关键词: 冠心病, 心源性脑卒中, 影响因素, 列线图

Abstract: Objective　To analyze the influencing factors of in patients with cardiogenic stroke in patients with, and to construct a risk prediction model. Methods　The clinical data of 249 patients with coronary heart disease admitted to the Northwest University First Hospital from January 2022 to January 2025 were retrospectively analyzed. The patients with cardiogenic stroke were counted, and these patients were classified as a case group (105 cases). Meanwhile, gender, age, body mass index, smoking history, and drinking history were used as matching variables. The patients without concurrent cardiogenic stroke were matched at a 1:1 ratio as a control group (105 cases). There were 58 males and 47 females in the case group, aged (66.23±6.53) years. There were 54 males and 51 females in the control group, aged (64.85±6.91) years old. The clinical data of the two groups were compared, and the influencing factors of coronary heart disease complicated with cardiogenic stroke were analyzed by multivariate logistic regression. A nomogram model of coronary heart disease complicated with cardiogenic stroke was drawn; the calibration curve, receiver operating characteristic curve (ROC), and decision curve analysis (DCA) were used to evaluate the predictive performance of the nomogram model. t test and χ² test were used as the statistical methods. Results　The proportion of the patients with hypertension, arrhythmia, cardiac mural thrombus, carotid plaque, severe coronary artery disease, left atrial diameter (LAD), left atrial diameter index (LADi), and homocysteine (Hcy) in the case group were higher than those in the control group [65.71% (69/105) vs. 40.95% (43/105), 71.43% (75/105) vs. 29.52% (31/105), 21.90% (23/105) vs. 6.67% (7/105), 48.57% (51/105) vs. 26.67% (28/105), 22.86% (24/105) vs. 5.71% (6/105), (38.16±5.81) mm vs. (35.92±4.73) mm, (22.69±3.24) mm/m² vs. (19.41±2.78) mm/m², and (16.92±4.20) μmol/L vs. (13.67±3.74) μmol/L], and the left ventricular ejection fraction (LVEF) was lower [(52.58±11.83)% vs. (57.40±9.89)%], with statistical differences (all P<0.05). The multivariate logistic regression analysis showed that hypertension, arrhythmia, cardiac mural thrombus, carotid plaque, severe coronary artery disease, LAD enlargement, high LADi, and high Hcy were risk factors for coronary heart disease and cardiogenic stroke (all P<0.05), and high LVEF was a protective factor (P<0.05). The internal verification of the nomogram model constructed based on the results of multivariate analysis showed that the predicted curve was similar to the actual curve, and the consistency index was 0.847. The results of ROC showed that the area under the curve (AUC), sensitivity, and specificity of the nomogram model in predicting coronary heart disease complicated with cardiogenic stroke were 0.836 (95%CI 0.779-0.884), 82.86%, and 80.95%, respectively. The results of DCA curve showed that the nomogram model had better clinical benefits when the threshold range was 0.08-0.93. Conclusions　Hypertension, arrhythmia, cardiac mural thrombus, carotid plaque, degree of coronary artery disease, LAD, LADi, LVEF, and Hcy are the influencing factors of coronary heart disease and cardiogenic stroke. The nomogram prediction model constructed based on the above factors has good clinical value.

Key words: Coronary heart disease, Cardiogenic stroke, Influencing factors, Nomogram