A predictive nomogram for intramyocardial hemorrhage in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention based on coronary angiography-derived index of microcirculatory resistance.

BACKGROUND

Intramyocardial hemorrhage (IMH) after ST-segment elevation myocardial infarction (STEMI) reperfusion increases the risk of major adverse cardiovascular events (MACE). We aimed to integrate a coronary angiography-derived index of microcirculatory resistance (caIMR) with clinical features in a nomogram model for predicting IMH in patients with STEMI following primary percutaneous coronary intervention (PCI).

METHODS

A retrospective study included 309 STEMI patients admitted at Xuzhou Medical University for primary PCI from 2022 to 2023 in training and validation cohorts. Their caIMR was calculated from coronary angiography images and IMH was assessed by cardiac Magnetic Resonance (CMR). A nomogram was constructed through logistic regression analyses. Predictive accuracy, calibration, and clinical usefulness were validated by an area under the curve (AUC) of the receiver operating characteristic (ROC) curve, calibration curves, and decision curve analysis (DCA), respectively. All statistical tests were two-sided.

RESULTS

A total of 247 patients were assigned to the training cohort and 62 to the validation cohort randomly. A nomogram was established using two independent predictors of IMH derived from multivariable analysis: caIMR and left ventricular ejection fraction (LVEF). The AUC for the nomogram was 0.844 (95% confidence interval (CI): 0.793-0.896) in the training cohort and 0.834 (95% CI: 0.724-0.944) in the validation cohort. The predicted and actual estimates were significantly correlated in both cohorts, indicating good calibration of the nomogram. The nomogram was clinically useful for the prediction of IMH, within a 10-88% and 10-74% threshold probability in the training and validation cohorts respectively, exhibited by DCA. Furthermore, the nomogram showed superior discriminative ability for MACE prediction compared to CMR-confirmed IMH (AUC 0.726 vs. 0.584, P < 0.001).

CONCLUSIONS

This novel caIMR-based nomogram resulted in high accuracy of prediction for IMH and MACE in STEMI patients undergoing primary PCI. It may become a convenient tool to predict IMH immediately after the PCI procedure, and help with prognostic judgment and early clinical intervention.