Study on risk factors of ischemic cerebrovascular disease in elderly patients with acute myocardial infarction after emergency PCI
Liu Lijie
Zhu Lihong
Wei Ruifang
Wang Jiliang
Abstract：Objective To investigate the risk factors of ischemic cerebrovascular disease in elderly patients with acute myocardial infarction(AMI)after emergency percutaneous coronary intervention(PCI).Methods A total of 328 elderly patients with AMI who underwent successful PCI in the hospital emergency department from July 2020 to July 2023 were selected as the study objects.New ICVD cases were confirmed by clinical evaluation and brain imaging studies(computed tomography and/or magnetic resonance imaging),including ischemic stroke and transient ischemic attack.The patients were divided into the ICVD group and the non-ICVD group according to whether ICVD occurred after PCI.The variables used to construct the ICVD risk model were screened using Lasso and Logistic regression,and validated by a nomogram and receiver operating characteristic(ROC)curve.Results The incidence of ICVDs after PCI was 15.24%(50/328).Age,GRACE score and plasma D-dimer(DD)were higher in ICVD group,and the proportion of patients with high grade of hypertension,atrial fibrillation,coronary artery calcification(CAC)and Killip heart function was also significantly higher than that in non-ICVD group(P＜0.05).Five independent risk factors for ICVD were identified by LASSO regression and multivariate Logistic regression analysis,including age≥80 years,global Acute Coronary Event Registry(GRACE)score≥140,hypertension,DD level and CAC(P＜0.05).The ROC curve analysis showed that the AUC of the nomogram model to predict the risk of ICVD after PCI was 0.903(95%CI:0.865～0.932),and the sensitivity and specificity were 84.00%and 80.07%,respectively.Meanwhile,the Hosmer-Lemeshow goodness of fit test showed that the model fit well(χ2=3.4457,P=0.1786).In addition,the net benefit rate of this column chart model was higher in the range 0.1～0.99,suggesting that it can bring a net clinical benefit to patients when the threshold probability is 0.1～0.99.Conclusion Age≥80 years,GRACE score≥140,hypertension,high plasma DD level,and the presence of CAC were associated with an increased risk of ICVD in AMI patients after PCI.
Keywords：Elderly acute myocardial infarctionPercutaneous coronary interventionIschemic cerebrovascular diseaseRisk factor
Publication Date：2025-06-20
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 695-699 )