Construction And Validation Of A Predictive Risk Model For Cardiac Rupture Among Acute ST-segment Elevation Myocardial Infarction Patients

Objective: To construct risk prediction model for cardiac rupture(CR)on the basis of risk factors in patients with ST-segment elevation myocardial infarction(STEMI).Methods: A total of 167 patients with CR were selected from 9053 STEMI patients enrolled in the Cardiovascular Center database of the First Hospital of Jilin University from January 1,2013 to June 30,2018 in this investigation.We divided the 167 CR patients into training cohort(117 patients)and validation cohort(50 patients).After clinical data were retrospectively analyzed,the risk factors of CR in STEMI patients were investigated.After constructing a predictive risk model,and verified the model in the validation cohort.Results: We,in the training cohort,previous stroke history(β=0.601,OR=1.824,95%CI:1.013-3.283,P=0.045),female sex(β=0.648,OR=1.911,95%CI:1.172-3.118,P=0.009),age(for 61-70 years old,β=0.797,OR=2.218,95%CI:1.190-4.136,P=0.012;71-80 years old,β=1.162,OR=3.195,95%CI:1.650-6.189,P=0.001;>80years old,β=1.515,OR=4.548,95%CI:1.886-10.969,P=0.001),without primary percutaneous coronary intervention [PCI,(β=1.041,OR=2.831,95%CI:1.658-4.833,P<0.001)],and Killip class III-IV at admission were(β=1.252,OR=3.498,95%CI:1.898-6.447,P<0.001)finally confirmed using univariate analysis and logistic regression analysis.Based on these five risk factors,we constructed a simple CR risk prediction model on the basis of ROC(0.771,95%CI: 0.723–0.819)and the H-L test(P=0.393).The risk score conferred that the patients were divided into the two groups: low risk group(0–3 risk score)and high risk group(4–9 risk score).Patients with CR in the high risk group were significantly more than those in the low risk group(70.1%vs.29.9%,P<0.001).The results in the validation cohort ROC(0.758,95%CI: 0.682–0.835),H-L test(P=0.669)supported those in the training cohort.Conclusion: Previous stroke history,female sex,age,without primary percutaneous coronary intervention(PCI),and Killip class III-IV at admission are the independent risk factors for CR in STEMI patients.The predictive risk model provides a potential identification for patients with CR in STEMI.