Development of a nomogram for the prediction of in-hospital mortality in patients with acute ST-elevation myocardial infarction after primary percutaneous coronary intervention: a multicentre, retrospective, observational study in Hebei province, China

Abstract

ObjectivesTo establish a clinical prognostic nomogram for predicting in-hospital mortality after primary percutaneous coronary intervention (PCI) among patients with ST-elevation myocardial infarction (STEMI).DesignRetrospective, multicentre, observational study.SettingThirty-nine hospitals in Hebei province.ParticipantsPatients with STEMI who underwent PCI from January 2018 to December 2019.InterventionsA multivariable logistic regression model was used to identify the factors associated with in-hospital mortality, and a nomogram was established using these factors. The performance of the nomogram was evaluated by the discrimination, calibration and clinical usefulness.Primary and secondary outcome measuresThe outcome was the factors associated with in-hospital mortality.ResultsThis study included 855 patients, among whom 223 died in hospital. Age, body mass index, systolic pressure on admission, haemoglobin, random blood glucose on admission, ejection fraction after PCI, use aspirin before admission, long lesions, thrombolysis in myocardial infarction flow grade and neutrophils/lymphocytes ratio were independently associated with in-hospital mortality (all p<0.05). In the training set, the nomogram showed a C-index of 0.947, goodness-of-fit of 0.683 and area under the receiver operating characteristic curve (AUC) of 0.947 (95% CI 0.927 to 0.967). In the testing set, the C-index was 0.891, goodness-of-fit was 0.462 and AUC was 0.891 (95% CI 0.844 to 0.939). The results indicate that the nomogram had good discrimination and good prediction accuracy and could achieve a good net benefit.ConclusionsA nomogram to predict in-hospital mortality in patients with STEMI after PCI was developed and validated in Hebei, China and showed a satisfactory performance. Prospective studies will be necessary to confirm the performance and clinical applicability and practicality of the nomogram.

Critical appraisal and assessment of bias among studies evaluating risk prediction models for in-hospital and 30-day mortality after percutaneous coronary intervention: a systematic review

“…Three studies exhibited a high risk of bias due to the use of multicentre data for retrospective analysis 16 20 22 ; 5 prospective cohort studies were deemed to show a low risk of bias as they inherently employed blinding 9 10 29 30 33 ; and the remaining 20 studies were identified with an unclear risk of bias as they did not report the methods used to measure or assess the predictors.…”

Predicting long-term prognosis after percutaneous coronary intervention in patients with acute coronary syndromes: a prospective nested case-control analysis for county-level health services

“…Previous research has linked the clinical profile of ACS patients at admission to prognosis, with age, cardiac insufficiency, and blood pressure clinically recognized as independent markers of poor prognosis following PCI in ACS patients (34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53).…”

ANMCO (Italian Association of Hospital Cardiologists) scientific statement: obesity in adults—an approach for cardiologists

“…Obesity is linked to many cardiovascular diseases, including stroke [ 158 ], venous thromboembolic disease [ 112 ], pulmonary embolism [ 113 ], HF [ 114 ], and arrhythmias, especially sudden cardiac death (SCD) [ 116 ] and atrial fibrillation (AF) [ 117 ]. Furthermore, it causes specific issues in key topics for cardiologic patient management, such as differences in specificity and sensitivity in non-invasive and invasive diagnostic tools [ 159 ], changes in platelet reactivity [ 160 , 161 ], a different short- and long-term outcome after percutaneous coronary intervention PCI [ 162 – 164 ] or cardiac surgery [ 159 ].…”