| BackgroundCoronary stenosis affects human health and life seriously.Coronary atherosclerosis is the main cause of such stenosis.Coronary stenosis caused by a variety of reasons can cause insufficient blood supply to the heart,resulting in myocardial cells' hypoxia,and atherosclerotic plaque ruptures and detaches,which can block the lumen and cause coronary occlusion,endangering the patient's life.At present,the incidence and prevalence of coronary heart disease in China have increased year by year,and the rate of increase is more obvious.If effective measures are not taken,we will not only bear the serious physical and mental health threats caused by this,but also bear the huge social economy burden.The mechanism of atherosclerosis have not been clearly elucidated,and the influencing factors are not fully understood.Therefore,there is still no effective measures in controlling atherosclerosis and preventing the occurrence and development of coronary heart disease.To understand the distribution spectrum of coronary artery stenosis,to indicate which parts are prone to stenosis,and which parts are not easy to stenosis,in order to further clarify the cause,it may provide clues for the mechanism mechanism of atherosclerosis,in order to prevent the occurrence of stenosis,It is possible to control and delay the progression of stenosis.Acute coronary syndrome(ACS)is a serious type of coronary heart disease,an acute clinical syndrome caused by acute myocardial ischemia,often manifested as arrhythmia,heart failure,and even sudden death,seriously affecting patients' quality of life,and even the patient lost the opportunity to rescue in a flash.In recent years,the advancement of various vascular interventional techniques,the improvement and improvement of surgical instruments have made great progress in the treatment of acute coronary syndromes,but such patients urgently need timely and clear diagnosis so that Get effective treatment.Now the clinician's diagnosis of acute coronary syndrome is based on the results of myocardial injury markers such as serum troponin and creatine kinase isoenzymes,as well as coronary CT and angiography.However,this diagnosis requires doctors to be rich in clinical experience.But it is difficult for primary and non-cardiologists.Even experienced physicians may have some deviations in their diagnosis.If the acute coronary syndrome discriminant model is constructed based on the above examination results,the patient can be easily discriminanted out in order to take timely and effective treatment measures.ObjectiveThis study is based on the Shandong Multi-Center Healthcare Big Data Platform.According to the American Heart Association,16 segments of the coronary arteries are used.Different scoring methods are used to describe the patient's imaging results,and the distribution of coronary artery stenosis is studied in detail to explore the crown in this group.The distribution of stenosis provides clues and evidence for relevant research in clinical medicine and basic medicine.According to the results of coronary angiography and laboratory tests,a simple and economical acute coronary syndrome discriminant model was established to identify patients with acute coronary syndrome,which can be used as a diagnostic tool for clinicians,especially emergency doctors.Method1.Distribution of coronary stenosisWe Select patients with coronary angiography data and completed basic information from the Shandong Multi-Center Healthcare Big Data Platform(SMCHBDP)between April 2014 and July 2016.The angiographic results of these patients were collated,and the distribution of coronary artery stenosis was studied according to the age and sex stratification according to the presence or absence of stenosis and stenosis in each coronary artery.2.Acute coronary syndrome discriminant modelConsidering the consistency of the modeling samples,we select a third-grade class-A hospital with the highest number of patients and the highest level of diagnosis and treatment from the above-mentioned platform,and screen out the well-diagnosed patients to form modeling samples.The discriminant variables included the gender,age and laboratory indicators,etc.We tried to increase the scores of three different coronary artery stenosis scores as discriminant variables,and use the logistic regression analysis method to construct the discriminant model of acute coronary syndrome.We use the area under the receiver operating characteristic curve(ROC curve)(AUC)evaluate the effect of the model and use ten-fold cross validation method for further internal verification.Results1.Distribution of coronary stenosisThe results showed that:1.The distribution of segments number involved in coronary artery stenosis was skewed,and the number of segments involved in most stenosis was 1-6 segments.2.The stenosis of the proximal and middle segments of the anterior descending branch,as well as the proximal and middle segments of the right coronary artery are most common,and the second diagonal branch and the second obtuse marginal are relatively rare.3.Severe stenosis is most common in the proximal segment of the anterior descending branch and the middle