School of Graduate, Hebei Medical University, Shijiazhuang, Hebei, China.
Department of Cardiology Center, Hebei General Hospital, Shijiazhuang, Hebei, China.
BMJ Open. 2022 Feb 2;12(2):e056101. doi: 10.1136/bmjopen-2021-056101.
To establish a clinical prognostic nomogram for predicting in-hospital mortality after primary percutaneous coronary intervention (PCI) among patients with ST-elevation myocardial infarction (STEMI).
Retrospective, multicentre, observational study.
Thirty-nine hospitals in Hebei province.
Patients with STEMI who underwent PCI from January 2018 to December 2019.
A 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.
The outcome was the factors associated with in-hospital mortality.
This 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.
A 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.
建立预测 ST 段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）后住院死亡率的临床预后列线图。
回顾性、多中心、观察性研究。
河北省 39 家医院。
2018 年 1 月至 2019 年 12 月期间接受 PCI 的 STEMI 患者。
使用多变量逻辑回归模型确定与住院死亡率相关的因素，并使用这些因素建立列线图。通过区分度、校准和临床实用性来评估列线图的性能。
结局为与住院死亡率相关的因素。
本研究共纳入 855 例患者，其中 223 例死亡。年龄、体重指数、入院时收缩压、血红蛋白、入院时随机血糖、PCI 后射血分数、入院前使用阿司匹林、长病变、心肌梗死溶栓血流分级和中性粒细胞/淋巴细胞比值与住院死亡率独立相关（均 P<0.05）。在训练集中，列线图的 C 指数为 0.947，拟合优度为 0.683，受试者工作特征曲线下面积（AUC）为 0.947（95%CI 0.927 至 0.967）。在测试集中，C 指数为 0.891，拟合优度为 0.462，AUC 为 0.891（95%CI 0.844 至 0.939）。结果表明，该列线图具有良好的区分度和预测准确性，能够实现良好的净获益。
在中国河北省建立并验证了预测 STEMI 患者 PCI 后住院死亡率的列线图，表现出令人满意的性能。需要前瞻性研究来确认该列线图的性能、临床适用性和实用性。
