Predicting and Analyzing Restenosis Risk after Endovascular Treatment in Lower Extremity Arterial Disease: Development and Assessment of a Predictive Nomogram.

IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE
Journal of Endovascular Therapy Pub Date : 2024-12-01 Epub Date: 2023-03-08 DOI:10.1177/15266028231158294
Jinxing Chen, Yanan Tang, Zekun Shen, Weiyi Wang, Jiaxuan Hou, Jiayan Li, Bingyi Chen, Yifan Mei, Shuang Liu, Liwei Zhang, Shaoying Lu
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引用次数: 0

Abstract

Purpose: This study aimed to develop and internally validate nomograms for predicting restenosis after endovascular treatment of lower extremity arterial diseases.

Materials and methods: A total of 181 hospitalized patients with lower extremity arterial disease diagnosed for the first time between 2018 and 2019 were retrospectively collected. Patients were randomly divided into a primary cohort (n=127) and a validation cohort (n=54) at a ratio of 7:3. The least absolute shrinkage and selection operator (LASSO) regression was used to optimize the feature selection of the prediction model. Combined with the best characteristics of LASSO regression, the prediction model was established by multivariate Cox regression analysis. The predictive models' identification, calibration, and clinical practicability were evaluated by the C index, calibration curve, and decision curve. The prognosis of patients with different grades was compared by survival analysis. Internal validation of the model used data from the validation cohort.

Results: The predictive factors included in the nomogram were lesion site, use of antiplatelet drugs, application of drug coating technology, calibration, coronary heart disease, and international normalized ratio (INR). The prediction model demonstrated good calibration ability, and the C index was 0.762 (95% confidence interval: 0.691-0.823). The C index of the validation cohort was 0.864 (95% confidence interval: 0.801-0.927), which also showed good calibration ability. The decision curve shows that when the threshold probability of the prediction model is more significant than 2.5%, the patients benefit significantly from our prediction model, and the maximum net benefit rate is 30.9%. Patients were graded according to the nomogram. Survival analysis found that there was a significant difference in the postoperative primary patency rate between patients of different classifications (log-rank p<0.001) in both the primary cohort and the validation cohort.

Conclusion: We developed a nomogram to predict the risk of target vessel restenosis after endovascular treatment by considering information on lesion site, postoperative antiplatelet drugs, calcification, coronary heart disease, drug coating technology, and INR.

Clinical impact: Clinicians can grade patients after endovascular procedure according to the scores of the nomograms and apply intervention measures of different intensities for people at different risk levels. During the follow-up process, an individualized follow-up plan can be further formulated according to the risk classification. Identifying and analyzing risk factors is essential for making appropriate clinical decisions to prevent restenosis.

预测和分析下肢动脉疾病血管内治疗后的再狭窄风险:下肢动脉疾病血管内治疗后再狭窄风险的预测与分析:预测提名图的开发与评估。
目的:本研究旨在开发并在内部验证用于预测下肢动脉疾病血管内治疗后再狭窄的提名图:回顾性收集2018年至2019年期间首次确诊的181例下肢动脉疾病住院患者。患者按 7:3 的比例随机分为初选队列(n=127)和验证队列(n=54)。采用最小绝对收缩和选择算子(LASSO)回归优化预测模型的特征选择。结合 LASSO 回归的最佳特征,通过多变量 Cox 回归分析建立了预测模型。预测模型的识别、校准和临床实用性通过C指数、校准曲线和决策曲线进行评估。通过生存分析比较了不同等级患者的预后。利用验证队列的数据对模型进行了内部验证:提名图中的预测因素包括病变部位、抗血小板药物的使用、药物涂层技术的应用、校准、冠心病和国际正常化比值(INR)。预测模型显示出良好的校准能力,C 指数为 0.762(95% 置信区间:0.691-0.823)。验证队列的 C 指数为 0.864(95% 置信区间:0.801-0.927),也显示出良好的校准能力。决策曲线显示,当预测模型的阈值概率大于 2.5%时,患者从我们的预测模型中获益显著,最大净获益率为 30.9%。根据提名图对患者进行分级。生存分析发现,不同分级患者的术后一次通畅率存在显著差异(log-rank p):我们开发了一种提名图,通过考虑病变部位、术后抗血小板药物、钙化、冠心病、药物涂层技术和 INR 等信息来预测血管内治疗后靶血管再狭窄的风险:临床影响:临床医生可根据提名图的评分对血管内治疗后的患者进行分级,并针对不同风险级别的患者采取不同强度的干预措施。在随访过程中,可根据风险分级进一步制定个性化的随访计划。识别和分析风险因素对于做出适当的临床决策以预防再狭窄至关重要。
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
CiteScore
5.30
自引率
15.40%
发文量
203
审稿时长
6-12 weeks
期刊介绍: The Journal of Endovascular Therapy (formerly the Journal of Endovascular Surgery) was established in 1994 as a forum for all physicians, scientists, and allied healthcare professionals who are engaged or interested in peripheral endovascular techniques and technology. An official publication of the International Society of Endovascular Specialists (ISEVS), the Journal of Endovascular Therapy publishes peer-reviewed articles of interest to clinicians and researchers in the field of peripheral endovascular interventions.
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