Risk factors and risk prediction models for left ventricular systolic dysfunction in patients with acute myocardial infarction
SUN Wan-wan
CHEN Ping
ZHANG Xiao
JIANG Cheng-gong
YU Jie
Abstract：Objective To investigate the risk factors of left ventricular systolic insufficiency(LVSD)in patients with acute myocardial infarction(AMI),and establish a risk prediction model based on the risk factors.Methods A total of 279 AMI patients admitted to our hospital from May 2021 to February 2024 were randomly separated into a modeling group(n=195)and a validation group(n=84)in a 7:3 ratio.The modeling group was also separated into a non LVSD group(n=113)and an LVSD group(n=82).Multivariate logistic regression analysis was conducted to analyze the influencing factors of AMI patients with LVSD,and a nomogram prediction model was constructed in R3.4.1 based on the screened risk factors.ROC curve and Hosmer-Lemeshow fit test were used to evaluate the predictive value of the model;The clinical application value of the model was analyzed by clinical decision curve(DCA).Results The total incidence of LVSD in 279 AMI patients was 43.01％.There were no obvious differences in heart rate,neutrophil to lymphocyte ratio(NLR),blood creatinine,and smoking history between modeling group and validation group(P＞0.05).Compared with the non LVSD group,the level of NLR[(6.28±1.19)vs.(5.03±1.08)]and Gensini scores[(28.02±5.86)scores vs.(23.54±4.35)scores]in the LVSD group were obviously higher(t=7.642,6.128,P＜0.05),and the proportions of smoking history(56.10％vs.36.28％),diabetes(31.71％vs 14.16％)and coronary artery lesions ≥3 branches(45.12％vs.23.89％)were also obviously higher(x2=7.500,8.659,9.712,P＜0.05).Multivariate logistic regression showed that NLR(OR=2.674),Gensini score(OR=1.185),smoking history(OR=3.009),diabetes(OR=6.730),and coronary artery lesions ≥3 branches(OR=4.387)were independent risk factors for LVSD in AMI patients(P＜0.05).ROC curve showed that the area under the curve(AUC)of the modeling group was 0.882(95％CI 0.833-0.932),and the AUC of the validation group was 0.917(95％CI 0.855-0.979);In the Hosmer-Lemeshow fit test,modeling groupx2=9.797,P=0.280,validation group x2=12.164,P=0.144.Clinical decision curve(DCA)shows that the model has high clinical application value.Conclusion AMI patients with high level of NLR,high Gensini scores,smoking history,diabetes,and coronary artery lesions ≥3 branches had a higher risk of LVSD.The model based on these five factors has better prediction differentiation and consistency,which is helpful for clinical evaluation of LVSD in AMI patients.
Keywords：Acute myocardial infarctionLeft ventricular systolic dysfunctionRisk factorsRisk model
Publication Date：2024-10-10
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 906-911 )