segment of the anterior descending artery.The proximal segment of the right coronary artery,the middle segment of the right coronary artery,the first diagonal branch and the middle segment of the circumflex artery are also more common,while the second obtuse marginal and the second diagonal branches are less common.The distribution of age-specific coronary stenosis showed:1 The number of segments involved in coronary artery stenosis increased significantly with age.2 Except for the second diagonal branch and the second obtuse marginal,the proportion of stenosis in all segments increased significantly with age.The segments with the highest proportion of stenosis in all age groups were anterior anterior descending branches.The proximal and middle segments and the proximal and middle segments of the right coronary artery;The proportion of the second diagonal branch and the second blunt branch stenosis in the stenosis of all age groups were all low,and the proportion has almost no significant change.3 The severity of stenosis in each segment is significantly related to age.Taking severe stenosis as an example,except for the second diagonal branch,all other segments have a trend between higher age and severity of severe stenosis;The proximal segment and the anterior descending segment are the most common.The right coronary artery,the right coronary artery,the first diagonal branch and the circumflex middle segment are also more common,while the second blunt edge and the second diagonal branch are more rare.The distribution of gender coronary stenosis showed:1 The average number of segments involved in male coronary stenosis was significantly higher than that in female.2 In addition to the second obtuse marginal,the percentage of stenosis in males was higher than that in females;the segment with the highest proportion of male and female stenosis was the proximal and middle segments of the anterior descending and the proximal and middle segments of the right coronary artery.The segments with the lowest proportion are the second diagonal branch and the second obtuse marginal.3 In addition to the second obtuse marginal,the proportion of severe stenosis in male coronary arteries was higher than that in females;the severity of male and female stenosis was significantly different:the branch with the highest proportion of male severe stenosis was the proximal segment of the anterior descending artery.In the middle segment and the proximal and middle segments of the right coronary artery,the branch with the lowest proportion of male severe stenosis is the second obtuse marginal and the second diagonal branch;the branch with the highest proportion of female severe stenosis is the proximal and middle segments of the anterior anterior descending branch,then In the first diagonal branch and the middle segment of the circumflex artery,the branch with the lowest proportion of female severe stenosis is the left main trunk and the second diagonal branch..2.Acute coronary syndrome discriminant modelLogistic regression was used to establish the model according to different scoring methods combined with age,gender and laboratory indicators.Finally,the TPS scoring model,SSS scoring model and Gensini scoring model with good relative results were selected.The variables included in the TPS scoring model included fibrinogen,high density lipoprotein cholesterol,low density lipoprotein cholesterol,creatine kinase isoenzyme,serum troponin,proximal coronary artery,middle right coronary artery,proximal anterior descending artery,proximal circumflex artery,middle circumflex artery,sex and In the age group,the AUC value was 0.782(95%CI:0.761,0.803)and the model o/e was 1.003.The variables included in the SSS scoring model included fibrinogen,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,and creatine kinase.Isozyme,serum troponin,proximal coronary artery,middle right coronary artery,proximal anterior descending artery,middle anterior descending artery,proximal circumflex artery and sex,AUC value was 0.819(95%CI:0.800,0.837),the oe ratio of model is 1.033;the variables included in the Gensini scoring model include fibrinogen,serum troponin,proximal coronary artery,middle right coronary artery,right coronary artery,proximal anterior descending artery,and anterior descending Middle LCX proximal,middle circumflex artery LCX and distal sex,the AUC value of 0.931(95%CI:0.917,0.943),the oe ratio of model is 1.004.Analysis conclusion1.The involved segments number of most patients with coronary stenosis ranging from 1 to 6 segments.2.The proportion of stenosis in different segments of coronary arteries is different.The proximal middle segment and the right middle segment of the right descending coronary artery are most common,while the second diagonal branch and the second branch are the least common.3.The number of segments in which coronary artery stenosis and the severity of stenosis in each segment increase with age.4.The severity of coronary stenosis in men is significantly higher than in women.5.In the discriminant model of this study,the Gensini scoring model is relatively effective. |
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