Establishment and evaluation of a nomogram prediction model for major adverse cardiovascular events in patients with coronary artery calcification after PCI
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1.Department of Cardiology, Fourth Affiliated Hospital of Xinjiang Medical University,Xinjiang Uygur Autonomous Region 830000, China ;2.Xinjiang Autonomous Region Institute of Traditional Chinese Medicine, Urumqi, Xinjiang Uygur Autonomous Region 830000, China)

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R5

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    Abstract:

    Aim To explore the risk factors of major adverse cardiovascular events(MACE) after percutaneous coronary intervention (PCI) in patients with coronary artery calcification(CAC), and to construct a nomogram prediction model for MACE in CAC patientsafter PCI. Methods Retrospective analysis of clinical data of 406 patients admitted to the Department of Cardiology of the Fourth Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2019, they were diagnosed with CAC by coronary angiography (CAG) or intravascular ultrasound (IVUS) and underwent PCI. The subjects were divided into event group (60 cases) and non-event group (346 cases) according to the incidence of MACE during the follow-up period. The LASSO regression and multivariate Logistic regression analysis were used to determine the independent risk factors of MACE in CAC patients after PCI, and then a nomogram prediction model was constructed and evaluated. Results LASSO regression and multivariate Logistic regression analysis results showed that advanced age, diabetes, renal dysfunction, elevated Gensini score and rotational atherectomy were risk factors for the incidence of MACE, and enlarged minimum lumen diameter (MLD) was a protective factor for the incidence of MACE (P<0.05). The nomogram prediction model was constructed using the above six predictive indicators. After internal validation, the AUC values of nomogram for predicting MACE in CAC patients after PCI was 0.824 (95%CI:0.767~0.875), the sensitivity was 0.771, and the specificity was 0.720, suggesting that the model had a good discrimination. The calibration curve indicated that the deviation correction curve of the nomogram prediction model had good consistency with the ideal curve. The clinical decision curve analysis (DCA) suggested that when the prediction threshold of the model was in range of 0~0.6, the patient's clinical net benefit level was the highest, and the nomogram model had good clinical applicability. Conclusion The nomogram prediction model established in this study can better quantitatively assess the risk degree of MACE in CAC patients after PCI, which is helpful for clinicians to screen high-risk patients, formulate individualized targeted interventions, and improvepatients, prognosis.

