急性冠状动脉综合征患者经皮冠状动脉介入治疗术后一过性心律失常的预测模型构建

doi:10.3969/j.issn.1006-5725.2025.13.012

Abstract

Abstract:

Objective To explore the factors affecting the occurrence of transient arrhythmia after percutaneous coronary intervention （PCI） in patients with acute coronary syndromes （ACS）， to establish a risk prediction model， and to test the prediction effect. Methods 480 ACS patients who underwent PCI in Western Theater Air Force Hospital of PLA from August 2022 to February 2024 were selected as study subjects and were divided into 336 cases in the construct group and 144 cases in the validation group according to the ratio of 7：3. The data of the construct group were used to construct the model， and the validation group was used to validate the model. The patients in the constructed group were divided into 84 cases in the occurrence group and 252 cases in the non-occurrence group according to whether they had experienced postoperative transient arrhythmia， and the validation group was divided into 36 cases in the occurrence group and 108 cases in the non-occurrence group. The baseline data of the study subjects in the two groups were observed， and the predictive value of continuous variables was analyzed using the ROC experiment； the influencing factors of the occurrence of transient arrhythmia after PCI in ACS patients were analyzed using multifactorial logistic regression； the Nomogram prediction model was constructed using the R language； and the model was evaluated and validated using calibration curves and decision curves. Results The results of a one-way analysis of the constructed group showed that older age， the presence of a history of diabetes mellitus， the time from onset to admission ≥ 6 h， and higher BNP levels were the main risk factors for the occurrence of transient arrhythmia after PCI in patients with ACS （P < 0.05）， and the prediction model established accordingly had an AUC of 0.865 and a 95% CI of 0.804 ~ 0.927， which was effective in predicting the occurrence of transient arrhythmia after PCI in patients with ACS. The model performed well in predicting the occurrence of transient arrhythmia after PCI， with a C-index of 0.858 （0.753 ~ 0.865）， and provided a good standardized net benefit when its risk threshold was between 0.10 to 0.96. The validation group ROC curve and calibration curve results are good， with an AUC of 0.846 and a C-index of 0.840 （0.737 ~ 0.851）， suggesting that the model has a good external predictive efficacy. The results of the validation group decision curve analysis indicated that the model could provide better standardized net returns when the risk threshold was between 0.06 and 0.94. Conclusion The results of univariate analysis showed that older age， the presence of a history of diabetes mellitus， onset-to-admission time ≥6 h， and higher BNP levels were the main risk factors for the occurrence of transient arrhythmia after PCI in patients with ACS， and the Nomogram model constructed on the basis of these four influencing factors could effectively predict the risk of transient arrhythmia after PCI in patients with ACS.

Key words: acute coronary syndrome, percutaneous coronary intervention, transient arrhythmia, nomogram

CLC Number:

R541.4

Zhiqiang LIU,Zhikun ZHAO,Wei MI,Gang WANG,Liang. LI. Predictive modeling of transient arrhythmia after PCI in patients with acute coronary syndromes[J]. The Journal of Practical Medicine, 2025, 41(13): 2025-2032.

