急性ST段抬高型心肌梗死患者PCI后左心室壁瘤形成的影响因素分析及预测模型的初步构建

Analysis of factors affecting left ventricular aneurysm formation after PCI in patients with acute ST-segment elevation myocardial infarction and preliminary development of a prediction model

摘要:

目的 探讨急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）后左心室壁瘤（LVA）形成的影响因素，并在此基础上初步构建LVA形成的预测模型。方法 回顾性分析2020年1月—2023年1月上饶市人民医院收治的110例STEMI患者的临床资料，按照PCI后是否发生LVA分为无LVA组（76例）和LVA组（34例），采用单因素分析及多因素逐步Logistic回归分析筛选STEMI患者PCI后LVA形成的影响因素，根据多因素分析结果，初步构建STEMI患者PCI后LVA形成的预测模型，并绘制受试者工作特征（ROC）曲线分析LVA形成预测模型预测STEMI患者PCI后LVA形成的价值。结果 LVA组女性占比、饮酒率、C反应蛋白（C-CRP）、脑钠肽（BNP）、基质金属蛋白酶-9（MMP-9）水平均高于无LVA组（P <0.05），左心室射血分数（LVEF）水平低于无LVA组（P <0.05）。ROC曲线分析结果表明，LVEF、CRP、BNP、MMP-9预测STEMI患者PCI后LVA形成的曲线下面积（AUC）分别为0.836、0.860、0.868和0.803，预测LVA形成的临界值分别为49.478%、27.905 mg/L、389.798 pg/mL、279.807 pg/mL。多因素逐步Logistic回归分析结果显示，女性［O^R=3.589（95% CI：1.428，7.215）］、饮酒［O^R=2.694（95% CI：1.437，5.482）］、LVEF ≤ 49.478% ［O^R=3.978（95% CI：0.537，1.176）］、CRP ≥ 27.905 mg/L ［O^R=4.959（95% CI：2.003，19.350）］、BNP ≥ 389.798 pg/mL ［O^R=2.739（95% CI：1.455，5.712）］、MMP-9 ≥ 279.807 pg/mL ［O^R=5.105（95% CI：1.684，14.178）］是STEMI患者PCI后LVA形成的危险因素（P <0.05）。根据多因素分析结果，将临床相关指标LVEF、CRP、BNP、MMP-9纳入LVA形成预测模型，Logit（P） = -31.584 + 1.381X_LVEF + 1.601X_CRP + 1.007X_BNP + 1.630X_MMP-9。ROC曲线分析结果表明，该模型预测STEMI患者PCI后LVA形成的临界值为31.580，AUC为0.941，敏感性为92.1%（95% CI：0.846，0.988），特异性为88.2%（95% CI：0.754，0.934）。LVA形成预测模型的敏感性优于各项指标单独预测。结论 女性、饮酒及LVEF、CRP、BNP、MMP-9水平是STEMI患者PCI后LVA形成的危险因素，临床应对存在该危险因素的患者进行长期跟踪随访，尽早发现LVA的发生，以便早期治疗。

Abstract:

Objective To explore the factors affecting left ventricular aneurysm (LVA) formation in patients with acute ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI), based on which to preliminarily develop a prediction model.Methods The clinical data of 110 STEMI patients admitted to our hospital from January 2020 to January 2023 were retrospectively analyzed. According to whether LVA occurred after PCI, they were divided into LVA-free group (76 cases) and LVA group (34 cases). Univariable analysis and multivariable Logistic regression analysis were performed to screen factors affecting LVA formation in STEMI patients after PCI. With the results of multivariable analysis, the prediction model for LVA formation in STEMI patients after PCI was preliminarily developed, and the performance of the prediction model was evaluated via the receiver operating characteristic (ROC) curve.Results The proportion of female patients, rate of alcohol consumption and levels of CRP, BNP and MMP-9 in the LVA group were higher than those in the LVA-free group (P < 0.05). The LVEF in the LVA group was lower than that in the LVA-free group (P < 0.05). The ROC curve analysis demonstrated that areas under curves (AUCs) of LVEF, CRP, BNP, and MMP-9 in predicting LVA formation in STEMI patients after PCI were 0.836, 0.860, 0.868, and 0.803 (P < 0.05), with the cut-off values being 49.478%, 27.905 mg/L, 389.798 pg/mL, and 279.807 pg/mL, respectively. The multivariable Logistic regression analysis showed that female [O^R = 3.589 (95% CI: 1.428, 7.25) ], alcohol consumption [O^R = 2.694 (95% CI: 1.437, 5.482) ], LVEF (≤ 49.478%) [O^R = 3.978 (95% CI: 0.537, 1.176) ], and levels of CRP (≥ 27.905 mg/L) [O^R = 4.959 (95% CI: 2.003, 19.350) ], BNP (≥ 389.798 pg/mL) [O^R = 2.739 (95% CI: 1.455, 5.712) ] and MMP-9 (≥ 279.807 pg/mL) [O^R = 5.105 (95% CI: 1.684, 14.178) ] were risk factors for LVA formation in STEMI patients after PCI (P < 0.05). Based on the results of multivariable Logistic regression analysis, relevant clinical indicators including LVEF, CRP, BNP, and MMP-9 were included in the prediction model, which was established as Logit (P) = -31.584 + 1.381X_LVEF + 1.601X_CRP + 1.007X_BNP + 1.630X_MMP-9. The ROC curve analysis indicated that the cut-off value of the prediction model for LVA formation in STEMI patients after PCI was 31.580, with an AUC of 0.941, a sensitivity of 92.1% (95% CI: 84.6%, 98.8%), and a specificity of 88.2% (95% CI: 75.4%, 93.4%). The sensitivity of the prediction model was higher than that of each indicators alone for predicting LVA formation after PCI in STEMI patients.Conclusions Female, alcohol consumption, and high LVEF and levels of CRP, BNP, and MMP-9 are risk factors for the formation of LVA in STEMI patients after PCI. Clinical follow-up should be conducted on patients with risk factors for a long time to early detect the occurrence of LVA and to facilitate early treatment.