Risk factors of major adverse cardiovascular events and establishment of Nomogram model after percutaneous coronary intervention

Wang Yutong; Yan Wei; Xu Yinan; Gu Yiyu; Zhang Mingyang; Yang Xinyu; Song Yumeng; Jiang Tingbo

doi:10.3969/j.issn.1674-4055.2023.09.18

Abstract：Objective To study the independent risk factors of major adverse cardiovascular events(MACE)occurred in patients with acute ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI),and a Nomogram model was established.Methods STEMI patients(n=875)undergone PCI were chosen by using case-control study design from the First Affiliated Hospital of Soochow University from Aug.2013 to July 2018.The baseline data and results of laboratory examinations and echocardiography were collected from the patients.All patients were divided,according MACE occurrence state,into case group and control group.The independent risk factors of MACE after PCI were analyzed by using Logistics regression analysis in R program,and a Nomogram model was established.The predictive efficacy of Nomogram model was analyzed by using Calibration curve and ROC curve.Results The percentages of patients with stroke or transient ischemic attack(TIA)and hypertension were higher,heart function was worse,number of diseases vessels were more and age was elder in case group compared with control group.The differences in estimated glomerular filtration rate(eGFR),aspertate aminotransferase(AST),white blood cell(WBC),serum creatinine(SCr),high sensitivity C-reactive protein(hs-CRP),supraventricular tachycardia(SVT),ventricular fibrillation(VF),creatine kinase-MB isoenzyme(CK-MB)and left ventricular end-systolic diameter(LVESd)had statistical significance between 2 groups(P<0.05).The results of multi-factor Logistic regression analysis showed that smoking(OR=1.67,95%CI:1.13～2.47,P=0.027),hypertension(OR=2.04,95%CI:1.36～3.95,P=0.002),Killip grade≥3(OR=5.48,95%CI:2.41～12.46,P<0.001),LVESd>40 mm(OR=1.6,95%CI:1.06～2.4,P=0.103)and hs-CRP>10 mg/L(OR=1.27,95%CI:0.87-～1.87,P=0.947)were independent risk factors of MACE occurrence after PCI.A Nomogram predictive model was established and results of ROC curve analysis showed that AUC was 0.666(95%CI:0.614～0.717,P<0.001),cutoff value of the model was 34,sensitivity was 0.574 and specificity was 0.685(P<0.05).Conclusion Based on R-Logistic regression analysis,smoking,hypertension,Killip grade≥3,LVESd>40 mm and hs-CRP>10 mg/L were independent risk factors of MACE occurrence after PCI.The establishment of Nomogram risk model can predict individualized risk in patients,and has some assistant effects on making decisions of clinical diagnosis and treatment.