Figures/Tables 10

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References 26

[1]	BHATT D L， LOPES R D， HARRINGTON R A. Diagnosis and Treatment of Acute Coronary Syndromes： A Review［J］. JAMA， 2022， 327（7）：662-675. doi:10.1001/jama.2022.0358 doi: 10.1001/jama.2022.0358
[2]	芮淑红，王晨芳，李云贺，等. 吲哚布芬联合尼可地尔对ACS患者PCI术后炎症因子、心肌损伤标志物和血小板功能的影响［J］. 实用医学杂志，2024，40（12）：1706-1711.
[3]	江树青，李昕，杨建中. 急性冠状动脉综合征导致心脏骤停的预警因素研究进展［J］. 中国医药，2024，19（2）：281-284.
[4]	LI B， FENG Q， YU C， et al. Predictive value of serum HIF-1α and VEGF for arrhythmia in acute coronary syndrome patients［J］. Exp Biol Med （Maywood）， 2023， 248（8）：685-690. doi:10.1177/15353702231171902 doi: 10.1177/15353702231171902
[5]	KEIVANLOU N， BABAIEASL F， JAMALI J， et al. The effect of education using the interactive avatar application on self-care and the ability to identify and respond to the symptoms of heart attack in patients with acute coronary syndrome： A randomized clinical trial［J］. BMC Health Serv Res， 2025， 25（1）：572. doi:10.1186/s12913-025-12756-z doi: 10.1186/s12913-025-12756-z
[6]	李圣博，冯玲，陈贝贝，等. 老年急性前壁心肌梗死患者急诊经皮冠状动脉介入术前主动脉内球囊反搏联合术后重组人脑利钠肽对心室重构的影响［J］. 实用医学杂志，2025，41（5）：699-703. doi:10.3969/j.issn.1006-5725.2025.05.012 doi: 10.3969/j.issn.1006-5725.2025.05.012
[7]	GAMVROULAS E M， JONES A E， SAUNDERS J A， et al. Trends in antiplatelet strategies 12-months following coronary stent placement in anticoagulated patients［J］. BMC Cardiovasc Disord， 2023， 23（1）：117. doi:10.1186/s12872-023-03161-7 doi: 10.1186/s12872-023-03161-7
[8]	WONGTHIDA T， LUMKUL L， PATUMANOND J， et al.Development of a Clinical Risk Score for Prediction of Life-Threatening Arrhythmia Events in Patients with ST Elevated Acute Coronary Syndrome after Primary Percutaneous Coronary Intervention［J］. Int J Environ Res Public Health， 2022， 19（4）：1997. doi:10.3390/ijerph19041997 doi: 10.3390/ijerph19041997
[9]	LÓPEZ-PALOP R， CARRILLO P， LOZANO Í. Transient new-onset atrial fibrillation during acute coronary syndrome： Transient arrhythmia， transient risk［J］. Int J Cardiol， 2024， 410：132163. doi:10.1016/j.ijcard.2024.132163 doi: 10.1016/j.ijcard.2024.132163
[10]	PECHA S， KIRCHHOF P， REISSMANN B. Perioperative Arrhythmias［J］. Dtsch Arztebl Int， 2023， 120（33/34）：564-574.
[11]	CHAKRABORTY P， AGGARWAL A K， NAIR M K K， et al. Restoration of calcium release synchrony： A novel target for heart failure and ventricular arrhythmia［J］. Heart Rhythm， 2023， 20（12）：1773-1781. doi:10.1016/j.hrthm.2023.08.040 doi: 10.1016/j.hrthm.2023.08.040
[12]	中国医师协会急诊医师分会，国家卫健委能力建设与继续教育中心急诊学专家委员会，中国医疗保健国际交流促进会急诊急救分会，等. 急性冠脉综合征急诊快速诊治指南（2019）［J］. 中国急救医学，2019，39（4）：301-308. doi:10.3969/j.issn.1002-1949.2019.04.001 doi: 10.3969/j.issn.1002-1949.2019.04.001
[13]	张超，王小兵，段丙军. PCI不同时间窗对急性NSTEMI合并室壁瘤患者室壁瘤逆转及血清NT-proBNP、cTnI水平的影响［J］.医学综述，2021，27（9）：1824-1829
[14]	MENG X M， YUAN J H， ZHOU Z F， et al. Evaluation of time-dependent phenotypes of myocardial ischemia-reperfusion in mice［J］. Aging （Albany NY）， 2023， 15（19）：10627-10639. doi:10.18632/aging.205103 doi: 10.18632/aging.205103
[15]	HAUSENLOY D J， YELLON D M. Myocardial ischemia-reperfusion injury： A neglected therapeutic target［J］. J Clin Invest， 2013， 123（1）：92-100. doi:10.1172/jci62874 doi: 10.1172/jci62874
[16]	QIN Z， FU L， GOU Q， et al. Establishment and application of an intraoperative reperfusion arrhythmia prediction model for PCI in elderly patients with acute coronary syndrome［J］. Am J Transl Res， 2024， 16（11）：6447-6456. doi:10.62347/jmby1770 doi: 10.62347/jmby1770
[17]	BOROVAC J A， KWOK C S， MOHAMED M O， et al. The Predictive Value of CHA2DS2-VASc Score on In-Hospital Death and Adverse Periprocedural Events Among Patients With the Acute Coronary Syndrome and Atrial Fibrillation Who Undergo Percutaneous Coronary Intervention： A 10-Year National Inpatient Sample （NIS） Analysis［J］. Cardiovasc Revasc Med， 2021， 29：61-68. doi:10.1016/j.carrev.2020.08.003 doi: 10.1016/j.carrev.2020.08.003
[18]	张茸祯，贾敏，娄豆豆，等. 合并心血管疾病的高血压患者强化降压治疗研究进展［J］. 新医学，2024，55（4）：248-254. doi:10.3969/j.issn.0253-9802.2024.04.002 doi: 10.3969/j.issn.0253-9802.2024.04.002
[19]	WU N， LI J， XU X， et al. Prediction Model of New Onset Atrial Fibrillation in Patients with Acute Coronary Syndrome［J］. Int J Clin Pract， 2023， 2023：3473603. doi:10.1155/2023/3473603 doi: 10.1155/2023/3473603
[20]	柯晨昕，虞博威，王宁荐，等. 2型糖尿病患者甲状腺激素水平与衰弱的关系：一项基于上海市11个社区人群的横断面研究［J］. 新医学，2025，56（2）：124-130.
[21]	周倩，李淑娟，李娜. 24 h动态心电图诊断2型糖尿病合并冠心病患者心律失常的临床价值［J］. 实用中西医结合临床，2024，24（11）：85-87+95. doi:10.13638/j.issn.1671-4040.2024.11.024 doi: 10.13638/j.issn.1671-4040.2024.11.024
[22]	张博，张莉，田甜甜，等. 急性冠状动脉综合征患者PCI术后发生恶性心律失常的危险因素分析［J］. 中国循证心血管医学杂志，2024，16（7）：863-865.
[23]	QIN Z， FU L， GOU Q， et al. Establishment and application of an intraoperative reperfusion arrhythmia prediction model for PCI in elderly patients with acute coronary syndrome［J］. Am J Transl Res， 2024， 16（11）：6447-6456. doi:10.62347/jmby1770 doi: 10.62347/jmby1770
[24]	OHTAROGLU TOKDIL K， TOKDIL H， DURMAZ E， et al. The Determinants of Delays and Their Impact on Clinical End Points in Acute ST-Segment Elevation Myocardial Infarction： A Single-Center Experience［J］. Medicina （Kaunas）， 2025， 61（3）：447. doi:10.3390/medicina61030447 doi: 10.3390/medicina61030447
[25]	LUBOVICH A， ISSAWY M， GROSMAN-RIMON L， et al. The Prognostic Value of Cardiovascular Risk Factors and Laboratory Biomarkers in Predicting 6-Month Outcomes in High-risk Patients with Non-ST Segment Elevation Myocardial Infarction［J］. Isr Med Assoc J， 2023， 25（3）：210-214.
[26]	COUCH L S， GARRARD J W， HENRY J A， et al. Comparison of troponin and natriuretic peptides in Takotsubo syndrome and acute coronary syndrome： A meta-analysis［J］. Open Heart， 2024， 11（1）：e002607. doi:10.1136/openhrt-2024-002607 doi: 10.1136/openhrt-2024-002607

