摘要
目的探讨急性A型主动脉夹层(ATAAD)患者经孙氏手术后新发心房颤动(POAF)的危险因素,构建列线图预测模型并进行验证。方法纳入2018年1月1日—2022年12月31日在齐鲁医院接受孙氏手术的ATAAD患者,并将患者分为POAF组和non-POAF组,比较两组患者的临床资料。使用R语言构建列线图并验证模型的预测能力。结果本次研究中共入组238例患者,其中POAF患者42例(17.65%)。年龄(OR=1.039,95%CI 1.007~1.071,P=0.017)、左心房直径(OR=1.069,95%CI 1.007~1.136,P=0.029)、右心房直径(OR=1.063,95%CI 1.006~1.124,P=0.029)、术前红细胞计数(OR=0.442,95%CI 0.233~0.837,P=0.012)和既往急性冠脉综合征(OR=7.445,95%CI 2.869~19.321,P<0.001)是POAF的独立影响因素。预测模型ROC曲线的曲线下面积是0.786。重复Bootstrap自抽样及内部验证过程1000次,生成了ROC曲线,得出的曲线下面积为0.808(95%CI 0.806~0.810),校准曲线可见拟合度良好。决策曲线分析显示模型有较高预测价值。结论ATAAD患者POAF风险预测模型可协助临床医师筛选高危人群,为临床决策提供参考。
Objective To investigate the risk factors for postoperative new-onset atrial fibrillation(POAF)in patients with acute type A aortic dissection(ATAAD)who underwent Sun’s procedure,and to construct and validate a nomogram prediction model.Methods Patients with ATAAD who underwent Sun’s procedure at Qilu Hospital from January 1,2018 to December 31,2022 were included in the study.They were divided into two groups:the POAF group and the non-POAF group.Clinical data were compared between the two groups.The nomogram was constructed and its predictive ability validated using R software.Results A total of 238 patients were included in the study,with 42 patients(17.65%)developing POAF.Age(OR=1.039,95%CI 1.007~1.071,P=0.017),left atrial diameter(OR=1.069,95%CI 1.007~1.136,P=0.029),right atrial diameter(OR=1.063,95%CI 1.006~1.124,P=0.029),preoperative red blood cells(OR=0.442,95%CI 0.233~0.837,P=0.012),and previous acute coronary syndrome emerged(OR=7.445,95%CI 2.869~19.321,P<0.001)as independent factors on POAF following Sun’s surgery.The area under the ROC curve(AUC)for the predictive model was 0.786.Validation of the model through bootstrapping(1000 repetitions)yielded an AUC of 0.808(95%CI 0.806~0.810),affirming its robustness.Decision curve analysis demonstrated high predictive value of the model.Conclusion The risk prediction model for POAF in patients with ATAAD can assist clinicians in identifying high-risk populations and provide a reference for clinical decision-making.
作者
杨志浩
付超
尤阳
刘子华
赵鑫
YANG Zhihao;FU Chao;YOU Yang;LIU Zihua;ZHAO Xin(Department of Cardiovascular Surgery,Qilu Hospital of Shandong University,Institute of Thoracoscopy in Cardiac Surgery,Shandong University,Jinan 250012,Shandong,China)
出处
《心血管病学进展》
CAS
2024年第10期928-934,共7页
Advances in Cardiovascular Diseases
基金
山东省自然科学基金(ZR2022MH170)。
关键词
急性A型主动脉夹层
术后新发心房颤动
危险因素
列线图模型
Acute type A aortic dissection
Postoperative new-onset atrial fibrillation
Risk factors
Nomogram model
