Risk Factors for Coronary Microcirculatory Dysfunction After PCI in STEMI Patients and Construction of a Predictive Model
NIU Xiaolong
DONG Suying
ZU Xiaohua
ZHOU Shuya
Abstract：Objective To investigate the risk factors of coronary microcirculation dysfunction(CMD)in patients with ST segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI),and to construct a nomogram prediction model.Methods A total of 198 STEMI patients who underwent PCI treatment in Xuchang People's Hospital from January 2023 to October 2024 were selected.The patients were divided into a CMD group(61 cases)and a non-CMD group(137 cases)based on whether or not they developed CMD within 24 hours after PCI.The clinical data of the two groups were compared,and the factors affecting the occurrence of CMD after PCI in STEMI patients were analyzed using univariate and multivariate LASSO-logistic regression analysis.Based on this,conventional models and new models were constructed,and the predictive value of the above models was evaluated using receiver operating characteristic(ROC)curves and calibration curves.The predictive ability of the two models was compared using net reclassification improvement(NRI)and integrated discrimination improvement(IDI).Results The proportion of patients with a history of smoking,diabetes,hypertension,symptoms to first medical contact(FMC)time＞4 hours,the time from FMC to heparin administration(FMC-H)time＞4 hours,coronary slow flow,brain natriuretic peptide(BNP),procalcitonin(PCT),24 hours urine microalbumin(24 h-UmAlb),and neutrophil/lymphocyte ratio(NLR)in the CMD group were higher than those in the non-CMD group(P＜0.05).Hypertension,symptom-to-FMC time＞4 hours,FMC-H time＞4 hours,coronary slow flow,PCT,24 h-UmAlb and NLR were all independent risk factors for CMD in STEMI patients after PCI(P＜0.05),and after adjusting for hypertension,symptom-to-FMC time＞4 hours,FMC-H time＞4 hours,and coronary slow flow,PCT,24 h-UmAlb,and NLR were still independent risk factors for CMD(P＜0.05).The area under the curve(AUC)of the conventional model constructed based on this was 0.827(95％CI:0.763-0.890),and the AUC of the new model was 0.902(95％CI:0.857-0.946).The calibration curve showed that the calibration degree and prediction ability of the new model were higher than those of the conventional model.Conclusion The independent risk factors for CMD in STEMI patients after PCI are hypertension,symptom-to-FMC time＞4 hours,FMC-H time＞4 hours,coronary slow flow,PCT,24 h-UmAlb,and NLR.The predictive ability and accuracy of the new model constructed based on these factors are higher than those of conventional models,which can provide a reference for clinical decision-making on the prevention and treatment of CMD.
Keywords：ST-segment elevation myocardial infarctionpercutaneous coronary interventionrisk factorspredictionconstruction of model
Publication Date：2025-12-13
Online Publishing Date：2026-09-12(First online date of this platform, not the publication date of the document)
Pages：6( 4292-4297 )