Development and Validation of a Prediction Model for Cardiovascular Events in Exercise Assessment of Coronary Heart Disease Patients After Percutaneous Coronary Intervention

Abstract

Objective: This study aimed to develop a model for predicting cardiovascular events in the exercise assessment of patients with coronary heart disease after percutaneous coronary intervention (PCI) based on multidimensional clinical information. Methods: A total of 2,455 post-PCI patients who underwent cardiopulmonary exercise testing (CPET) at the Peking University Third Hospital from January 2016 to September 2019 were retrospectively included in this study; 1,449 post-PCI patients from January 2018 to September 2019 were assigned as the development cohort; and 1,006 post-PCI patients from January 2016 to December 2017 were assigned as the validation cohort. Clinical data of patients before testing and various indicators in the exercise assessment were collected. CPET-related cardiovascular events were also collected, including new-onset angina pectoris, frequent premature ventricular contractions, ventricular tachycardia, atrial tachycardia, and bundle branch block during the examination. A nomogram model for predicting CPET-related cardiovascular events was further developed and validated. Results: In the development cohort, the mean age of 1,449 post-PCI patients was 60.7 ± 10.1 years. CPET-related cardiovascular events occurred in 43 cases (2.9%) without fatal events. CPET-related cardiovascular events were independently associated with age, glycosylated hemoglobin, systolic velocity of mitral annulus, ΔVO2/ΔWR slope inflection, and VE/VCO2 slope > 30. The C-index of the nomogram model for predicting CPET-related cardiovascular events was 0.830, and the area under the ROC curve was 0.830 (95% CI: 0.764–0.896). For the validation cohort of 1,006 patients, the area under the ROC curve was 0.807 (95% CI: 0.737–0.877). Conclusion: Post-PCI patients with older age, unsatisfactory blood glucose control, impaired left ventricular systolic function, oxygen uptake parameter trajectory inflection, and poor ventilation efficiency have a higher risk of cardiovascular events in exercise assessment. The nomogram prediction model performs well in predicting cardiovascular events in the exercise assessment of post-PCI patients and can provide an individualized plan for exercise risk prediction.