Retrospective Cohort Study: Nomogram for 1-Year in-Stent Restenosis After PCI in Coronary Heart Disease.

IF 2 4区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Risk Management and Healthcare Policy Pub Date : 2025-08-11 eCollection Date: 2025-01-01 DOI:10.2147/RMHP.S533714

Xin-Fu Cao, Dao-Hai Chen, Ya-Li Qiu, Chao Tang, Xiao-Long Li, Zhen-Hua Gu

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引用次数: 0

Abstract

Objective: To construct a nomogram for risk prediction of in-stent restenosis (ISR) within one year after percutaneous coronary intervention (PCI) for coronary heart disease (CHD).

Methods: This study included 842 patients with severe CHD who underwent PCI at Changzhou Affiliated Hospital of Nanjing University of Chinese Medicine between March 2016 to March 2024. Based on the occurrence of ISR within one year post-PCI, patients were stratified into two groups: the ISR group (n=112) and the non-ISR group (n=730). Potential risk factors were initially identified using LASSO regression, followed by multivariate logistic regression to determine independent predictors. A nomogram prediction model was developed using R software (version 4.2.6) and internally validated via the bootstrap resampling method (1000 iterations). Model performance was assessed through receiver operating characteristic (ROC) curve analysis, calibration curve analysis, and decision curve analysis (DCA).

Results: This analysis revealed seven risk factors for ISR: diabetes (OR=1.380, 95% CI: 1.090-1.747), neutrophil/lymphocyte ratio (NLR, OR=2.312, 95% CI: 1.830-2.922), low-density lipoprotein (LDL) > 1.8 mmol/L (OR=2.159, 95% CI: 1.080-4.315), calcified lesions (OR=3.780, 95% CI: 2.051-6.968), stent diameter <3 mm (OR=2.595, 95% CI: 1.404-4.796), smoking (OR=2.796, 95% CI: 1.511-5.174) and no intravascular ultrasound (IVUS) assisted (OR=2.176, 95% CI: 1.342~3.257). These seven factors were incorporated into the nomogram model. The model demonstrated excellent discriminative ability, with an area under the curve (AUC) of 0.892 (95% CI: 0.859-0.924) and a consistency index (C-index) of 0.923. Calibration analysis showed close agreement between predicted and observed outcomes, while DCA indicated strong clinical utility across a wide probability threshold range (5.0%-86.2%). The relative importance of the risk factors, ranked in descending order, was as follows: calcified lesions, stent diameter <3 mm, no IVUS assisted, LDL>1.8 mmol/L, smoking, NLR and diabetes.

Conclusion: The study identifies several risk factors for ISR in CHD patients within one year after PCI. The constructed nomogram model has good predictive efficiency and clinical applicability.

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回顾性队列研究：冠心病PCI术后1年支架内再狭窄的Nomogram。

目的：构建预测冠心病（CHD）经皮冠状动脉介入治疗（PCI）术后1年内支架内再狭窄（ISR）风险的nomogram。方法：本研究纳入2016年3月至2024年3月在南京中医药大学常州附属医院行PCI治疗的842例重症冠心病患者。根据pci术后1年内发生ISR的情况，将患者分为两组：ISR组（n=112）和非ISR组（n=730）。最初使用LASSO回归确定潜在危险因素，然后使用多变量逻辑回归确定独立预测因子。利用R软件（4.2.6版）建立了nomogram预测模型，并通过bootstrap重采样法（1000次迭代）进行了内部验证。通过受试者工作特征（ROC）曲线分析、校准曲线分析和决策曲线分析（DCA）评估模型的性能。结果：本分析揭示了7个ISR的危险因素：糖尿病（OR=1.380, 95% CI: 1.090 ~ 1.747）、中性粒细胞/淋巴细胞比值（NLR， OR=2.312, 95% CI: 1.830 ~ 2.922）、低密度脂蛋白(LDL) > 1.8 mmol/L （OR=2.159, 95% CI: 1.080 ~ 4.315）、钙化病变（OR=3.780, 95% CI: 2.051 ~ 6.968）、支架直径1.8 mmol/L、吸烟、NLR和糖尿病。结论：本研究确定了冠心病患者PCI术后一年内发生ISR的几个危险因素。所构建的模态图模型具有良好的预测效果和临床适用性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Risk Management and Healthcare Policy Medicine-Public Health, Environmental and Occupational Health

CiteScore

6.20

自引率

2.90%

发文量

242

审稿时长

16 weeks

期刊介绍： Risk Management and Healthcare Policy is an international, peer-reviewed, open access journal focusing on all aspects of public health, policy and preventative measures to promote good health and improve morbidity and mortality in the population. Specific topics covered in the journal include: Public and community health Policy and law Preventative and predictive healthcare Risk and hazard management Epidemiology, detection and screening Lifestyle and diet modification Vaccination and disease transmission/modification programs Health and safety and occupational health Healthcare services provision Health literacy and education Advertising and promotion of health issues Health economic evaluations and resource management Risk Management and Healthcare Policy focuses on human interventional and observational research. The journal welcomes submitted papers covering original research, clinical and epidemiological studies, reviews and evaluations, guidelines, expert opinion and commentary, and extended reports. Case reports will only be considered if they make a valuable and original contribution to the literature. The journal does not accept study protocols, animal-based or cell line-based studies.