Development and external validation of a diagnostic model for in-hospital bleeding in patients with acute ST elevation myocardial infarction

Abstract

Background: Bleeding complications in patients with acute ST segment elevation myocardial infarction(STEMI) are associated with an increased risk of subsequent adverse consequences. We want to develop and externally validate a diagnostic model of in-hospital bleeding in the population of unselected real-world patients with acute STEMI. Methods: Design: Multivariable logistic regression of a cohort for hospitalized patients with acute STEMI . Setting: Emergency department ward of a university hospital. Participants: Diagnostic model development: Totally 4262 hospitalized patients with acute STEMI from January 2002 to December 2013 in Beijing Anzhen Hospital, Capital Medical University. External validation: Totally 6015 hospitalized patients with acute STEMI from January 2014 to August 2019 in Beijing Anzhen Hospital, Capital Medical University. Outcomes: All-cause in-hospital bleeding not related to coronary artery bypass graft surgery or catheterization. Results: In-hospital bleeding occurred in 2.6%(112/4262)of patients in the development data set and 1.9%(117/6015)of patients in the validation data set. The strongest predictors of in-hospital bleeding were advanced age and high Killip classification. We developed a diagnostic model of in-hospital bleeding. The area under the receiver operating characteristic (ROC)curve (AUC) was 0.777 0.021, 95% confidence interval(CI)= 0.73576 ~ 0.81823. We constructed a nomograms using the development database based on age , and Killip classification. The AUC was 0.7234 0.0252, 95% CI= 0.67392 ~ 0.77289 in the validation data set . Discrimination, calibration, and decision curve analysis were satisfactory. Conclusions: We developed and externally validated a moderate diagnostic model of in-hospital bleeding in patients with acute STEMI . We registered this study with WHO International Clinical Trials Registry Platform (ICTRP) (registration number: ChiCTR1900027578; registered date: 19 Novmober 2019). http://www.chictr.org.cn/edit.aspx?pid=45926&htm=4. Key Words: coronary disease; ST elevation myocardial infarction; hemorrhage; nomogram