Construction Of Coronary Artery Disease Risk Scoring System In Type 2 Diabetes Mellitus Patients

BackgroundDiabetes is a common complication of coronary artery disease,and it is also one of the risk factors for coronary artery disease.At present,there are few studies on the risk prediction model and scoring system of coronary artery disease in patients with type 2 diabetes mellitus.The independent protective and risk factors of coronary artery stenosis in patients with type 2 diabetes mellitus complicated with coronary artery disease have not been fully clarified.ObjectiveTo construct a scoring system for the risk of coronary artery disease in patients with type 2 diabetes mellitus,and to conduct a correlation analysis on the degree of coronary artery stenosis in patients with type 2 diabetes mellitus complicated with coronary artery disease.MethodsIn the related study on the risk of coronary artery disease in patients with type 2diabetes,a retrospective study was conducted on 465 patients with type 2 diabetes who underwent coronary angiography in the Department of Cardiology of the second affiliated Hospital of Guangzhou Medical University from January 2021 to December2021.The independent protection and risk factors of coronary artery disease in patients with type 2 diabetes mellitus were obtained by univariate and multivariate logistic regression analysis.The prediction model and scoring system of coronary artery disease risk in patients with type 2 diabetes mellitus were established.The Hosmer-Lemeshow goodness-of-fit test was used to evaluate its calibration and the area under the curve（AUC）of the Receiver operating characteristic（ROC）curve to evaluate its differentiation.A total of 250 patients with type 2 diabetes who underwent coronary angiography in the Department of Cardiology of the second affiliated Hospital of Guangzhou Medical University from January 2022 to June 2022 were selected as the verification group.The scoring system was externally verified and its predictive efficiency was evaluated.In the related study on the degree of coronary artery stenosis in patients with type 2 diabetes mellitus complicated with coronary artery disease,305 patients with type 2 diabetes mellitus complicated with coronary artery disease who underwent coronary angiography in the Department of Cardiology of the second affiliated Hospital of Guangzhou Medical University from January 2021to December 2021 were retrospectively studied.Univariate and multivariate linear regression analysis was conducted according to Gensini score,and the independent protection and risk factors of coronary artery stenosis were obtained.Bivariate correlation analysis was used to study the correlation between coronary artery disease risk score and Gensini score in patients with type 2 diabetes mellitus.Result1.In the related study on the risk of coronary artery disease in type 2 diabetes mellitus,a total of 465 patients with type 2 diabetes were included in the study,including 160 cases in the non-coronary artery disease group（34.4%）and 305 cases in the coronary artery disease group（65.6%）.A total of 250 patients with type 2diabetes were included in the verification group,including 82 patients in the non-coronary artery disease group（32.8%）and 168 patients in the coronary artery disease group（67.2%）.（1）Through multivariate binary logistic regression,it was found that high-density lipoprotein cholesterol（OR=0.23,95%CI:0.09-0.60,P=0.003）,albumin/globulin ratio（OR=0.27,95%CI:0.10-0.74,P=0.011）,and absolute value of lymphocytes（OR=0.54,95%CI:0.38-0.78,P=0.001）were independent protective factors in patients with type2 diabetes mellitus complicated with coronary artery disease,while glycated hemoglobin（OR=1.31,95%CI:1.11-1.53,P=0.001）,low-density lipoprotein cholesterol（OR=1.31,95%CI:1.03-1.67,P=0.026）,male（OR=1.73,95%CI:1.02-2.93,P=0.041）,smoking（OR=2.20,95%CI:1.09-4.44,P=0.028）,and previous stroke（OR=3.32,95%CI:1.37-8.08,P=0.008）are independent risk factors for patients with type 2 diabetes mellitus complicated with coronary artery disease.