变量	建构组（n = 336）	验证组（n = 144）	χ²/t值	P值
性别/［例（%）］			0.059	0.808
男	194（57.74）	82（56.94）
女	142（42.26）	62（43.06）
年龄/岁	64.63 ± 8.75	64.09 ± 8.34	0.813	0.417
BMI/（kg/m²）	22.34 ± 2.86	22.55 ± 2.90	0.820	0.413
高血压病史/［例（%）］			0.152	0.697
是	185（55.06）	79（54.86）
否	151（44.94）	65（45.14）
糖尿病病史/［例（%）］			0.047	0.829
是	187（55.65）	79（54.86）
否	149（44.35）	65（45.14）
脑梗死病史/［例（%）］			0.305	0.581
是	96（28.57）	40（27.78）
否	240（71.43）	104（72.22）
吸烟史/［例（%）］			0.026	0.871
是	269（80.06）	115（79.86）
否	67（19.94）	29（20.14）
饮酒史/［例（%）］			0.124	0.725
是	151（44.94）	65（45.14）
否	185（55.06）	79（54.86）
发病到入院时间/［例（%）］			0.067	0.796
< 6 h	225（66.96）	95（65.97）
≥ 6 h	111（33.04）	49（34.03）
LVFS/%	35.02 ± 4.13	34.92 ± 4.10	1.814	0.070
LVED/mm	55.56 ± 6.01	55.21 ± 5.89	0.107	0.915
LVEF/%	50.29 ± 6.33	50.46 ± 6.41	1.148	0.251
BNP/（pg/mL）	302.63 ± 65.11	300.27 ± 64.85	1.222	0.222
CK-MB/（U/L）	70.26 ± 7.59	70.35 ± 7.55	2.478	0.013
D-二聚体/（mg/L）	0.78 ± 0.12	0.79 ± 0.11	1.196	0.232

