Chen Qin, Chen Yuxiang, Hong Ruijin, Zhong Jiaxin, Chen Lihua, Yan Yuanming, Chen Lianglong, Luo Yukun
Fujian Key Laboratory of Vascular Aging (Fujian Medical University), Department of Cardiology, Fujian Medical University Union Hospital, 350001 Fuzhou, Fujian, China.
Fujian Key Laboratory of Vascular Aging (Fujian Medical University), Fujian Institute of Coronary Heart Disease, 350001 Fuzhou, Fujian, China.
Rev Cardiovasc Med. 2024 May 6;25(5):155. doi: 10.31083/j.rcm2505155. eCollection 2024 May.
Revascularized patients still experience adverse cardiovascular events. This is particularly true for elderly patients over the age of 65, as they often have more co-morbid vascular conditions. It is important to develop a tool to assist clinicians in comprehensively assessing these patients' prognosis. The objective of this study is to create a comprehensive visual nomogram model combining clinical and physiological assessments to predict outcomes in elderly patients undergoing percutaneous coronary intervention (PCI).
This study is a retrospective investigation of patients who underwent PCI between January 2016 and December 2017. A total of 691 patients with 1461 vessels were randomly divided into a training (n = 483) and a validation set (n = 208). A multivariate Cox regression model was employed using the training set to select variables for constructing a nomogram. The performance of the nomogram was assessed through the receiver operating characteristic curve (ROC) and calibration curves to evaluate its discrimination and predictive accuracy. To further assess the clinical usefulness, Kaplan-Meier curve analysis and landmark analysis were conducted.
Independent risk factors, including diabetes mellitus (DM), post-PCI quantitative flow ratio (QFR), previous myocardial infarction (MI), and previous PCI, were contained in the nomogram. The nomogram exhibited a good area under the curve (AUC) ranging from 0.742 to 0.789 in the training set, 0.783 to 0.837 in the validation set, and 0.764 to 0.786 in the entire population. Calibration curves demonstrated a well-fitted curve in all three sets. The Kaplan-Meier curves showed clear separation and the patients with higher scores in the nomogram model exhibited a higher incidence of target vessel revascularization (TVR) (7.99% vs. 1.24% for 2-year, 0.001 and 13.54% vs. 2.23% for 5-years, 0.001, respectively).
This study has developed the visually intuitive nomogram to predict the 2-year and 5-year TVR rates for elderly patients who underwent PCI. This tool provides more accurate and comprehensive healthcare guidance for patients and their physicians.
血管重建术后的患者仍会经历不良心血管事件。对于65岁以上的老年患者尤其如此，因为他们通常有更多的合并血管疾病。开发一种工具来协助临床医生全面评估这些患者的预后非常重要。本研究的目的是创建一个综合视觉列线图模型，结合临床和生理评估，以预测接受经皮冠状动脉介入治疗（PCI）的老年患者的预后。
本研究是对2016年1月至2017年12月期间接受PCI的患者进行的回顾性调查。共有691例患者的1461支血管被随机分为训练集（n = 483）和验证集（n = 208）。使用训练集采用多变量Cox回归模型选择构建列线图的变量。通过受试者工作特征曲线（ROC）和校准曲线评估列线图的性能，以评估其辨别力和预测准确性。为进一步评估临床实用性，进行了Kaplan-Meier曲线分析和地标分析。
列线图包含独立危险因素，包括糖尿病（DM）、PCI术后定量血流比（QFR）、既往心肌梗死（MI）和既往PCI。列线图在训练集中的曲线下面积（AUC）良好，范围为0.742至0.789，在验证集中为0.783至0.837，在整个人口中为0.764至0.786。校准曲线在所有三个数据集中均显示拟合良好的曲线。Kaplan-Meier曲线显示出明显的分离，列线图模型中得分较高的患者靶血管重建（TVR）发生率较高（2年时分别为7.99%对1.24%，P = 0.001；5年时分别为13.54%对2.23%，P = 0.001）。
本研究开发了直观的列线图，以预测接受PCI的老年患者的2年和5年TVR率。该工具为患者及其医生提供了更准确和全面的医疗指导。