（2）The risk prediction model of coronary heart disease in patients with type 2diabetes is Logit（P）=1.898-1.476X₁（high density lipoprotein cholesterol）-1.305X₂（albumin/globulin ratio）-0.612X₃（absolute value of lymphocytes）+0.267X₄（glycosylated hemoglobin）+0.273X₅（low density lipoprotein cholesterol）+0.55X₆（male）+0.787X₇（smoking）+1.201X₈（previous stroke）.The Hosmer-Lemeshow goodness-of-fit test of the prediction model wasΧ²=5.071（P=0.75）,and the AUC of the ROC curve was 0.766（95%CI:0.722-0.811,P<0.001）,indicating that the calibration and differentiation of the prediction model were high.（3）According to the regression coefficientβof each variable,the scoring system of coronary artery disease risk in patients with type 2 diabetes mellitus was constructed,including high density lipoprotein cholesterol≥1.08mmol/L（-6 points）,albumin/globulin ratio≥1.30（-5 points）,absolute value of lymphocytes≥2.11×10^9/L（-2 points）,glycosylated hemoglobin≥8.35%（1 point）,low density lipoprotein cholesterol≥2.75mmol/L（1 point）,male（2 points）,smoking（3 points）,previous stroke（4 points）.The total score is the sum of the risk scores of each variable,and the score ranges from-14 to 11.The Hosmer-Lemeshow goodness of fit test of the scoring system showed thatΧ²=11.257（P=0.188）,and the area under the ROC curve is 0.753（95%CI:0.706-0.799,P<0.001）,indicating that the calibration and discrimination of the scoring system were high.According to the ROC curve of the scoring system and the actual maximum Jordan index,the best diagnostic cut-off value is-2 points,so patients with type 2 diabetes are divided into high-risk groups of coronary artery disease（-2～11 points）,low-risk groups of coronary artery disease（-14～-3 points）.The sensitivity of the scoring system was 56.7%（173/305）,the specificity was 81.9%（131/160）,the positive predictive value was 85.6%（173/202）,the negative predictive value was 49.8%（131/263）,and the accuracy is 67.5%（314/465）.There was no significant difference in the AUC of the ROC curve between the prediction model and the risk scoring system by Delong’s method（P=0.359）,indicating that the scoring system can replace the prediction model to assess the risk of coronary artery disease in patients with type 2 diabetes mellitus.（4）External verification of the scoring system:the sensitivity of the scoring system in the verification group was 57.1%（96/168）,the specificity was 65.9%（54/82）,the positive predictive value was 77.4%（96/124）,the negative predictive value was 42.9%（54/126）,and the accuracy was 60.0%（150/250）,respectively.The Hosmer-Lemeshow goodness-of-fit test shows thatΧ²=3.424（P=0.905）,and the AUC of ROC curve was 0.648（95%CI:0.575-0.720,P<0.001）,indicating that the prediction efficiency of the score system was still good in the verification group.2.In the study on the degree of coronary artery stenosis in patients with type 2diabetes mellitus complicated with coronary artery disease,305 patients with type 2diabetes mellitus complicated with coronary artery disease were included in the study.Through multivariate linear regression analysis of Gensini score,it was found that absolute neutrophil count,mean platelet volume and smoking were positively correlated with Gensini score,which were independent risk factors for the degree of coronary artery stenosis in patients with type 2 diabetes mellitus complicated with coronary artery disease,while albumin/globulin was negatively correlated with Gensini score,which was an independent protective factor for the degree of coronary artery stenosis in patients with type 2 diabetes mellitus complicated with coronary artery disease.In addition,there was a positive correlation between the risk score of coronary artery disease in patients with type 2 diabetes mellitus and the Gensini score in patients with type 2 diabetes mellitus complicated with coronary artery disease（r=0.318,P<0.001）,indicating that there was a certain correlation between the risk score and the degree of coronary artery stenosis.ConclusionThe risk score system can evaluate the risk of coronary artery disease in patients with type 2 diabetes mellitus to a certain extent,and there is a certain correlation between the risk score and the degree of coronary artery stenosis in patients with type2 diabetes mellitus complicated with coronary artery disease.