Influencing factors of bradycardia in elderly patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention and establishment and validation of a risk prediction model using a column chart

TANG Ning-cheng; YANG Wei; HE Xiao-wei

doi:10.3969/j.issn.1672-5301.2025.12.009

Abstract：Objective To explore the risk factors of bradycardia after percutaneous coronary intervention(PCI)in the elderly patients with ST-segment elevation myocardial infarction(STEMI)and construct a column chart model for the prediction.Methods A total of 282 elderly patients with STEMI who underwent percutaneous coronary intervention(PCI)at Rugao People's Hospital from January 2019 to January 2023 were enrolled as study subjects.The patients were separated into the non bradycardia group(n=217)and the bradycardia group(n=65)based on whether bradycardia occurred after surgery.All clinical basic data and serological indicators of the elderly STEMI patients were collected.Multivariate Logistic regression was used to analyze the influencing factorsI.R software was applied to construct a column chart model for predicting bradycardia in STEMI patients after PCI.ROC curves and calibration graphs were drawn to verify the model's differentiation and consistency.The clinical decision curves was drawn using the rmda package.Results There were significant differences in the location of lesions,the number of lesion branches,the absence of reflow during surgery and the levels of low-density lipoprotein cholesterol(LDL-C)and C-reactive protein(CRP)between the 2 groups after PCI(P<0.05).Lesion location,no intraoperative reflow,LDL-C and CRP were the independent risk factors for bradycardia in the elderly STEMI patients after PCI(P<0.05).Based on the aforementioned influencing factors,a regression model was established.The results indicated that the calibration curve slope for predicting post-PCI BC occurrence in the elderly STEMI patients approached 1.The Hosmer-Lemeshow goodness-of-fit test yielded χ2=8.395,P=0.396,demonstrating good consistency.The ROC curve results showed that the area under the curve(AUC)was 0.821(95%CI 0.771-0.864),indicated that the model had good predictive ability.When the probability of high-risk threshold was between 0.08 and 0.92,the clinical utility of using this nomogram model to predict the occurrence of BC in elderly patients with STEMI after PCI was relatively higher.Further focusing on clinically feasible thresholds,the core interval of 0.25 to 0.42 represented a relatively stable net benefit for the model,which was more aligned with the actual scenarios of clinical decision-making.The priority could be given to using the model for risk stratification and intervention decisions within this interval.Conclusion The location of the lesion,the absence of reflow during surgery,the content of LDL-C and CRP were the influencing factors for BC after PCI in elderly patients with STEMI.The model for the prediction would be good in the stratification and consistency.