Abstract: Background　Acute ST-segment elevation myocardial infarction（STEMI）has a high mortality and disability rate. Percutaneous coronary intervention（PCI）is an important revascularization method that can improve prognosis. However，some patients experience recurrent angina after PCI，which affects their quality of life and long-term prognosis. Drug-metabolizing enzyme gene polymorphisms influence drug efficacy and adverse reactions. Cytochrome P450 2C19（CYP2C19）is involved in the metabolism of multiple drugs，and its gene polymorphisms can alter enzyme activity and affect drug metabolism. The correlation between different CYP2C19 metabolic levels and recurrent angina after PCI in STEMI patients is worth exploring. Objective　To investigate the correlation between different CYP2C19 metabolic levels and recurrent angina after PCI in STEMI patients. Methods　A total of 128 patients who underwent emergency PCI for acute coronary occlusion at the Chest Pain Center of the First Affiliated Hospital of Inner Mongolia Medical University in 2022 were selected as the study subjects. The patients' medical records and CYP2C19 gene test results were collected. Follow-up was conducted via telephone or outpatient visits at 1，3，6，and 12 months after PCI，with the follow-up ending on December 31，2023. The endpoint event was angina attack. Lasso regression analysis was used to screen variables related to angina attacks，followed by the construction of a predictive model using multivariate logistic regression analysis and the development of a nomogram. Bootstrap resampling was used for internal model validation. The training and validation sets were evaluated using receiver operating characteristic（ROC）curves，goodness-of-fit tests，calibration curves，and decision curve analysis（DCA）to construct a risk prediction model for recurrent angina after PCI in elderly STEMI patients. Results　A total of 128 patients were included，with 92 males（71.9%）and 36 females（28.1%），and a median age of 63.5（61.0，66.0）years. During follow-up，45 patients（35.2%）experienced recurrent angina，while 83 patients（64.8%）did not. There were statistically significant differences in gender，low-density lipoprotein cholesterol（LDL-C），high-density lipoprotein cholesterol（HDL-C），and CYP2C19 genotype between patients with and without recurrent angina （P<0.05）. Lasso regression analysis identified 7 independent predictive variables，including gender，LDL-C，HDL-C，homocysteine（Hcy），apolipoprotein B（ApoB），D-dimer，and CYP2C19 genotype. Multivariate logistic regression analysis showed that female gender（OR=3.492 9，95%CI=1.288 8-15.066 2），elevated LDL-C（OR=3.123 7，95%CI=1.685 9-6.348 4），and elevated Hcy（OR=1.061 4，95%CI=1.028 8-1.103 6）were risk factors for recurrent angina after STEMI intervention，while elevated HDL-C（OR=0.016 7，95%CI=0.000 9-0.209 1），intermediate CYP2C19 metabolism（OR=0.273 4，95%CI=0.0747-0.923 7），and normal CYP2C19 metabolism（OR=0.086 7，95%CI=0.025 5-0.256 1）were protective factors against recurrent angina after STEMI intervention. The model was internally validated using Bootstrap resampling with 1 000 replications，and the Hosmer-Lemeshow calibration curve showed good model fit. ROC curves were plotted for the training and validation sets，with areas under the ROC curve（AUC）of 0.869（95%CI=0.796-0.943）and 0.789（95%CI=0.701-0.877），respectively，indicating good discrimination in both the modeling and validation populations. Further DCA showed that the model had good clinical utility. Conclusion　Intermediate and normal CYP2C19 metabolic types are protective factors against recurrent angina after STEMI intervention. This study established a risk prediction model for recurrent angina that includes five clinical indicators: female gender，LDL-C，Hcy，HDL-C，and CYP2C19. The model can be used to predict the risk of recurrent angina in patients for early screening and has good fit，discrimination，and clinical application value.

Key words: ST elevation myocardial infarction, Angina pectoris, CYP2C19, Percutaneous coronary intervention, Prediction model, Nomogram

摘要： 背景　急性ST段抬高型心肌梗死（STEMI）致死致残率高，经皮冠状动脉介入治疗（PCI）是其重要血运重建方式，能改善预后。但部分患者PCI术后心绞痛复发，影响生活质量与长期预后。药物代谢酶基因多态性影响药物疗效与不良反应，细胞色素P450 2C19（CYP2C19）参与多种药物代谢，其基因多态性可改变酶活性，影响药物代谢。在STEMI患者PCI术后用药中，CYP2C19不同代谢水平与心绞痛复发相关性值得探讨。目的　探讨CYP2C19基因不同代谢水平与STEMI患者PCI术后心绞痛复发相关性。方法　选取2022年内蒙古医科大学第一附属医院胸痛中心因急性冠脉闭塞行急诊PCI治疗患者128例为研究对象，收集患者病例资料和CYP2C19基因检测结果。于PCI术后1、3、6、12月分别对纳入患者进行电话或门诊随访，随访截至2023-12-31。终点事件为心绞痛发作。采用Lasso回归分析筛选心绞痛发作事件的相关变量，随后构建多因素Logistic回归分析构建预测模型并绘制列线图，采用Bootstrap进行模型内部验证。训练集及验证集模型分别通过受试者工作（ROC）曲线、拟合优度检验、校准曲线以及决策曲线分析（DCA）评估，构建老年STEMI患者PCI术后心绞痛复发风险预测模型。结果　共纳入患者128例，男92例（71.9%），女（27.1%），中位年龄63.5（61.0，66.0）岁。随访期间45例（35.2%）患者心绞痛复发，83例患者（74.8%）未出现心绞痛复发。无心绞痛复发患者与心绞痛复发患者性别、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、CYP2C19分型比较，差异有统计学意义（P<0.05）。Lasso回归分析共筛选出7个独立预测因子变量，包括性别、LDL-C、HDL-C、同型半胱氨酸（Hcy）、载脂蛋白B（ApoB）、D-二聚体及CYP2C19分型。多因素Logistic回归分析结果显示，性别（女）（OR=3.492 9，95%CI=-1.288 8~15.066 2）、LDL-C升高（OR=3.123 7，95%CI=1.685 9~6.348 4）、Hcy升高（OR=1.061 4，95%CI=1.028 8~1.103 6）为STMEI介入术后心绞痛复发的危险因素，HDL-C升高（OR=0.016 7，95%CI=0.000 9~0.209 1）、CYP2C19中间代谢型（OR=0.273 4，95%CI=0.074 7~0.923 7）、CYP2C19正常代谢型（OR=0.086 7，95%CI=0.025 5~0.256 1）为减少STMEI介入术后心绞痛复发的保护因素。利用Bootstrap重抽样法重复抽样1 000次对模型进行内部验证，Hosmer-Lemeshow校准曲线显示模型拟合度较好。绘制训练集和验证集的ROC曲线并计算ROC曲线下面积（AUC），在训练集和验证集中AUC分别为0.869（95%CI=0.796~0.943）和0.789（95%CI=0.701~0.877），表明预测模型在建模集和验证集人群均具有良好的区分度。进一步行DCA显示，模型具有较好的临床实用性。结论　CYP2C19中间代谢型与正常代谢型为减少STMEI介入术后心绞痛复发的保护因素。本研究建立了包含性别（女性）、LDL-C、Hcy、HDL-C以及CYP2C19共5项临床指标的心绞痛复发风险预测模型，可用于预测早期筛查可疑患者的心绞痛复发风险，模型具有良好的拟合度、区分度和临床应用价值。

关键词: ST 段抬高型心肌梗死, 心绞痛, 细胞色素 P450 2C19, 经皮冠状动脉介入治疗, 预测模型, 列线图