Clinical analysis of acute coronary syndrome patients with Qi-blood syndromes: establishment of a diagnostic prediction model for syndrome differentiation.

Abstract

It has been proven that blood stasis plays an important role in the occurrence and development of acute coronary syndrome (ACS) due to Qi-stagnation or Qi-deficiency in traditional Chinese medicine (TCM). However, the diagnosis of Qi-stagnation and blood stasis (QSBS) and Qi-deficiency and blood stasis (QDBS) syndromes mainly depends on the subjective signs or symptoms in clinical practice. Using a combination of TCM and modern medicine, this study aimed to investigate the clinical characteristics of patients with QSBS or QDBS syndromes and to establish a diagnostic prediction model for Qi-blood syndrome differentiation in clinical practice. Patients with ACS who were diagnosed with QSBS syndrome or QDBS syndrome and met the inclusion criteria were enrolled. Clinical characteristics, laboratory evaluation, and angiographic characteristics of the two syndrome groups were compared and analyzed. Potential predictive factors associated with QSBS and QDBS syndromes were explored to establish a diagnostic model for syndrome differentiation. A total of 216 participants with ACS, including 108 patients with QSBS syndrome and 108 patients with QDBS syndrome, were enrolled from Beijing Anzhen Hospital Affiliated to Capital Medical University from April 2018 to July 2019. We found that patients with QSBS syndrome were more likely to be males, and have of triple-vessel lesions, relatively high blood stasis syndrome score, normal ejection fraction, and a relatively low-density lipoprotein cholesterol (LDL-C) level. Meanwhile, patients with QDBS syndrome were more likely to have low ejection fraction, high LDL-C level, left main non-triple-vessel lesions, and a relatively low blood stasis syndrome score. The receiver operating characteristic curve and Hosmer-Leme show tests confirmed the discrimination power and reliability of the logistic regression model. The present study suggested that male sex, the level of LDL-C, ejection fraction, left main lesions, triple-vessel disease, and the score of blood stasis syndrome were the independent predictive factors of Qi-blood syndromes. A good discrimination power of clinical diagnostic prediction model was established using a combination of TCM and modern medicine, and could assist in the differentiation of QSBS syndrome and QDBS syndrome in clinical practice.