Construction Of A Model For Predicting The Risk Of Bleeding And Swelling Of The Lateral Limb After Transradial PCI

Objective:Regarding the occurrence time of bleeding and swelling caused by the radial artery decompression devices of the study subjects,who undergo percutaneous coronary intervention via radial artery as the breakthrough point,we observe the pressure value,decompression value,decompression interval time,decompression frequency and total compression time of the compression device at different time points to analyze the correlation between these indexes and the occurrence time of bleeding and swelling.The purpose of this study is to obtain the risk values of bleeding and swelling,which will provide a basis for the nursing observation of the puncture site and the operated side limb of the patients after transradial artery PCI.Methods:The convenience sampling method was adopted and 788 patients were selected,who underwent transradial coronary intervention in the Department of Cardiology of a Grade 3A General Hospital in Nanchang from November 2018 to December 2019.Combined with expert inquiry and clinical pre-experiment,we produced a questionnaire to investigate the general data of patients and screened the observation indexes of decompression scheme of radial artery compressor,which were designed with structured text.Firstly,the demographic data,pressure values at different time points,decompression values,decompression interval time,decompression frequency and total compression time,and the time characteristics of bleeding and swelling were recorded.Secondly,the differences of bleeding and swelling incidence and occurrence time under different baseline characteristics and decompression schemes were compared,and the correlation between different pressure values,decompression values,decompression interval time and postoperative lateral limb bleeding and swelling were discussed.Then,the risk prediction models of bleeding and swelling were constructed individually,and the subject operating characteristic(ROC)curve was used to analyze the predictive value of bleeding at the puncture site and the risk of limb swelling after PCI.Results:In this study,a total of 788 samples were included,excluding those who dropped out and those with incomplete data from the 841 patients.(1)212 patients developed bleeding complications at the puncture site within 6hours after operation,with an incidence of 26.90%,of which 56 cases occurred before the first decompression and 156 cases occurred after the first decompression;186cases(87.74%)occurred within 1 hour after operation,with the highest incidence of bleeding.(2)196 patients developed swelling on the side limb within 6 hours after operation,with an incidence of 24.87%,including 5 cases of IV grade swelling,8cases of III grade swelling,43 cases of II grade swelling and 140 cases of grade I swelling.The highest incidence of swelling occurred 2.5 hours later after operation with 144 cases(73.47%).(3)Among the subjects included,there were 576 patients without bleeding(non-bleeding group)and 212 patients with bleeding(bleeding group)within 6 hours after operation.There were significant differences in baseline systolic blood pressure,use of anticoagulants and prothrombin time between the two groups(P < 0.05).Lasso regression analysis showed that the frequency of decompression,the value of the first pressure,the value of the first decompression and the time of the first decompression were significantly correlated with the risk of bleeding at the puncture site after operation,which could be used to predict the risk of postoperative bleeding.The model training set AUC was 0.931,95% CI(0.930,0.934),the verification set AUC was 0.932,95% CI(0.922,0.946),and the areas under the ROC curve were 0.931~0.932.(4)Among the subjects included,there were 592 cases without swelling(non-swelling group)and 196 cases with swelling(swelling group)within 6 hours after operation.There were significant differences in diabetes history and operation time between the two groups(P < 0.05).Lasso regression analysis showed that the first decompression time,the second decompression time,the first pressure value,the pressure value after the first decompression,the pressure value after the second decompression,and the baseline systolic blood pressure were significantly correlated with the risk of postoperative swelling,which could be used to predict the risk of postoperative swelling.The model training set AUC was 0.870,95% CI(0.867,0.877),the verification set AUC was 0.857,0.905% CI(0.815,0.905),and the areas under the ROC curve were 0.857 ~ 0.870.Conclusions:(1)The incidences of bleeding at the puncture site and swelling on the side limb were higher after transradial artery PCI.Moreover,the key observation period was within 1 hour and 2.5 hours later after operation,respectively.(2)The patients with higher baseline systolic blood pressure,the use of anticoagulants within 6 hours after operation and longer prothrombin time had a higher risk of bleeding at the puncture site.Moreover,the bleeding early warning model,which prediction effect was stable,suggested that the frequency of decompression,the time of the first decompression,the first pressure value,and the first decompression value were all correlated with the risk of bleeding.These indexes could be used to predict the risk of bleeding.(3)Diabetic history and longer operation time will increase the risk of limb swelling after PCI.Moreover,the swelling early warning model,which prediction effect was stable,indicated that the first decompression time,the second decompression time,the first pressure value,the pressure value after the first decompression,the pressure value after the second decompression and the baseline systolic blood pressure were correlated with the risk of limb swelling.These indexes could be used to predict the risk of swelling on the side limb.