目的 构建经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）术后再狭窄或复发心肌梗死（简称心梗）风险预测模型，验证并评价该模型的预测性能，为临床医务人员预测评估提供工具。方法 采用分层抽样法，选取贵州省3所医院的1359例PCI术后患者作为建模组，随访1年，根据临床结局是否发生再狭窄或复发分为事件组185例及非事件组1174例进行病例对照研究；采用Logistic回归构建再狭窄或复发心梗的风险预测模型，通过受试者工作特征曲线下面积评估预测能力；前瞻性收集395例患者纳入验证组对模型进行验证。结果 有冠心病及糖尿病家族史、高敏肌钙蛋白I＞0.342 μg/L、低密度脂蛋白胆固醇≥3.37 mmol/L、术后缺乏运动为再狭窄或复发心梗的独立危险因素；ROC曲线下面积为0.80，AUC＞0.70；约登指数最大值为0.48，灵敏度为80%，特异度为68.40%；验证组ROC曲线下面积为0.76，灵敏度为77.90%，特异性为65.70%。结论 本研究构建的风险预测模型拟合度良好，准确性较高，预测能力良好，可为临床医护人员及早识别高危复发心梗患者提供参考。

Objective To construct a risk prediction model for reinfarction or recurrent myocardial infarction(MI) after percutaneous coronary intervention (PCI),to validate and evaluate the predictive performance of the model,and to provide a prediction and evaluation tool for clinical medical staff to predict and evaluate.Methods A stratified sampling method was used to select 1359 patients who underwent PCI in 3 hospitals in Guizhou province as the modeling group.They were followed up for 1 year,and were divided into the event group (185 cases) and the non-event group (1174 cases) according to whether reinfarction or recurrence occurred.A case-control study was conducted.Logistic regression was used to construct a risk prediction model for reinfarction or recurrent myocardial infarction,and the predictive ability was evaluated by the area under the receiver operating characteristic curve (AUC).A total of 395 patients were prospectively collected to form the validation group to validate the model.Results Family history of coronary heart disease and diabetes,high-sensitivity troponin I ＞ 0.342 μg/L,low density lipoprotein cholesterol ≥ 3.37 mmol/L,and lack of exercise after operation were the independent risk factors for reinfarction or recurrent myocardial infarction.ROC curve area was 0.80 and AUC＞0.70.The maximum Youden index was 0.48.Sensitivity was 80%,and specificity was 68.40%.The ROC curve area of the validation group was 0.76,with the sensitivity as 77.90%,and specificity as 65.70%.Conclusions The risk prediction model constructed has good fitness,high accuracy,and good predictive ability.It can provide reference for clinical medical staff to identify high-risk patients with myocardial infarction early.

R873.54

贵州省科技成果应用及产业化项目（黔科合成果-LC[2021]039）