Wu Zu-Fei, Su Wen-Tao, Chen Shi, Xu Bai-Da, Zong Gang-Jun, Fang Cun-Ming, Huang Zheng, Hu Xue-Jun, Wu Gang-Yong, Ma Xiao-Lin
Department of Cardiology, Xuancheng People's Hospital, Xuanchen, Anhui, 242000, People's Republic of China.
Department of Cardiology, the 904th Hospital of the PLA Joint Logistics Support Force, Wuxi, Jiangsu, 214044, People's Republic of China.
Ther Clin Risk Manag. 2023 Aug 23;19:699-712. doi: 10.2147/TCRM.S420335. eCollection 2023.
To investigate the correlation between serum parathyroid hormone (PTH) levels and in-hospital major adverse cardiovascular events (MACE) in patients with acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI), and establish a risk prediction model based on parameters such as PTH for in-hospital MACE.
This observational retrospective study consecutively enrolled 340 patients who underwent primary PCI for STEMI between January 2016 and December 2020, divided into a MACE group (n=92) and a control group (n=248). The least absolute shrinkage and selection operator (LASSO) and logistic regression analyses were used to determine the risk factors for MACE after primary PCI. The rms package in R-studio statistical software was used to construct a nomogram, to detect the line chart C-index, and to draw a calibration curve. The decision curve analysis (DCA) method was used to evaluate the clinical application value and net benefit.
Correlation analysis revealed that PTH level positively correlated with the occurrence of in-hospital MACE. Receiver operating characteristic curve analyses revealed that PTH had a good predictive value for in-hospital MACE. Multivariate logistic regression analysis indicated that Killip class II-IV, and FBG were independently associated with in-hospital MACE after primary PCI. A nomogram model was constructed using the above parameters. The model C-index was 0.894 and the calibration curve indicated that the model was well calibrated. The DCA curve suggested that the nomogram model was better than TIMI score model in terms of net clinical benefit.
Serum PTH levels in patients with STEMI are associated with in-hospital MACE after primary PCI, and the nomogram risk prediction model based on PTH demonstrated good predictive ability with obvious clinical practical value.
探讨急性ST段抬高型心肌梗死（STEMI）患者在直接经皮冠状动脉介入治疗（PCI）后血清甲状旁腺激素（PTH）水平与院内主要不良心血管事件（MACE）之间的相关性，并基于PTH等参数建立院内MACE的风险预测模型。
本观察性回顾性研究连续纳入了2016年1月至2020年12月期间因STEMI接受直接PCI的340例患者，分为MACE组（n = 92）和对照组（n = 248）。采用最小绝对收缩和选择算子（LASSO）及逻辑回归分析来确定直接PCI后MACE的危险因素。使用R-studio统计软件中的rms包构建列线图，检测线图C指数，并绘制校准曲线。采用决策曲线分析（DCA）方法评估临床应用价值和净效益。
相关性分析显示PTH水平与院内MACE的发生呈正相关。受试者工作特征曲线分析显示PTH对院内MACE具有良好的预测价值。多因素逻辑回归分析表明，Killip分级II-IV级和空腹血糖（FBG）与直接PCI后的院内MACE独立相关。使用上述参数构建了列线图模型。该模型的C指数为0.894，校准曲线表明模型校准良好。DCA曲线表明，在净临床效益方面，列线图模型优于TIMI评分模型。
STEMI患者的血清PTH水平与直接PCI后的院内MACE相关，基于PTH的列线图风险预测模型具有良好的预测能力，具有明显的临床实用价值。
