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| 急性心肌梗死合并室间隔穿孔患者30天内死亡风险预测模型 |
| Establishment of a risk prediction model of death within 30 days of patients with acute myocardial infarction and ventricular septal perforation |
| 投稿时间：2021-11-22 |
| DOI：10.3969/j.issn.1000-0399.2023.01.010 |
| 中文关键词: 急性心肌梗死 室间隔穿孔 短期预后 列线图模型 |
| 英文关键词: Acute myocardial infarction Ventricular septal perforation Short-term prognosis Nomogram model |
| 基金项目:2020年度河南省医学科技攻关计划项目(编号:LHGJ20200733) |
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| 中文摘要: |
| 目的 探究急性心肌梗死合并室间隔穿孔患者30天内死亡的影响因素,构建预测急性心肌梗死(AMI)合并室间隔穿孔患者30天内死亡风险的列线图模型。方法 选取2011年1月至2021年3月郑州市第七人民医院收治的AMI合并室间隔穿孔患者72例为研究对象,根据患者30天内存活情况分为死亡组(n=50)和存活组(n=22)。采用logistic回归分析影响AMI合并室间隔穿孔患者30天内死亡的危险因素。采用R软件构建预测AMI合并室间隔穿孔患者30天内死亡风险的列线图模型。结果 死亡组发生前壁心肌梗死比例、AMI出现室间隔穿孔时间为1~6 d的比例、Killip心功能分级≥Ⅲ级患者比例高于存活组,死亡组室间隔穿孔直径大于存活组,但死亡组接受介入封堵术患者比例低于存活组,差异均有统计学意义(P均＜0.05)。logistic回归分析结果显示,发生前壁心肌梗死(OR=14.057,95%CI:1.411~140.097)、AMI出现室间隔穿孔时间为1~6 d(OR=35.757,95%CI:3.592~355.976)、Killip心功能分级≥Ⅲ级(OR=5.894,95%CI:1.608~32.533)是影响AMI合并室间隔穿孔患者30天内死亡的危险因素(P＜0.05),接受介入封堵术(OR=0.103,95%CI:0.014~0.782)是AMI合并室间隔穿孔患者30天内死亡的保护因素(P＜0.05);预测AMI合并室间隔穿孔患者30天内死亡风险的列线图模型预测值与实际值基本一致,且Hosmer-Lemeshow拟合优度检验χ2=8.674,P=0.371。曲线下面积(AUC)为0.955(95%CI:0.913~0.998)。结论 发生前壁心肌梗死、AMI出现室间隔穿孔时间为1~6 d、Killip心功能分级≥Ⅲ级是AMI合并室间隔穿孔患者30天内死亡的危险因素,接受介入封堵术为保护因素,以此构建预测AMI合并室间隔穿孔患者30天内死亡风险的列线图模型,具有较好的区分度和一致性。 |
| 英文摘要: |
| Objective To construct a nomogram model to predict the risk of death within 30 days of patients with acute myocardial infarction (AMI) combined with ventricular septal perforation.Methods A total of 72 AMI patients with ventricular septal perforation admitted to Zhengzhou Seventh People’s Hospital from January 2011 to March 2021 were selected as the research objects. According to the 30-day survival of the patients, they were divided into death group (50 cases) and survival group (22 cases). Logistic regression was used to analyze the risk factors affecting death within 30 days of patients with AMI combined with ventricular septal perforation. R software was used to construct a nomogram model to predict the risk of death within 30 days of patients with AMI combined with ventricular septal perforation. Results The anterior wall myocardial infarction, ventricular septal perforation time 1~6 days, Killip cardiac function grade≥ Ⅲof the death group were significantly higher than those of the survival group, and the diameter of ventricular septal perforation of the death group was significantly longer than that of the survival group,but the proportion of patients receiving interventional occlusionin the death group was lower than that in the survival group,and the difference was statistically significant (P<0.05). Logistic regression analysis showed that the anterior wall myocardial infarction (OR=14.057, 95%CI:1.411~140.097),ventricular septal perforation time 1~6 days (OR=35.757, 95%CI:3.592~355.976),and Killip cardiac function ≥ grade Ⅲ (OR=5.894, 95%CI:1.608~32.533) were risk factors affecting death within 30 days of patients with AMI combined ventricular septal perforation(P<0.05),and receiving interventional occlusion(OR=0.103, 95%CI:0.014~0.782) was a protective factor for death within 30 days of patients with AMI combined with ventricular septal perforation(P<0.05).The constructed nomogram prediction model had good distinction and consistency, and Hosmer-Lemeshow goodness-of-fit test χ2=8.674, P=0.371. The area under the curve (AUC) was 0.955 (95%CI: 0.913~0.998). Conclusions The nomogram model constructed in this study to detect the aboverisk factors andprotective factorin the prediction of the risk of death within 30 days of patients with AMI and ventricular septal perforation has good distinction and consistency. |
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