Influencing factors of left ventricular thrombosis in elderly patients with acute ST segment elevation myocardial infarction and the construction of a Nomogram risk prediction model

GUI Yuan; ZHAN Ji-dong; JIANG Yi; XIAO Ting; ZHANG Jing; YU Jing

doi:10.3969/j.issn.1672-5301.2024.08.009

Abstract：Objective To explore the influencing factors of left ventricular thrombosis(LVT)formation in elderly patients with acute ST segment elevation myocardial infarction(STEMI)and to construct the Nomogram risk prediction model.Methods A total of 873 elderly acute STEMI patients admitted to Tongji Hospital from January 2020 to December 2023 were separated into the training set(n=611)and the validation set(n=262)at a ratio of 7:3.According to the occurrence of LVT in the training set,the patients were separated into the non LVT group(n=549)and LVT group(n=62).Multivariate logistic regression was applied to analyze the influencing factors of LVT in the patients.RMS package of R software was applied to construct the Nomogram model for predicting the risk of LVT in the patients;and ROC and Hosmer-Lemeshow tests were applied to verify its predictive performance.Results Compared with the non LVT group,the LVT group had maredly lower hemoglobin(Hb)[(131.15±15.99)g/L vs.(143.28±16.71)g/L]and left ventricular ejection fraction(LVEF)[(39.99±5.01)％vs.(45.24±6.69)％](t=5.441,5.991,P＜0.05);the proportions of patients with concomitant ventricular aneurysm(37.10％vs.20.40％),baseline thrombolysis in myocardial infarction(TIMI)blood flow grade 0(59.68％vs.44.81％),no formation of coronary collateral circulation(88.71％vs.72.13％),and no emergency percutaneous coronary intervention(PCI)or drug thrombolysis(69.35％vs.48.82％)were markedly higher(x2=9.022,4.953,7.921,9.403,P＜0.05).Multivariate logistic regression showed that Hb(OR=0.948)and LVEF(OR=0.868)were the protective factors for LVT in the patients(P＜0.05),while concomitant ventricular aneurysm(OR=6.812),baseline TIMI blood flow grade 0(OR=6.884),no formation of coronary collateral circulation(OR=7.273),and no emergency PCI or drug thrombolysis(OR=4.173)were the independent risk factors(P＜0.05).ROC analysis showed that the AUC of the training set was 0.871(95％CI 0.830-0.912),and the AUC of the validation set was 0.838(95％CI 0.731-0.945);in the Hosmer-Lemeshow test,the training set showed x2=11.379,P=0.181 and the validation set showed x2=11.261,P=0.187.Conclusion The occurrence of LVT in the elderly acute STEMI patients is closely related to Hb,LVEF,ventricular aneurysm,baseline TIMI grade,formation of coronary collateral circulation,and receiving emergency PCI or drug thrombolysis.The Nomogram prediction model constructed based on these factors has good discrimination and consistency,which is helpful for clinical prediction.