CatLet冠状动脉评分系统预测老年冠心病患者远期预后:一项基于时间依赖性ROC曲线的生存分析研究OA
Prognostic value of CatLet coronary scoring system in elderly patients with coronary artery disease:a survival analysis based on time-dependent receiver operating characteristic curve
目的 探讨冠状动脉树描述、病变评估及治疗信息收集系统(CatLet冠状动脉评分系统)在老年(年龄≥60岁)冠心病患者中的风险分层能力和预后预测价值.方法 连续纳入2018年1-12月合肥市第一人民医院因胸痛行冠状动脉造影的老年冠心病患者,收集患者入院时基本资料和入院后首次化验的生化指标、心超结果、造影图等数据.对纳入患者根据造影图进行残余病变评分(rCatLet),并进行6年预后随访.主要终点为主要不良心脑血管事件(MACCEs),次要终点包括全因死亡和心源性死亡.采用Kaplan-Meier方法估算生存率,采用Cox回归分析确定影响临床结局的独立预测因子,采用时间依赖受试者工作特征曲线下面积(tAUC)评估rCatLet预测价值.结果 最终纳入患者208例,MACCEs、全因死亡和心源性死亡的发生率分别为42.31％(88/208)、27.88％(58/208)和16.83％(35/208).所有终点事件的Kaplan-Meier曲线显示,随着rCatLet评分三分位分组等级升高,事件发生率呈上升趋势,Log-rank检验的P值均＜0.001.Cox比例风险模型分析显示,在校正年龄、糖尿病、左室射血分数、血清肌酐的多变量模型中,以rCatLet低分位组为参照,rCatLet中分位组和高分位组的MACCEs风险均升高[风险比(HR)及95％置信区间(95％CI)分别为1.75(0.92～3.35)、4.93(2.73～8.93),趋势检验P值＜0.001].时间依赖受试者工作特征曲线分析显示,1、3、6年随访时点rCatLet评分多变量模型的tAUC(95％CI)分别为0.84(0.74～0.92)、0.77(0.70～0.85)和 0.82(0.74～0.86).结论 rCatLet 冠状动脉评分对老年冠心病患者 1、3、6年的MACCEs均具有较好的预测价值,联合临床因素的多变量模型可显著提升其预测效能.
Objective To investigate the risk stratification capability and prognostic prediction value of the coronary artery tree description,lesion evaluation and treatment information collecting system(CatLet coronary scoring system)in elderly patients(age ≥60 years)with coronary heart dis-ease(CHD).Methods Elderly coronary heart disease patients underwent coronary angiography for chest pain at Hefei First People's Hospital from January to December 2018 were consecutively enrolled.Baseline data,biochemical indicators from the first laboratory tests after admission,echocardiographic results,and angiographic images were collected.Residual CatLet(rCatLet)scores were calculated based on angiographic images for all enrolled patients,and a 6-year prognostic follow-up was conduc-ted.The primary endpoint was major adverse cardiovascular and cerebrovascular events(MACCEs),and secondary endpoints included all-cause death and cardiac death.Kaplan-Meier analysis was used to estimate survival rates,Cox regression analysis was performed to identify independent predic-tors of clinical outcomes,and time-dependent area under the curve(tAUC)of receiver operating characteristic curve was used to evaluate the predictive value of rCatLet.Results A total of 208 pa-tients were finally enrolled,with the incidence rates of MACCEs,all-cause death,and cardiac death being 42.31％(88/208),27.88％(58/208)and 16.83％(35/208),respectively.Kaplan-Meier curves for all endpoints showed an increasing trend in event rates with higher rCatLet tertile groups(all log-rank P＜0.001).Multivariable Cox proportional hazards model analysis,adjusted for age,diabetes,left ventricular ejection fraction,and serum creatinine,demonstrated that compared with the low rCatLet tertile group(reference),both the middle and high tertile groups had significantly increased risks of MACCEs[hazard ratio(HR)and 95％confidence interval(95％CI),1.75(0.92 to 3.35)and 4.93(2.73 to 8.93),respectively;trend test P＜0.001].The tAUC(95％CI)of re-ceiver operating characteristic curve analysis revealed that the rCatLet multivariable model at 1-,3-,and 6-year follow-up was 0.84(0.74 to 0.92),0.77(0.70 to 0.85),and 0.82(0.74 to 0.86),respectively.Conclusion The rCatLet coronary scoring system demonstrates good predictive value for MACCEs at 1,3,and 6 years in elderly coronary heart disease patients.A multivariable model incorporating clinical factors can significantly enhance its predictive performance.
徐明星;王静;汪永生;赫兰;王书
安徽医科大学第三附属医院/合肥市第一人民医院,老年医学科,安徽 合肥,230000安徽医科大学第三附属医院/合肥市第一人民医院,老年医学科,安徽 合肥,230000安徽医科大学第三附属医院/合肥市第一人民医院,心血管内科,安徽 合肥,230000上海交通大学医学院附属胸科医院超声科,上海,200030安徽医科大学第三附属医院/合肥市第一人民医院,老年医学科,安徽 合肥,230000
医药卫生
冠心病老年人群冠状动脉树描述、病变评估及治疗信息收集系统预后血管造影术主要不良心脑血管事件时间依赖受试者工作特征曲线生存分析
《实用临床医药杂志》 2026 (14)
7-15,9
国家自然科学基金青年科学基金项目(82502378)安徽省卫生健康科研项目(2023-262)安徽医科大学校基金(2023xkj112)
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