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基于机器学习的经皮冠状动脉介入治疗后非 ST 段抬高型心肌梗死患者再入院风险预测模型的建立与验证。

Development and validation of a machine learning-based readmission risk prediction model for non-ST elevation myocardial infarction patients after percutaneous coronary intervention.

机构信息

Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, No. 63, Wenhua Road, Nanchong, 637000, Sichuan Province, People's Republic of China.

Department of Cardiology, People's Hospital of Guang'an District, Guang'an, 638550, People's Republic of China.

出版信息

Sci Rep. 2024 Jun 11;14(1):13393. doi: 10.1038/s41598-024-64048-x.


DOI:10.1038/s41598-024-64048-x
PMID:38862634
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11166920/
Abstract

To investigate the factors that influence readmissions in patients with acute non-ST elevation myocardial infarction (NSTEMI) after percutaneous coronary intervention (PCI) by using multiple machine learning (ML) methods to establish a predictive model. In this study, 1576 NSTEMI patients who were hospitalized at the Affiliated Hospital of North Sichuan Medical College were selected as the research subjects. They were divided into two groups: the readmitted group and the non-readmitted group. The division was based on whether the patients experienced complications or another incident of myocardial infarction within one year after undergoing PCI. Common variables selected by univariate and multivariate logistic regression, LASSO regression, and random forest were used as independent influencing factors for NSTEMI patients' readmissions after PCI. Six different ML models were constructed using these common variables. The area under the ROC curve, accuracy, sensitivity, and specificity were used to evaluate the performance of the six ML models. Finally, the optimal model was selected, and a nomogram was created to visually represent its clinical effectiveness. Three different methods were used to select seven representative common variables. These variables were then utilized to construct six different ML models, which were subsequently compared. The findings indicated that the LR model exhibited the most optimal performance in terms of AUC, accuracy, sensitivity, and specificity. The outcome, admission mode (walking and non-walking), communication ability, CRP, TC, HDL, and LDL were identified as independent predicators of readmissions in NSTEMI patients after PCI. The prediction model constructed by the LR algorithm was the best. The established column graph model established proved to be effective in identifying high-risk groups with high accuracy and differentiation. It holds a specific predictive value for the occurrence of readmissions after direct PCI in NSTEMI patients.

摘要

采用多种机器学习(ML)方法,探讨经皮冠状动脉介入治疗(PCI)后急性非 ST 段抬高型心肌梗死(NSTEMI)患者再入院的影响因素,建立预测模型。本研究选取我院收治的 1576 例 NSTEMI 患者为研究对象,将其分为再入院组和未再入院组。根据患者 PCI 术后 1 年内是否发生并发症或再次发生心肌梗死进行分组。采用单因素和多因素逻辑回归、LASSO 回归和随机森林选择常见变量,将其作为 NSTEMI 患者 PCI 后再入院的独立影响因素。利用这些常见变量构建了 6 种不同的 ML 模型,使用 ROC 曲线下面积、准确率、敏感度和特异度评估 6 种 ML 模型的性能。最终选择最优模型,绘制列线图直观表示其临床效果。采用三种不同方法选择 7 个有代表性的常见变量,将其用于构建 6 种不同的 ML 模型,并进行比较。结果显示,LR 模型在 AUC、准确率、敏感度和特异度方面表现最优。入院方式(步行和非步行)、沟通能力、CRP、TC、HDL、LDL 是 PCI 后 NSTEMI 患者再入院的独立预测因子。LR 算法构建的预测模型最优。建立的列线图模型证明在识别高风险组方面具有较高的准确性和区分度,对 NSTEMI 患者直接 PCI 后再入院的发生具有特定的预测价值。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0105/11166920/321c70e625a9/41598_2024_64048_Fig9_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0105/11166920/9c4eb1189045/41598_2024_64048_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0105/11166920/f1e7d4211d29/41598_2024_64048_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0105/11166920/a209971c870e/41598_2024_64048_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0105/11166920/c68179a984f9/41598_2024_64048_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0105/11166920/5f48798dd46b/41598_2024_64048_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0105/11166920/b71ad0a0a488/41598_2024_64048_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0105/11166920/cd33b3490732/41598_2024_64048_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0105/11166920/47254af9e790/41598_2024_64048_Fig8_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0105/11166920/321c70e625a9/41598_2024_64048_Fig9_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0105/11166920/9c4eb1189045/41598_2024_64048_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0105/11166920/f1e7d4211d29/41598_2024_64048_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0105/11166920/a209971c870e/41598_2024_64048_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0105/11166920/c68179a984f9/41598_2024_64048_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0105/11166920/5f48798dd46b/41598_2024_64048_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0105/11166920/b71ad0a0a488/41598_2024_64048_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0105/11166920/cd33b3490732/41598_2024_64048_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0105/11166920/47254af9e790/41598_2024_64048_Fig8_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0105/11166920/321c70e625a9/41598_2024_64048_Fig9_HTML.jpg

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引用本文的文献

[1]
Enhancing one-year mortality prediction in STEMI patients post-PCI: an interpretable machine learning model with risk stratification.

Front Artif Intell. 2025-8-22

[2]
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J Med Internet Res. 2025-7-18

[3]
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Eur J Med Res. 2025-3-25

[4]
Predictive and prognostic nomogram models for liver metastasis in colorectal neuroendocrine neoplasms: a large population study.

Front Endocrinol (Lausanne). 2025-1-7

本文引用的文献

[1]
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