Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China.
School of Stomatology, Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China.
BMC Cardiovasc Disord. 2022 Aug 27;22(1):386. doi: 10.1186/s12872-022-02831-2.
To develop and validate clinical evaluators that predict adverse left ventricular remodeling (ALVR) in non-ST-elevation myocardial infarction (NSTEMI) patients after primary percutaneous coronary intervention (PCI).
The retrospective study analyzed the clinical data of 507 NSTEMI patients who were treated with primary PCI from the Affiliated Hospital of Xuzhou Medical University and the Second Affiliated Hospital of Xuzhou Medical University, between January 1, 2019 and September 31, 2021. The training cohort consisted of patients admitted before June 2020 (n = 287), and the remaining patients (n = 220) were assigned to an external validation cohort. The endpoint event was the occurrence of ALVR, which was described as an increase ≥ 20% in left ventricular end-diastolic volume (LVEDV) at 3-4 months follow-up CMR compared with baseline measurements. The occurrence probability of ALVR stemmed from the final model, which embodied independent predictors recommended by logistic regression analysis. The area under the receiver operating characteristic curve (AUC), Calibration plot, Hosmer-Lemeshow method, and decision curve analysis (DCA) were applied to quantify the performance.
Independent predictors for ALVR included age (odds ratio (OR): 1.040; 95% confidence interval (CI): 1.009-1.073), the level of neutrophil to lymphocyte ratio (OR: 4.492; 95% CI: 1.906-10.582), the cardiac microvascular obstruction (OR: 3.416; 95% CI: 1.170-9.970), peak global longitudinal strain (OR: 1.131; 95% CI: 1.026-1.246), infarct size (OR: 1.082; 95% CI: 1.042-1.125) and left ventricular ejection fraction (OR: 0.925; 95% CI: 0.872-0.980), which were screened by regression analysis then merged into the nomogram model. Both internal validation (AUC: 0.805) and external validation (AUC: 0.867) revealed that the prediction model was capable of good discrimination. Calibration plot and Hosmer-Lemeshow method showed high consistency between the probabilities predicted by the nomogram (P = 0.514) and the validation set (P = 0.762) and the probabilities of actual occurrence. DCA corroborated the clinical utility of the nomogram.
In this study, the proposed nomogram model enabled individualized prediction of ALVR in NSTEMI patients after reperfusion and conduced to guide clinical therapeutic schedules.
开发并验证可预测非 ST 段抬高型心肌梗死（NSTEMI）患者经皮冠状动脉介入治疗（PCI）后不良左心室重构（ALVR）的临床评估工具。
本回顾性研究分析了 2019 年 1 月 1 日至 2021 年 9 月 31 日期间在徐州医科大学附属医院和徐州医科大学第二附属医院接受 PCI 治疗的 507 例 NSTEMI 患者的临床资料。训练队列纳入 2020 年 6 月前入院的患者（n=287），其余患者（n=220）被纳入外部验证队列。终点事件为 ALVR 的发生，定义为与基线测量相比，3-4 个月 CMR 随访时左心室舒张末期容积（LVEDV）增加≥20%。最终模型体现了逻辑回归分析推荐的独立预测因子，其概率来源于 ALVR 的发生。受试者工作特征曲线下面积（AUC）、校准图、Hosmer-Lemeshow 方法和决策曲线分析（DCA）用于量化性能。
ALVR 的独立预测因子包括年龄（比值比（OR）：1.040；95%置信区间（CI）：1.009-1.073）、中性粒细胞与淋巴细胞比值（OR：4.492；95% CI：1.906-10.582）、心肌微血管阻塞（OR：3.416；95% CI：1.170-9.970）、峰值整体纵向应变（OR：1.131；95% CI：1.026-1.246）、梗死面积（OR：1.082；95% CI：1.042-1.125）和左心室射血分数（OR：0.925；95% CI：0.872-0.980），这些因子通过回归分析筛选后合并入列线图模型。内部验证（AUC：0.805）和外部验证（AUC：0.867）均表明该预测模型具有良好的区分能力。校准图和 Hosmer-Lemeshow 方法表明，列线图预测的概率（P=0.514）与验证集（P=0.762）和实际发生概率之间具有高度一致性。DCA 证实了列线图的临床实用性。
本研究提出的列线图模型可对 NSTEMI 患者再灌注后 ALVR 进行个体化预测，有助于指导临床治疗方案。
