,total length of implanted stent are the influencing factor of MACE after PCI in female ACS patients(p<0.05).The initial C-index value and area under the ROC curve of the established nomogram prediction model for the risk of MACE in female ACS patients after PCI were 0.947(95%CI:0.926-0.967).The internal validation of the bootstrap method was 0.930,it indicated that this model has positive discrimination and the calibration curve fits well.In addition,the DCA plot shows that a good net gain can be achieved using this nomogram model.ConclusionsThis study determined the risk assessment content of MACE after PCI in female ACS patients by reviewing and quality evaluation of relevant literature.The nomogram model based on amenorrhea time,diastolic blood pressure,diabetes,self-care ability score,creatinine,brain natriuretic peptide,D-dimer,aspartate aminotransferase,left ventricular ejection fraction,number of lesions,total length of stent implanted that add up to 11 parameters can effectively predict the incidence of MACE in female ACS patients one year after PCI,and provide an important scientific basis for the prognosis of female ACS patients after cardiovascular intervention.