Predictive Modeling Of MACE Events In Acute Non-ST-Segment Elevation Myocardial Infarction And Comparison With GRACE Score

Objective:Acute non-ST-segment elevation myocardial infarction(NSTEMI)is one of the most common cardiovascular diseases nowadays and is relatively insidious in terms of early electrocardiographic changes,leaving some patients at risk of poor prognosis after discharge,even if early revascularization is performed to restore perfusion.The Global Registry of Acute Coronary Syndrome Events(GRACE)score is a widely used score to identify NSTEMI patients who have high risk factors for early diagnosis,but the evaluation of patients with NSTEMI using the GRACE score alone is too limited and easily biased.Therefore,this study was designed to explore the risk factors for major adverse cardiac events(MACE)in NSTEMI patients within 1 year after percutaneous coronary intervention(PCI),and combine with the GRACE score to establish a Nomogram model to predict the prognosis of NSTEMI patients.Methods:1.In this study,a total of 515 patients with NSTEMI who were hospitalized in the Department of Cardiovascular Medicine of the First Affiliated Hospital of Soochow University from January 2019 to December 2021 were retrospectively collected,with regular follow-up for 12 months,excluding 109 cases with diseases,absent data and loss to follow-up,and finally 406 cases were included,of which 320 were male and 86 were female,with an average age of 62 years.Patients’basic information,vital signs at admission,laboratory test results,routine cardiac ultrasound results were collected and GRACE score was calculated.2.Patients were divided into MACE group(n=59)and non-MACE group(n=347)according to whether they had MACE events within 1-year after PCI,and the baseline data,laboratory test results,cardiac ultrasound indexes,and the GRACE score were compared between the two groups.The independent risk factors for the occurrence of MACE events were screened by multi-factor Logistic regression analysis with SPSS software.3.Using SPSS and R software,the subject work curve(ROC)of GRACE score,independent risk factors for the occurrence of MACE events and the Nomogram model jointly established by the two were plotted and the calibration curves of the Nomogram model were used to analyze the predictive ability of the model.4.Patients were divided into a high-risk group(n=115)and a low-risk group(n=291)according to the best cut-off value of the Nomogram,and Kaplan-Meier curves were drawn to compare the prognostic risk of the two groups.Results:1.Patients in the MACE group were older,more with diabetes and Killip classification ≥2,longer hospital days and higher GRACE scores than those in the non-MACE group;in terms of preoperative test results,patients in the MACE group had higher erythrocyte distribution width,creatinine,D-dimer and left ventricular end-diastolic internal diameter than those in the non-MACE group,while glutamate transaminase,glomerular filtration rate(eGFR),and LDL cholesterol were lower than those in the non-MACE group.The differences between the above results were statistically significant(P<0.05).2.Multi-factor Logistic regression analysis was performed to determine the number of hospital days≥8.5 days(OR=2.821,95%CI:1.489-5.345,P=0.001),with diabetes(OR=3.035,95%CI:1.605-5.739,P=0.001),erythrocyte distribution width≥13.05%(OR=3.200,95%CI:1.682-6.089,P=0.000),and the GRACE score ≥137.5(OR=6.030,95%CI:3.072-11.833,P=0.000)were independent risk factors for the occurrence of MACE events in NSTEMI patients at 1 year(P<0.05).3.By plotting and comparing the subject operating curves(ROC)of the GRACE score,statistically significant independent risk factors other than the GRACE score after validation by multi-factor Logistic regression(multiple indicators),and the Nomogram model created by combining above,the Nomogram model showed the largest area under the curve with an AUC of 0.837(SE=0.029,95%CI:0.780-0.894),a sensitivity of 0.763 and a specificity of 0.798.4.By comparing the risk of MACE events and 1-year all-cause mortality between the high-risk and low-risk groups by plotting Kaplan-Meier curves,it was suggested that patients in the high-risk group had a greater risk of MACE events than those in the low-risk group(p<0.0001)and a higher all-cause mortality rate than those in the low-risk group(p=0.0014).Conclusions:1.Hospital days≥8.5 days,with diabetes,erythrocyte distribution width≥13.05%and the GRACE score≥ 137.5 were independent risk factors affecting the occurrence of MACE events in NSTEMI patients within 1 year.2.In this study,the Nomogram model based on Logistic regression had better predictive ability and higher predictive value than the GRACE score alone for the occurrence of MACE events within 1 year in NSTEMI patients,which can help clinical treatment decisions to a certain extent.3.After assigning scores based on each independent risk factor in the Nomogram model,NSTEMI patients with an overall model score higher than 127.5 can be considered to be at high risk of occurring MACE events.The higher the overall model score,the higher the risk of MACE events and all-cause mortality,and the worse the prognosis.