Construction of a dynamic scoring model for progressive worsening of moderate cor-onary stenosis based on coronary CT-fractional flow reserve
10.20039/j.cnki.1007-3949.2025.11.004
- VernacularTitle:基于冠状动脉CT-血流储备分数构建冠状动脉中度狭窄进行性加重的动态评分模型
- Author:
Lei XIA
1
;
Qiuzhen XU
1
Author Information
1. 东南大学附属中大医院江北院区影像科,江苏省南京市 210044
- Publication Type:Journal Article
- Keywords:
fractional flow reserve;
moderate coronary stenosis;
risk factor;
dynamic nomogram model
- From:
Chinese Journal of Arteriosclerosis
2025;33(11):944-952
- CountryChina
- Language:Chinese
-
Abstract:
Aim To explore the risk factors for the progressive worsening of moderate coronary stenosis and con-struct a nomogram model for predicting the progression of moderate coronary stenosis based on coronary CT-fractional flow reserve(FFR).Methods 293 patients with moderate coronary stenosis admitted to the hospital from April 2020 to A-pril 2023 were selected as the research subjects.Coronary CT angiography(CCTA)was performed on the selected pa-tients,and CT-FFR software was used to analyze the CCTA images and obtain the FFR values.According to the progres-sive worsening of moderate coronary stenosis,the patients were divided into two groups:the progression group and the sta-ble group,and the data of gender,age,hyperlipidemia,history of cerebral infarction,multivessel disease,obesity,diabe-tes,malnutrition,lack of physical activity,hypertension,drinking,smoking and place of residence of the patients in the two groups were collected.The ten-fold cross-validation in LASSO analysis was used to screen for predictive factors of progressive worsening of moderate coronary stenosis,Logistic regression was used to screen for risk factors of progressive worsening of moderate coronary stenosis,R(4.2.3)was used to establish a nomogram model of progressive worsening of moderate coronary stenosis,and this nomogram model was validated.Results Among 293 patients with moderate cor-onary stenosis,there were 61 cases of progressive worsening,and the incidence of progressive worsening of moderate coro-nary stenosis was 20.82％(61/293).The sex,age,hyperlipidemia,history of cerebral infarction,multi vessel disease,malnutrition,hypertension,alcohol consumption and place of residence of the progression group and the stable group had no statistical significance(P＞0.05),while the proportion of obesity,diabetes,lack of physical activity and smoking in the progression group was significantly higher than those in the stable group,and the FFR was significantly lower than that in the stable group(P＜0.05).LASSO analysis showed that the history of cerebral infarction,obesity,diabetes,lack of physical activity,smoking and FFR were predictive factors with non-zero coefficients.After ten-fold cross-validation,six variables including the history of cerebral infarction,obesity,diabetes,lack of physical activity,smoking and FFR were re-tained into the model.Logistic regression analysis showed that obesity(OR=2.411,95％CI:1.151～5.053),diabetes(OR=3.401,95％CI:1.671～6.923),lack of physical activity(OR=2.818,95％CI:1.427～5.564),smoking(OR=3.577,95％CI:1.526～8.387)were all risk factors for progressive worsening of moderate coronary stenosis,and FFR(OR=0.001,95％CI:0.000～0.036)was the antagonistic factor for progressive worsening of moderate coronary stenosis(P＜0.05).A dynamic nomogram model for the progressive worsening of moderate coronary stenosis was established based on risk factors,and the area under the ROC curve of the nomogram model was 0.777(95％CI:0.711～0.842);The predicted values of the calibration curve are basically consistent with the actual values;When the decision curve showed a threshold probability of 2％to 64％,the nomogram model had a good benefit value for predicting the progressive worsening of moderate coronary stenosis.Conclusion The nomogram model constructed in this study has high accuracy in predicting the progression of moderate coronary stenosis and good clinical practicality.
