Study On Predictive Model For Long-term Adverse Cardiovascular Events In Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Objective:Risk stratification of patients with acute myocardial infarction(AMI)is of great clinical significance for clinical decision-making and prognosis evaluation.Due to the continuous change of AMI patients’ clinical characteristics and management,the current clinical risk score may be not applicable to the existing clinical situation.Therefore,it is necessary to improve the prediction accuracy of long-term adverse cardiovascular events in patients with AMI after percutaneous coronary intervention(PCI)to remains sufficient for individualized patient management strategies.We aim to develop a risk model to predict adverse cardiovascular events after AMI patients undergoing PCI.Methods:In part 1.A single center cohort study of AMI patients undergoing PCI was established.Hospitalized patients diagnosed with AMI and undergoing PCI were recruited from the An Zhen hospital.Based on the inclusion and exclusion criteria,the data of patients with suitable conditions(including clinical features,general conditions,hematological indexes,influencing indexes,etc.)were collected,and the patients were followed up of the patients was performed via telephone interviews.The primary endpoint was a composite of all-cause mortality,non-fatal myocardial infarction,non-fatal stroke,malignant arrhythmia,new heart failure or heart failure exacerbation readmission,and unplanned repeat revascularization.In order to verify the efficacy of the global acute coronary event registration(GRACE)score in evaluating the prognosis of patients with AMI after PCI,GRACE score was analyzed by the receiver operating characteristic(ROC)curve to predict the efficacy of MACE.In part 2.In the cohort of AMI patients undergoing PCI,LASSO regression was conducted to identify candidate risk factors of long-term adverse cardiovascular events.Multivariate Logistic regression analyses were used to construct prediction model and nomograms.ROC curve and the concordance statistic(C-index)was used to evaluate discrimination ability of the prediction model and its scoring system.Net reclassification index(NRI)and integrated discrimination index(IDI)were computed to compare the GRACE score.Results:In part 1.A cohort study of AMI patients undergoing PCI was established,including1130 patients with a median follow-up of 2.4 years.The final cohort included 962 patients,aged 58.0 ± 11.2 years,782 males and 180 females.A total of 122(12.680%)adverse cardiovascular events occurred of the patients who were successfully followed up.At the same time,Clinical data,general data,hematological index data,cardiac color Doppler ultrasound index data,coronary artery condition data and discharge medication data were collected.The area under the curve(AUC)of the GRACE score is 0.697 [95%CI(0.648,0.746)],indicating that the GRACE score has a general predictive value for the long-term MACE risk of patients,but it is still limited.The data of this cohort can be used to construct a series of MACE risk prediction models for follow-up patients,and evaluate the incremental effectiveness of the prediction model and the GRACE score in predicting endpoint events.In part 2.Five predictive variables were identified by LASSO regression,including ST-segment deviation,diabetes history,hemoglobin(HB),left ventricular ejection fractions(LVEF),estimated glomerular filtration rate(e GFR).The prediction model was established by multivariate logistic regression analysis.The prediction model exhibited an area under the curve(AUC)of 0.774[95%CI(0.710,0.834)] for the training cohort and an AUC of 0.751[95%CI(0.686,0.815)] for the testing cohort.The prediction model was better than the GRACE score in the overall population [ΔAUC=0.050,P=0.015;IDI=0.055,95%CI(0.028,0.081),P<0.001;NRI=0.493,95%CI(0.303,0.682),P<0.001)].Conclusion:In part 1.A cohort of AMI patients undergoing PCI was established,which was mainly used to study and integrate risk factors to predict the long-term MACE risk of AMI patients undergoing PCI.The established patient cohort was used to verify the efficacy of the GRACE score in evaluating the prognosis of AMI patients undergoing PCI.In part 2.Five factors(ST-segment deviation,diabetes history,HB,LVEF,e GFR)were contained in the prediction model.It may be useful in predicting prognosis in patients having AMI during long-term follow-up.