Construction of a risk prediction model for myocardial injury after direct percutaneous coronary intervention in pa-tients with acute coronary syndrome

Mayire Aji; ZaiMira Ilham; Xie Yaohui; Abudushalamu; Wang Xumin

doi:10.3969/j.issn.1671-6450.2025.12.003

Abstract：Objective To analyze the risk factors of myocardial injury in patients with acute coronary syndrome(ACS)after direct percutaneous coronary intervention(PCI),and to construct a risk prediction model based on these risk fac-tors.Methods The clinical data of 126 patients with ACS who underwent direct PCI treatment in the Department of Cardio-vascular Medicine of the Sixth Affiliated Hospital of Xinjiang Medical University from March 2019 to April 2023 were retro-spectively selected.Patients were divided into myocardial injury group(n=44)and non-myocardial injury group(n=82)based on the occurrence of myocardial injury.Multivariate Logistic regression was used to analyze the influencing factors of myocar-dial injury in patients with ACS,and the nomogram risk prediction model was drawn using R software and rms package.The correction curve was drawn by the Bootstrap method using the caret package for internal verification,and the receiver operat-ing characteristic(ROC)curve and decision curve(DCA)were used to evaluate the prediction model.Results The proportion of patients aged over 60 years old in the myocardial injury group showed higher levels of high-sensitivity C-reac-tive protein(hs-CRP),lipoprotein-associated phospholipase A2(Lp-PLA2),galectin-3(GAL3),heart-type fatty acid binding protein(H-FABP),and tissue protease S(CTSS)compared to the non-myocardial injury group(t/P=8.287/0.004,5.137/＜0.001,7.939/＜0.001,5.243/＜0.001,6.913/＜0.001,4.999/＜0.001).Multivariate Logistic regression analysis showed that age＞60 years,high Lp-PLA2,high GAL3,high H-FABP,and high CTSS were independent risk factors for myocardial injury in ACS patients after direct PCI[OR(95％CI)=5.916(1.298-26.967),1.035(0.743-6.637),2.270(1.015-1.054),1.392(1.092-1.774),1.489(1.044-2.125)].Based on the risk factors,a risk prediction model was constructed:the column-line diagram model showed that C-index was 0.961,and the internal correction curve and the ideal curve fit well and were highly coinci-dent.ROC curve showed that AUC predicted by the model was 0.961,sensitivity and specificity were 0.846 and 0.939,respec-tively.The decision curve showed that the clinical net benefit of the model was ideal.Conclusion Age over 60 years old and high levels of Lp-PLA2,GAL3,H-FABP,and CTSS are all risk factors for myocardial injury in ACS patients after direct PCI.Based on these factors,a risk prediction model can be constructed to visualize the risk and have ideal predictive value.