Risk factor analysis and predictive nomogram development for in-hospital mortality in patients with ST-segment elevation myocardial infarction.

BACKGROUND

Identifying predictors of in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) is a major concern in cardiology. The aim of this study was to identify risk factors and develop a nomogram to predict in-hospital mortality in STEMI patients.

MATERIALS AND METHODS

This single-center study was a retrospective cohort analysis of all STEMI patients consecutively referred to Farshchian Hospital (Hamadan Province-Iran) from April 2021 to August 2024. Four different feature selection methods were used to select common important variables in the prediction model: Boruta, Recursive Feature Elimination (RFE), Random Forest (RF) and LASSO. The uneven distribution of the different classes 2,356 (91.7%) alive and 212 (8.3%) dead) was dealt with using the SMOTE method. After splitting the data into a training (70%) and a test (30%) dataset, a multiple logistic regression model was formulated using the significant variables identified. A nomogram predicting in-hospital mortality was then constructed and validated.

RESULTS

The findings indicate that age (OR = 1.05: 95% CI: 1.03–1.06), gender (female OR = 1.71: 95% CI: 1.22–2.41), length of stay (OR = 0.89: 95% CI: 0.83–0.96), blood urea nitrogen level (OR = 1.02: 95% CI: 1.00-0.03), white blood cell count (OR = 1.07: 95% CI: 1.03–1.1), Creatinine (OR = 1.74: 95% CI: 1.36–2.22), fasting blood glucose (OR = 1.007: 95% CI: 1.005–1.009), uric acid (OR = 1.07: 95% CI: 1.02–1.12), potassium (OR = 1.2: 95% CI: 0.95–1.52) and systolic blood pressure (OR = 0.98: 95% CI: 0.97–0.99) are pivotal factor in predicting in-hospital mortality in STEMI patients. The predictive model demonstrated high accuracy (84%) and excellent discriminatory ability with an AUC of 0.91. The calibration plot demonstrated the model’s strong discriminatory performance in distinguishing between the two classes.

CONCLUSIONS

The development of a nomogram for reliably predicting in-hospital mortality in STEMI patients provides clinicians with a practical visual aid for identifying high-risk patients. By enabling tailored care strategies, this tool improves therapeutic precision and ultimately leads to better clinical outcomes.

CLINICAL TRIAL NUMBER

Not applicable.