| 摘要: |
| 目的 明确高龄冠心病患者经皮冠状动脉介入治疗(PCI)术后发生院内不良心血管事件的危险因素并建立相应的危险评分。 方法 选取我院2005年1月至2010年12月共计1 007例接受PCI的高龄冠心病患者(年龄≥75岁)病例资料作为研究组,通过单因素及多因素logistic回归分析确定院内不良心血管事件发生的独立危险因素,并根据分析结果建立危险评分模型。收集我院2011年1月至2012年12月共计527例接受PCI治疗的高龄冠心病患者(年龄≥75岁)病例资料作为验证组,对该危险评分模型进行验证,检验其受试者工作特征(ROC)曲线下面积和Hosmer-Lemeshow拟合优度,判断其预测及判别性能。 结果 多因素logistic回归分析提示7个独立危险因素最终入选PCI危险评分模型并赋予相应分值如下:急诊PCI治疗(3分)、肾功能不全(2分)、左主干病变(2分)、糖尿病(1分)、急性心肌梗死(1分)、C型病变(1分),植入支架≥3枚(1分)。验证提示该危险评分对院内不良心血管事件的发生具有较高的辨识度及校准度(ROC曲线下面积为0.89,Hosmer-Lemeshow拟合优度检验P=0.586)。 结论 最终建立的PCI危险评分包括7个危险因素,各因素得分为1~3分不等,总分共11分。该PCI危险因素评分能够较为准确地预测高龄冠心病患者PCI术后院内不良心血管事件的发生。 |
| 关键词: 老年人 冠心病 经皮冠状动脉介入术 危险因素 危险评分 |
| DOI：10.3724/SP.J.1008.2015.00851 |
| 投稿时间：2015-02-10修订日期：2015-04-06 |
| 基金项目:上海市科委科技支撑项目(13411950302). |
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| Risk factor score for predicting in-hospital adverse cardiovascular events in elderly patients undergoing percutaneous coronary intervention |
| LI Mao-wei,ZHANG Bi-li,ZHENG Xing*,CHEN Feng,LI Ran,SHEN Ming |
(Department of Cardiovasology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To identify the risk factors of in-hospital adverse cardiovascular events in elderly patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI) and to establish a risk factor score for these CAD patients. Methods A total of 1 007 consecutive elderly patients with coronary heart disease, aged over 75 years old, who underwent PCI in our hospital from January 2005 to December 2010, were enrolled in this study. Univariate and multivariate logistic regression analysis were performed to determine the risk factors associated with adverse cardiovascular events, and then a risk score model was constructed according to the analysis results. The risk score model was then validated with 527 elderly CAD patients over 75 years old who underwent PCI in our hospital between January 2011 and December 2012. The area under the receiver operating characteristic (ROC) curve and the Hosmer-Lemeshow goodness of fit data were calculated to assess the performance and calibration of this risk score. Results Multivariate logistic regression analysis indicated 7 independent predictors with their associated risk weights as follows: urgent PCI (3 scores), renal insufficiency (2 scores), left main disease (2 scores), diabetes mellitus (1 score), acute myocardial infarction (1 score), type C lesion (1 score), and ≥3 stents placed (1 score). The validation results showed that the risk score model had a good performance in terms of discrimination and calibration, with the area under ROC curve being 0.89 and Hosmer-Lemeshow P value being 0.586. Conclusion Finally 7 risk factors are included for the risk score model, with the risk factor scores of each ranging 1-3 and the highest total score being 11. The constructed score model can accurately predict the adverse cardiovascular events in elderly CAD patients undergoing PCI. |
| Key words: aged coronary disease percutaneous coronary intervention risk factors risk score |
