Predictive value of ABI, HEART and TIMI scores for restenosis after stent implantation in patients with lower extremity arteriosclerosis obliterans / 国际外科学杂志

ABSTRACT

Objective:To explore the predictive value of ankle brachial index (ABI), HEART and thrombolysis in myocardial infarction (TIMI)scores for restenosis in patients with lower extremity arteriosclerosis obliterans (LEASO) after stent implantation.Methods:A retrospective study of 100 patients who were admitted to the Heyuan City People′s Hospital for stent implantation for LEASO from January 2015 to January 2020 and met the inclusion criteria were collected, and the patients were divided into restenosis group ( n=28) and patency group ( n=72) according to whether they were restenosis after operation. The clinical data of the two groups of patients were compared, including gender, age, disease course, history of cardiovascular and cerebrovascular diseases, smoking history, regular medication after surgery, number of stents, total length, bilateral lesions, total occlusion of lower extremities, length of vascular lesions, high-sensitivity C-reactive protein (hs-CRP), fasting blood glucose, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total cholesterol, fibrinogen, hemoglobin, platelet count and red blood cell count, and ABI, HEART, TIMI scores were compared, the relationship between ABI, HEART and TIMI scores and postoperative restenosis was further analyzed. Measurement data were expressed as mean±standard deviation ( ± s), and two independent samples t-test was used for comparison between groups; enumeration data were compared between groups by Chi-square test. Based on independent risk factors in multivariate Logistic regression analysis, a nomogram prediction model was constructed using R 3.3.2 software and software package rms. Correlations were analyzed using bivariate Pearson linear correlation analysis. The receiver operating characteristic curve (ROC) was used to evaluate the predictive value of each score and nomogram model for postoperative restenosis, and the results were expressed as the area under the curve (AUC) and the 95% confidence interval (95% CI) of the area. Results:Patients in the restenosis group and the patency group had a history of smoking, the proportion of irregular postoperative medications, the number of implanted stents, the total length of implanted stents, hs-CRP, fibrinogen, total cholesterol, red blood cell count levels, and ABI, HEART, TIMI scores were significantly different ( P<0.05). Pearson correlation analysis showed that ABI score ( r=-0.527, P=0.001) was negatively correlated with postoperative restenosis, and the HEART score ( r=0.604, P=0.010) and TIMI score ( r=0.719, P=0.005) were positively correlated with postoperative restenosis. A history of smoking, irregular medication after surgery, number of implanted stents>2, total length of implanted stent>212 mm, hs-CRP>2 mg/L, fibrinogen>3.7 g/L, ABI score ≤0.58, HEART score>6.30, and TIMI score>4.30 were independent risk factors for postoperative restenosis. The ABI, HEART, and TIMI scores predict the AUC of the ROC curve for postoperative restenosis of 0.813, 0.789, and 0.798, cutoff points were 0.58, 6.30 and 4.30 score, sensitivities were 95.64%, 91.17% and 92.51%, specificities were 64.18%, 55.43% and 58.62%, respectively. The consistency index (C-index) and ROC curve AUC of the nomogram prediction model were 0.811 (95% CI 0.721-0.901) and 0.818 (95% CI 0.732-0.904), respectively, indicating a good degree of discrimination. Conclusions:ABI, HEART and TIMI scores are independent risk factors for restenosis after stent implantation in LEASO patients. ABI, HEART and TIMI scores can effectively predict the risk of restenosis after stent implantation in patients.