    Reference
    [1] 柴萌, 张海涛, 杜俣, 等.冠状动脉复杂钙化病变治疗的循证医学进展.中国实用内科杂志, 9,9(1):81-85.CHAI M, ZHANG H T, DU W, et al.Advances in evidence-based medicine in the treatment of complex calcification of coronary arteries.Chin J Pract Int Med, 9,9(1):81-85.
    [2] 王伟民, 霍勇, 葛均波.冠状动脉钙化病变诊治中国专家共识(2021版).中国介入心脏病学杂志, 1,9(5):251-259.WANG W M, HUO Y, GE J B.Chinese expert consensus on the diagnosis and treatment of coronary artery calcification (2021 edition).Chin J Interv Cardiol, 1,9(5):251-259.
    [3] FAROOQ V, SERRUYS P W, GARCIA-GARCIA H M, et al.The negative impact of incomplete angiographic revascularization on clinical outcomes and its association with total occlusions:the SYNTAX (synergy between percutaneous coronary intervention with taxus and cardiac surgery) trial.J Am Coll Cardiol, 3,1(3):282-294.
    [4] 温尚煜, 尚瑞平, 于宏颖, 等.冠状动脉内旋磨术并发症分析、预防及处理技巧.中国介入心脏病学杂志, 7,5(12):677-681.WEN S Y, SHANG R P, YU H Y, et al.Analysis, prevention and management of complications of internal rotation of coronary artery.Chin J Interv Cardiol, 7,5(12):677-681.
    [5] KOBAYASHI Y, OKURA H, KUME T, et al.Impact of target lesion coronary calcification on stent expansion.Circ J, 4,8(9):2209-2214.
    [6] 王凯阳, 闵轩, 宁怡, 等.GRACE评分联合血栓弹力图对急性冠脉综合征患者主要心血管不良事件的早期预测价值.石河子大学学报(自然科学版), 2,0(3):383-389.WANG K Y, MIN X, NING Y, et al.Early predictive value of GRACE score combined with thromboelastography for major adverse cardiovascular events in patients with acute coronary syndrome.J Shihezi Univ (Nat Sci Ed), 2,0(3):383-389.
    [7] WANG K Y, ZHENG Y Y, WU T T, et al.Predictive value of Gensini score in the long-term outcomes of patients with coronary artery disease who underwent PCI.Front Cardiovasc Med, 1,8:778615.
    [8] 中华医学会心血管病学分会, 中国医师协会高血压专业委员会.中国高血压防治指南(2018年修订版).中国心血管杂志, 9,4(1):24-56.CHINESE MEDICAL ASSOCIATION CARDIOVASCULAR SOCIETY, CHINESE MEDICAL DOCTOR ASSOCIATION HYPERTENSION PROFESSIONAL COMMITTEE.Chinese guidelines for prevention and treatment of hypertension (2018 revision).Chin J Cardiol, 9,4(1):24-56.
    [9] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2020年版)(上).中国实用内科杂志, 1,1(8):668-695.DIABETES SOCIETY OF CHINESE MEDICAL ASSOCIATION.Guidelines for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition) (one part) .Chin J Pract Int Med, 1,1(8):668-695.
    [10] 李伯睿, 邓雪蓉, 宋志博, 等.银屑病关节炎患者中代谢综合征的患病率及其各组分与临床特征的关联研究.中华风湿病学杂志, 1,5(2):97-103.LI B R, DENG X R, SONG Z B, et al.The prevalence of metabolic syndrome in patients with psoriatic arthritis and its correlation with clinical characteristics.Chin J Rheumatol, 1,5(2):97-103.
    [11] 上海市肾脏病临床质量控制中心专家组.慢性肾脏病早期筛查、诊断及防治指南(2022年版).中华肾脏病杂志, 2,8(5):453-464.EXPERT GROUP OF SHANGHAI CLINICAL QUALITY CONTROL CENTER OF NEPHROLOGY.Guidelines for early screening, diagnosis and prevention of chronic kidney disease (2022 edition).Chin J Nephrol, 2,8(5):453-464.
    [12] 中国老年医学学会内分泌代谢分会.中国老年2型糖尿病防治临床指南(2022年版).中国糖尿病杂志, 2,0(1):2-51.ENDOCRINOLOGY BRANCH OF CHINESE GERIATRICS SOCIETY.Clinical guidelines for the prevention and treatment of type 2 diabetes in the elderly in China (2022 edition) .Chin J Diab, 2,0(1):2-51.
    [13] GNREUX P, MADHAVAN M V, MINTZ G S, et al.Ischemic outcomes after coronary intervention of calcified vessels in acute coronary syndromes.Pooled analysis from the HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) and ACUITY (acute catheterization and urgent intervention triage strategy) trials.J Am Coll Cardiol, 4,3(18):1845-1854.
    [14] 李其勇, 李刚, 陶剑虹.旋磨联合切割球囊治疗冠状动脉重度钙化病变的可行性及安全性.重庆医学, 9,8(2):233-236.LI Q Y, LI G, TAO J H.Feasibility and safety of the treatment of severe coronary artery calcification with rotary grinding combined with cutting balloon.Chongqing Med J, 9,8(2):233-236.
    [15] KUBO T, SHINKE T, OKAMURA T, et al.Optical frequency domain imaging vs.intravascular ultrasound in percutaneous coronary intervention (OPINION trial):study protocol for a randomized controlled trial.J Cardiol, 6,8(5):455-460.
    [16] HOEBERS L P, CLAESSEN B E, DANGAS G D, et al.Long-term clinical outcomes after percutaneous coronary intervention for chronic total occlusions in elderly patients (≥75 years):five-year outcomes from a 1 791 patient multi-national registry.Catheter Cardiovasc Interv, 3,2(1):85-92.
