Analysis of influencing factors and construction of risk prediction model for myocardial microcirculation perfusion disorders in patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention
WANG Jing
LIU Shu-kai
ZHANG Li
FAN Yan-ru
WANG Hai-shan
Abstract：Objective To analyze the influencing factors of myocardial microcirculation perfusion disorders in patients with acute ST segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI)and to construct a risk prediction model.Methods The clinical data of 384 STEMI patients who underwent PCI in Tangshan Maternal and Child Health Hospital from May 2020 to January 2024 were reviewed and divided into the modeling group(n=269)and verification group(n=1 15)by random number table method.According to the postoperative TIMI myocardial perfusion grading(TMPG)of patients in the modeling group,they were separated into the obstacle group(n=61)and the normal group(n=208).The influencing factors of myocardial microcirculation disturbance after PCI in STEMI patients were analyzed by multivariate logistic regression.A nematographic prediction model for predicting myocardial microcirculation disturbance in STEMI patients after PCI was constructed,and the calibration curve and ROC curve were drawn to evaluate the prediction efficiency of the model.Results Compared with the normal group,the left ventricular ejection fraction(LVEF)in the obstacle group was lower but the proportions of diabetes,hypertension,symptom first medical contact(FMC)＞4 h,FMC heparin(H)＞4 h,and coronary slow flow were higher(P＜0.05).Multivariate logistic regression found that LVEF(OR=0.875),diabetes(OR=2.284),hypertension(OR=2.417),symptom-FMC time(0R=3.200),FMC-H time(OR=2.185)and coronary slow flow(OR=2.416)were all the influencing factors of myocardial microcirculation perfusion obstruction in STEMI patients after PCI(P＜0.05).The area under the ROC curve of the modeling group was 0.820(95％CI 0.761-0.880),with a sensitivity of 72.13％and a specificity of 80.77％;the area under the ROC curve of the validation group was 0.899(95％CI 0.814-0.984),with a sensitivity of 90.00％and a specificity of 80.00％.In the Hosmer-Lemeshow fit test,the modeling group x2=11.877,P=0.157,and the validation group x2=10.438,P=0.236.Conclusion The occurrence of myocardial microcirculation perfusion disorder in STEMI patients after PCI is closely related to LVEF,diabetes,hypertension,symptom-FMC time,FMC-H time and coronary slow flow;the distinction of risk prediction model based on these factors is better.
Keywords：Acute ST segment elevation myocardial infarctionPercutaneous coronary interventionMyocardial microcirculation perfusion disordersInfluencing factorsPrediction model
Publication Date：2024-06-10
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 543-548 )