Development and external validation of a diagnostic model for periprocedural bradycardia during primary percutaneous coronary intervention

Abstract

Background Periprocedural bradycardia weaks the benefit of primary percutaneous coronary intervention (PPCI) and has deleterious effects on organ perfusion of patients with acute ST elevation myocardial infarction (STEMI). Objective To develop and externally validate a diagnostic model of periprocedural bradycardia. . Methods Design: Multivariable logistic regression of a cohort of acute STEMI patients. Setting: Emergency department ward of a university hospital. Participants: Diagnostic model development: Totally 1820 acute STEMI patients who were consecutively treated with PPCI from November 2007 to December 2015 in Beijing Anzhen Hospital, Capital Medical University. External validation: Totally 716 acute STEMI patients who were treated with PPCI from January 2016 to June 2018 in Beijing Anzhen Hospital, Capital Medical University. Outcomes:Periprocedural bradycardia during PPCI. Periprocedural bradycardia was defined as preoperative heart rate >=50 times / min, intraoperative heart rate <50 times / min persistent or transient. Results Totally 332 (18.2%)patients presented periprocedural bradycardia in the development dataset and 102 (14.2%) patients presented periprocedural bradycardia in the validation dataset. The strongest predictors of periprocedural bradycardia were intra-procedural hypotension, the culprit vessel was not left anterior descending (LAD), using thrombus aspiration devices during procedure, sex, history of coronary artery disease, total occlusion of culprit vessel, and no-reflow. We developed a diagnostic model of periprocedural bradycardia.The area under the receiver operating characteristic(ROC) curve(AUC) was 0.8384 0.0122 in the development set. We constructed a nomogram based on predictors of periprocedural bradycardia using the development database. The AUC was 0.8437 0.0203 in the validation set . Discrimination, calibration, and decision curve analysis were satisfactory. Conclusions We developed and externally validated a diagnostic model of periprocedural bradycardia during PPCI. We registered this study with WHO International Clinical Trials Registry Platform(ICTRP);. Registration number: ChiCTR1900023214. Registered Date :16 May 2019. http://www.chictr.org.cn/edit.aspx?pid=39087&htm=4 Key Words: coronary disease; ST elevation myocardial infarction; Bradycardia; Percutaneous coronary intervention; Nomogram