变量	发生组（n = 84）	未发生组（n = 252）	χ²/t值	P值
性别			0.202	0.653
男	50（59.52）	144（57.14）
女	34（40.48）	108（42.86）
BMI（x ± s）/（kg/m²）	22.79 ± 2.84	22.71 ± 2.79	0.226	0.821
高血压病史			0.006	0.939
是	45（53.57）	140（55.56）
否	39（46.43）	112（44.44）
脑梗死病史			0.047	0.828
是	25（29.76）	71（28.17）
否	59（70.24）	181（71.83）
吸烟史			0.643	0.423
是	68（80.95）	201（79.76）
否	16（19.05）	51（20.24）
饮酒史			0.006	0.941
是	38（45.24）	113（44.84）
否	46（54.76）	139（55.16）

变量	发生组（n = 84）	未发生组（n = 252）	χ²/t值	P值
年龄/岁	68.84 ± 8.09	60.31 ± 6.51	9.683	< 0.001
糖尿病病史/［例（%）］			27.535	< 0.001
是	63（75.00）	124（49.21）
否	21（25.00）	128（50.79）
发病到入院时间/［例（%）］			29.314	< 0.001
< 6 h	39（46.43）	186（73.81）
≥ 6 h	45（53.57）	66（26.19）
LVFS/%	34.62 ± 4.02	34.12 ± 3.93	1.006	0.315
LVED/mm	55.03 ± 5.76	54.91 ± 5.59	0.177	0.859
LVEF/%	49.65 ± 6.13	50.20 ± 6.09	0.722	0.471
BNP/（pg/mL）	351.21 ± 67.91	286.33 ± 65.71	7.772	< 0.001
CK-MB/（U/L）	68.52 ± 7.39	69.02 ± 7.46	0.538	0.591
D-二聚体/（mg/L）	0.81 ± 0.14	0.80 ± 0.12	0.965	0.335

变量	变量说明	赋值情况
年龄	连续变量	值
糖尿病病史	二分类变量	是=2，否=1
发病到入院时间	二分类变量	≥ 6 h = 2，< 6 h = 1
BNP	连续变量	值

变量	回归系数	标准误	Wals	P值	OR	95%CI
年龄	1.254	0.310	16.333	< 0.001	3.503	1.907 ~ 6.434
糖尿病病史	0.765	0.283	7.287	0.007	2.148	1.233 ~ 3.743
发病到入院时间	1.311	0.291	20.287	< 0.001	3.708	2.096 ~ 6.559
BNP	1.570	0.337	17.341	< 0.001	4.808	2.296 ~ 10.067

Predictive modeling of transient arrhythmia after PCI in patients with acute coronary syndromes

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变量	AUC	最佳截断值	Youden指数	S.E	95%CI	P值	灵敏度（%）	特异度（%）
年龄	0.782	1	0.564	0.033	0.728 ~ 0.830	< 0.001	69.81	86.64
糖尿病病史	0.712	1	0.423	0.036	0.654 ~ 0.765	< 0.001	58.49	83.87
发病到入院时间	0.722	1	0.443	0.035	0.664 ~ 0.774	< 0.001	66.04	78.34
BNP	0.748	1	0.496	0.035	0.692 ~ 0.799	< 0.001	56.60	93.09
建构组	0.865	0.714	0.620	0.031	0.804 ~ 0.927	< 0.001	71.70	90.32
验证组	0.846	0.901	0.544	0.067	0.760 ~ 0.910	< 0.001	90.00	64.44

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