    [17] BATCHELOR W B, ANSTROM K J, MUHLBAIER L H, et al.Contemporary outcome trends in the elderly undergoing percutaneous coronary interventions:results in 7 472 octogenarians.National Cardiovascular Network Collaboration.J Am Coll Cardiol, 0,6(3):723-730.
    [18] GENSINI G G.A more meaningful scoring system for determining the severity of coronary heart disease.Am J Cardiol, 3,1(3):606-610.
    [19] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2020年版).国际内分泌代谢杂志, 1,1(5):482-548.DIABETES SOCIETY OF CHINESE MEDICAL ASSOCIATION.Guidelines for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition).Int J Endocrinol Metab, 1,1(5):482-548.
    [20] UEDA H, MITSUSADA N, HARIMOTO K, et al.Glycosylated hemoglobin is a predictor of major adverse cardiac events after drug-eluting stent implantation in patients with diabetes mellitus.Cardiology, 0,6(1):51-57.
    [21] KASSAIAN S E, GOODARZYNEJAD H, BOROUMAND M A, et al.Glycosylated hemoglobin (HbA1c) levels and clinical outcomes in diabetic patients following coronary artery stenting.Cardiovasc Diabetol, 2,1(3):82-85.
    [22] 中华医学会糖尿病学分会微血管并发症学组.中国糖尿病肾脏病防治指南(2021年版).国际内分泌代谢杂志, 1,1(4):388-410.MICROVASCULAR COMPLICATIONS GROUP, DIABETES SOCIETY OF CHINESE MEDICAL ASSOCIATION.Chinese guidelines for prevention and treatment of diabetic nephropathy (2021 edition).Int J Endocrinol Metab, 1,1(4):388-410.
    [23] 苏胜, 邱宁, 张红, 等.糖尿病对老年冠状动脉慢性完全闭塞患者经皮介入治疗后的影响.介入放射学杂志, 3,2(9):714-717.SU S, QIU N, ZHANG H, et al.Effect of diabetes mellitus on chronic complete coronary artery occlusion in elderly patients after percutaneous interventional therapy.J Interv Radiol, 3,2(9):714-717.
    [24] 中华医学会糖尿病学分会.中国糖尿病肾脏病防治指南(2021年版).中华糖尿病杂志, 1,3(8):762-784.DIABETES SOCIETY OF CHINESE MEDICAL ASSOCIATION.Chinese guidelines for prevention and treatment of diabetic nephropathy (2021 edition).Chin J Diabet Mellit, 1,3(8):762-784.
    [25] 吕明智, 宁彬.旋磨与球囊预扩张治疗冠状动脉重度钙化病变的疗效分析.中国动脉硬化杂志, 0,8(4):344-349.LV M Z, NING B.Efficacy analysis of rotational atherectomy and balloon predilation in the treatment of severe coronary artery calcification.Chin J Arterioscler, 0,8(4):344-349.
    [26] ABDEL-WAHAB M, RICHARDT G, JOACHIM BTTNER H, et al.High-speed rotational atherectomy before paclitaxel-eluting stent implantation in complex calcified coronary lesions:the randomized ROTAXUS (rotational atherectomy prior to taxus stent treatment for complex native coronary artery disease) trial.JACC Cardiovasc Interv, 3,6(1):10-19.
    [27] DE WAHA S, ALLALI A, BTTNER H J, et al.Rotational atherectomy before paclitaxel-eluting stent implantation in complex calcified coronary lesions:two-year clinical outcome of the randomized ROTAXUS trial.Catheter Cardiovasc Interv, 6,7(4):691-700.
    [28] 吴永健.冠状动脉钙化病变预处理不同方法的选择.临床心血管病杂志, 2,8(7):517-520.WU Y J.Selection of different pretreatment methods for coronary artery calcification.J Clin Cardiol, 2,8(7):517-520.
    [29] 王凯阳, 闵轩, 马依彤, 等.冠状动脉慢性完全闭塞病变患者PCI术后主要不良心血管事件影响因素的Meta分析.中国动脉硬化杂志, 2,0(9):778-786.WANG K Y, MIN X, MA Y T, et al.Meta-analysis of major adverse cardiovascular events in patients with chronic complete coronary artery occlusion after PCI.Chin J Arterioscler, 2,0(9):778-786.
    [30] KORNOWSKI R, FORT S, ALMAGOR Y, et al.Impact of vessel size, lesion length and diabetes mellitus on angiographic restenosis outcomes:insights from the NIRTOP study.Acute Card Care, 8,0(2):104-108.
    [31] 李晓冉, 赵笑男, 陈晖.冠状动脉钙化病变干预策略及治疗进展.中国循证心血管医学杂志, 0,2(4):509-512.LI X R, ZHAO X N, CHEN H.Intervention strategy and treatment progress of coronary artery calcification.Chin J Evid Based Cardiovasc Med, 0,2(4):509-512.
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WANG Kaiyang, Alfira·PARHATI, YANG Yan, LI Xiufen. Establishment and evaluation of a nomogram prediction model for major adverse cardiovascular events in patients with coronary artery calcification after PCI[J]. Editorial Office of Chinese Journal of Arteriosclerosis,2023,31(2):122-130.

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History
  • Received:August 23,2020
  • Revised:October 23,2022
  • Online: January 12,2023
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