Wang Bojian, Du Yanwei, Cao Pengyu, Liu Min, Yang Jinting, Zhang Ningning, Shao Wangshu, Zhao Lijing, Li Rongyu, Wang Lin
School of Nursing, Jilin University, Changchun, Jilin, China.
The Second People's Hospital of Changzhou, The Third Affiliated Hospital of Nanjing Medical University, Changzhou Jiangsu, China.
PLoS One. 2025 May 7;20(5):e0318445. doi: 10.1371/journal.pone.0318445. eCollection 2025.
The aim of this study is to examine the critical variables that impact the long-term prognosis of patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) and to create a multidimensional predictive risk assessment model that can serve as a theoretical basis for accurate cardiac rehabilitation.
The study involved ACS patients who received PCI at the First Hospital of Jilin University from June 2020 to March 2021. Participants were categorized into two groups: acute myocardial infarction (AMI) and unstable angina (UA), according to clinical data and angiographic findings. Hospitalization data, physical performance, exercise tolerance prior to discharge, average daily steps, major adverse cardiac events (MACE), and a follow-up period of 36 months were documented. The dates for accessing data for research purposes are February 10, 2022 (10/2/2022) to December 10, 2023 (10/12/2023).
We observed substantial increases in weight, fasting plasma glucose (FPG), total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), white blood cell (WBC) count, neutrophil granulocyte count, monocyte count, hemoglobin (Hb) levels, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels in the acute myocardial infarction (AMI) cohort relative to the unstable angina (UA) cohort. We found white blood cell count (WBC) (OR: 4.110) and the effective average number of daily steps (ANS) (OR: 2.689) as independent prognostic risk factors for acute myocardial infarction (AMI). The independent risk factors for unstable angina prognosis were white blood cell count (OR: 6.257), VO2 at anaerobic threshold (OR: 4.294), and effective autonomic nervous system function (OR: 4.097). The whole prognostic risk assessment score for acute myocardial infarction (AMI) is 5 points, with 0 points signifying low risk, 2-3 points representing intermediate risk, and 5 points indicating high risk. The overall prognostic risk assessment score for UA is 7 points, with 0-3 classified as low risk, 4-5 as intermediate risk, and 6-7 as high risk.
This study developed a multimodal predictive model that integrates the inflammatory response after onset, physical performance and exercise tolerance before discharge, and daily activity after discharge to predict the long-term prognosis of patients with ACS. The multidimensional model is more effective than the single-factor model for assessing risk in ACS patients. This work also establishes a theoretical basis for improving the prognosis of potentially high-risk individuals with accurate and reasonable exercise prescriptions.
本研究旨在探讨影响急性冠状动脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）后长期预后的关键变量，并创建一个多维预测风险评估模型，为准确的心脏康复提供理论依据。
本研究纳入了2020年6月至2021年3月在吉林大学第一医院接受PCI的ACS患者。根据临床资料和血管造影结果，将参与者分为两组：急性心肌梗死（AMI）和不稳定型心绞痛（UA）。记录住院数据、身体机能、出院前运动耐力、日均步数、主要不良心脏事件（MACE）以及36个月的随访期。用于研究目的的数据获取日期为2022年2月10日（2022/2/10）至2023年12月10日（2023/12/10）。
我们观察到，相对于不稳定型心绞痛（UA）队列，急性心肌梗死（AMI）队列中的体重、空腹血糖（FPG）、总胆固醇、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、白细胞（WBC）计数、中性粒细胞计数、单核细胞计数、血红蛋白（Hb）水平、天冬氨酸转氨酶（AST）和丙氨酸转氨酶（ALT）水平均有显著升高。我们发现白细胞计数（WBC）（OR：4.110）和有效日均步数（ANS）（OR：2.689）是急性心肌梗死（AMI）的独立预后危险因素。不稳定型心绞痛预后的独立危险因素为白细胞计数（OR：6.257）、无氧阈值时的摄氧量（OR：4.294）和有效自主神经系统功能（OR：4.097）。急性心肌梗死（AMI）的整体预后风险评估评分为5分，0分为低风险，2 - 3分为中度风险，5分为高风险。UA的整体预后风险评估评分为7分，0 - 3分为低风险，4 - 5分为中度风险，6 - 7分为高风险。
本研究建立了一个多模式预测模型，并整合了发病后的炎症反应、出院前的身体机能和运动耐力以及出院后的日常活动，以预测ACS患者的长期预后。该多维模型在评估ACS患者风险方面比单因素模型更有效。这项工作还为通过准确合理的运动处方改善潜在高危个体的预后奠定了理论基础。
