Construction Of Near-term Clinical Outcomes And Mortality Risk Prediction Models For Patients With Acute STEMI Complicated By Acute Heart Failure

Part I Analysis of risk factors for in-hospital mortality in patients with acute STEMI complicated with acute heart failureObjective: To study the risk factors of death in patients with acute STEMI complicated with acute heart failure during hospitalization.Methods: a total of 130 patients with acute STEMI complicated with acute heart failure hospitalized in Anqing First People’s Hospital from January 2017 to December 2020 were divided into death group and survival group according to whether they had cardiac death during hospitalization,and the baseline clinical data,physiological indicators,hospitalization treatment and other related indicators between the two groups were compared.The risk factors of death in hospital were screened out by Logistic single factor and multiple factor regression analysis.Results: Of the 130 patients,21(16.15%)died of cardiac disease and 109(83.85%)survived.Cardiac troponin I,NT-Pro BNP level,reperfusion therapy,serum potassium,urea nitrogen,serum creatinine,Killip classification,LVEF,occurrence of malignant arrhythmia during hospitalization,time from onset to admission and time from first medical contact to balloon dilation were risk factors,and the differences were statistically significant(all P ≤ 0.05);Multivariate regression analysis showed that there were significant differences in cardiac troponin I,occurrence of malignant arrhythmia during hospitalization,reperfusion therapy,Killip grade and LVEF between the two groups(all P ≤ 0.05).Conclusion: High troponin I,malignant arrhythmia during hospitalization,no reperfusion therapy,Killip III-IV grade and low LVEF were the risk factors of in-hospital death.Part II Analysis of risk factors for out-of-hospital mortality in patients with acute STEMI complicated with acute heart failureObjective: To study the risk factors of recent out-of-hospital death in patients with acute STEMI complicated with acute heart failure,and to provide a theoretical basis for early identification of high-risk patients out of hospital.Methods: The clinical data of patients with acute STEMI complicated with acute heart failure in the first part of the study were collected,and the survival status of the included cases was also collected.The cardiac death was the main end point of the follow-up,and the survival patients were followed up by outpatient or telephone until 6 months after discharge,and were divided into death group and survival group according to the survival status during the follow-up.The baseline clinical data,physiological indicators,hospitalization,cardiac status at discharge and treatment after discharge were compared between the two groups,and Logistic regression analysis was performed to screen the risk factors for out-of-hospital death.Results: Among the 119 patients who were followed up for 6 months,there were 11 cases(10.09%)of cardiac death and 98 cases(89.91%)of survival.There were significant differences in heart rate,pulse pressure,LVEF,the use of β-blockers and ACEI/ARB/ARNI between the two groups(all P ≤ 0.05).Conclusion: Heart rate,pulse pressure,LVEF,taking ACEI/ARB/ARNI drugs or not and taking β-receptor blocker or not are the risk factors of out-of-hospital death.part III Construction of prediction model of in-hospital and out-of-hospital death in patients with acute STEMI complicated with acute heart failureObjective: To develop a simple and practical model for predicting inhospital and out-of-hospital mortality in patients with acute STEMI complicated with acute heart failure,so that clinicians can identify high-risk patients early and take individualized treatment accordingly.Methods: The risk factors of in-hospital and out-of-hospital mortality were analyzed by nomogram,and the in-hospital and out-of-hospital risk prediction model was established,and the accuracy of the prediction model was evaluated by ROC(Recerver Operating Characteristic).The area under the curve(area under thecurve,AUC)assessed the predictive value of the model.Hosmere-Lemeshow method was used to test the goodness of fit of the model,and P > 0.05 indicated that the goodness of fit of the model was good.The decision curve(DCA)was used to analyze the clinical practicability of the prediction model.Results:(1)The area under the ROC curve(AUC)was 0.828(95CI:0.739-0.916)after analyzing the risk factors of cardiac troponin I,malignant arrhythmia during hospitalization,reperfusion treatment,Killip classification and LVEF.The DCA curve showed a high clinical net benefit.(2)The area under the ROC curve(AUC)of heart rate,pulse pressure,LVEF,beta-blockers and ACEI/ARB/ARNI was 0.803(95%CI:0.708-0.897).The DCA curve showed a high clinical net benefit.Conclusion: The risk prediction model constructed by analyzing the risk factors of in-hospital and out-of-hospital death respectively has good predictive ability and high predictive value after verification.