优化综合急救流程下急性ST段抬高型心肌梗死患者行PCI的救治效果及影响因素预测模型构建OA
Rescue efficacy of PCI in patients with acute ST segment elevation myocardial infarction under optimized comprehensive emergency procedures and construction of prediction model of influencing factors
目的 探讨优化综合急救流程下的急性ST段抬高型心肌梗死(STEMI)患者行经皮冠状动脉介入(PCI)治疗的救治效果,并构建急性STEMI患者行PCI的救治效果影响因素预测模型.方法 选取2018年1月—2024年2月行PCI救治的急性STEMI患者673例,其中2018年1月—2020年12月行PCI救治的232例急性STEMI患者接受常规院前急救流程,纳入常规急救流程组;2021年1月—2024年2月行PCI救治的441例急性STEMI患者接受优化院前综合急救流程,纳入优化综合急救流程组.比较两组救治效果;同时收集所有急性STEMI患者一般临床资料,根据术后30 d治疗结局分为救治效果不良组及救治效果良好组.经单因素、多因素Logistic回归分析救治效果不良的影响因素,构建列线图预测模型,分别采用受试者工作特征(ROC)曲线、校准曲线、决策曲线(DCA)验证模型的效能.结果 术后30 d,救治效果不良率为14.56％(98/673).优化综合急救流程组救治效果不良率[9.98％(44/441)]低于常规急救流程组[23.28％(54/232)](P＜0.05).年龄(OR=1.029,95％CI:1.023,1.035)、院前病情初步评估时间(OR=1.024,95％CI:1.021,1.028)、院前生命体征判断时间(OR=1.007,95％CI:1.005,1.010)、院前急救时间(OR=1.105,95％CI:1.102,1.108)、总缺血时间(OR=1.059,95％CI:1.052,1.067)、首次医疗接触至球囊扩张(FMC2B)时间(OR=1.040,95％CI:1.028,1.053)、改良早期预警评分(OR=1.045,95％CI:1.018,1.073)、接受优化综合急救流程(OR=0.363,95％CI:0.252,0.523)、肌钙蛋白Ⅰ(OR=1.099,95％CI:1.078,1.120)是急性STEMI患者行PCI救治效果不良的影响因素(P＜0.01).急性STEMI患者行PCI救治效果不良的列线图预测模型的ROC曲线的曲线下面积为0.907(95％CI:0.871,0.942),校准曲线显示模型预测概率与实际观测结果基本一致,DCA提示在0.19～0.78阈概率范围内具有较高的临床正向净获益.结论 优化综合急救流程可改善急性STEMI患者行PCI的救治效果,年龄、院前病情初步评估时间、院前生命体征判断时间、院前急救时间、总缺血时间、FMC2B时间、改良早期预警评分、接受优化综合急救流程、肌钙蛋白Ⅰ是急性STEMI患者行PCI救治效果不良的影响因素,所构建的列线图风险预测模型的预测效能、校准度及临床效用良好,可用以指导临床制定针对性风险防护措施.
Objective To investigate the rescue efficacy of percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI)under the optimized comprehensive emergency procedure,and to construct a prediction model of influencing factors for the rescue efficacy of PCI in patients with acute STEMI.Methods A total of 673 patients with acute STEMI who underwent PCI from January 2018 to February 2024 were selected.Among them,232 patients with acute STEMI who underwent PCI from January 2018 to December 2020 received routine emergency procedures and were included in the routine emergency procedure group.From January 2021 to February 2024,441 patients with acute STEMI who underwent PCI were included in the optimized comprehensive emergency procedure group.The rescue efficacy of the two groups were compared.In the meantime,the general clinical data of all patients with acute STEMI were collected,and the patients were divided into poor rescue efficacy group and good rescue efficacy group according to the treatment outcome at 30 d after operation.Univariate and multivariate logistic regression analyses were used to analyze the influencing factors of poor rescue efficacy,and a nomogram prediction model was constructed.The receiver operating characteristic(ROC)curve,calibration curve and decision curve analysis(DCA)were used to verify the effectiveness of the model.Results The rate of poor rescue efficacy at 30 d after operation was 14.56％(98/673).The rate of poor rescue efficacy in the optimized comprehensive emergency procedure group[9.98％(44/441)]was lower than that in the routine emergency procedure group[23.28％(54/232)](P＜0.05).Age(OR=1.029,95％CI:1.023,1.035),pre-hospital initial assessment time(OR=1.024,95％CI:1.021,1.028),pre-hospital vital signs assessment time(OR=1.007,95％CI:1.005,1.010),pre-hospital emergency response time(OR=1.105,95％CI:1.102,1.108),total ischemia time(OR=1.059,95％CI:1.052,1.067),first medical contact to balloon dilatation(FMC2B)time(OR=1.040,95％CI:1.028,1.053),modified early warning score(MEWS)(OR=1.045,95％CI:1.018,1.073),receiving optimized comprehensive emergency protocol(OR=0.363,95％CI:0.252,0.523),cardiac troponin Ⅰ(cTnI)(OR=1.099,95％CI:1.078,1.120)were influencing factors for poor outcomes in patients with acute STEMI undergoing PCI(P＜0.0 1).The ROC curve of the nomogram prediction model for acute STEMI patients with poor PCI treatment showed that the area under the curve was 0.907(95％CI:0.871,0.942).The calibration curve showed that the prediction probability of the model was basically consistent with the actual observation results,and DCA suggested that there was a high clinical positive net benefit in the range of 0.19-0.78 threshold probability.Conclusion Optimized comprehensive emergency procedure can improve the rescue efficacy of PCI in patients with acute STEMI.Age,pre-hospital initial assessment time,pre-hospital vital sign assessment time,pre-hospital emergency response time,total ischemia time,FMC2 B time,MEWS,receiving optimized comprehensive emergency protocol,cTnI are the influencing factors of poor rescue efficacy of PCI in patients with acute STEMI.The nomogram risk prediction model has good prediction efficiency,calibration and clinical utility,which can be used to guide the clinical formulation of targeted risk protection measures.
黄雯;景晓;侯静;琅哲;梁喜凤
石家庄市急救中心急救业务科,石家庄 050031石家庄市急救中心办公室,石家庄 050031石家庄市急救中心急救业务科,石家庄 050031石家庄市人民医院急诊科,石家庄 050031石家庄市急救中心急救培训科,石家庄 050031
急性ST段抬高型心肌梗死经皮冠状动脉介入优化综合急救流程救治效果肌钙蛋白Ⅰ改良早期预警系统预测模型
acute ST-segment elevation myocardial infarctionpercutaneous coronary interventionoptimized comprehensive emergency protocolrescue efficacycardiac troponin Ⅰmodified early warning scoreprediction model
《临床误诊误治》 2026 (8)
36-42,66,8
河北省2024年度医学科学研究课题计划(20240558)
评论