| Objective:We describe the clinical features of patients with NSTEMI combined with acute occlusion and constructed a clinical prediction model to predict NSTEMI combined with acute occlusion of the culprit vessel,and validated the model to assess its predictive value Method:This study is a single-center retrospective study.The study population was NSTEMI patients who attended the First Hospital of Jilin University for coronary angiography in 2019-2021.Cases meeting the study entry criteria were randomly divided into training and validation sets in a 7:3ratio.We construct the predictive model in the training set by the Logistic regression analysis and verify its stability in the validation set Result:The study finally included 1168 patients with NSTEMI who underwent coronary angiography.Assessing the vascular lesions in these 408 patients,the incidence of vascular occlusion was 36.52%,with occluded vessels mostly seen in LCX(42.02%),followed by RCA(30.37%)and LAD(26.38%),and LM was rare(1.32%).Small vessel occlusion was more common in LAD lesions(p<0.001).There were differences in the distribution of vascular lesions between the occluded and non-occluded groups(p=0.020),with a higher incidence of three-branch lesions in the occluded group(p<0.001).A higher proportion of patients in the occluded group were male(p=0.043),younger(p<0.001),had a lower proportion of hypertension(p<0.001),had a higher proportion of smoking history(p<0.001),had a lower Grace score on admission(p<0.001),differed in the Killip classification of cardiac function(p=0.004),and in laboratory tests On examination,patients had higher myoglobin(p=0.030),troponin(p=0.003),CK-MB(p=0.028),peak troponin(p<0.001),and SII(p<0.001)on admission,as well as lower uric acid levels(p=0.007),and cardiac ultrasound findings suggested a higher rate of ventricular wall segmental motion abnormalities in the occlusion group(p=0.006);in multifactorial analysis,history of previous hypertension(p=0.001,0.517(0.355-0.754)),history of smoking(p<0.001,3.579(2.432-5.319)),MYO>270.5 ng/m L(p=0.006,1.853(1.190-2.884)),and peak c Tn I>3.075 ng/m L(p<0.001,24.683(9.731-62.610)),SII>821.45(p<0.001,5.502(3.668-8.252)),and uric acid<303.5 umol/L(p=0.027,1.552(1.051-2.293))were potential predictors of NSTEMI combined with acute occlusion of the offender vessel;and a clinical prediction model was constructed based on this.In the training set,the cutoff value for predicting NSTEMI patients with combined offender vessel occlusion was 11.5 with an AUC of 0.852,the sensitivity of 80.2%,and specificity of 73.7% based on the ROC curve;in the validation set,the AUC was 0.741,and the sensitivity was 83.8% and specificity was 51.9% when using 9.5 as the cutoff value.Conclusions:The incidence of coronary triple lesions was higher in the occlusion group,and occluded vessels were more often seen in LCX,followed by RCA and LAD,and LM lesions were less common.In terms of laboratory tests,patients had higher levels of myoglobin,troponin,CK-MB,peak troponin,and SII at admission,and lower uric acid levels,and cardiac ultrasound findings suggested higher rates of ventricular wall segmental motion abnormalities in the occluded group.No previous history of hypertension,smoking history,MYO>270.5 ng/m L,peak c Tn I>3.075ng/m L,SII>821.45,and uric acid<303.5 umol/L were potential predictors of acute occlusion of convict vessels in NSTEMI,and a clinical prediction model based on these predictors had some predictive value. |
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