Risk factors of major adverse cardiovascular events within one year in patients with ST-segment eleva-tion myocardial infarction after percutaneous coronary intervention and establishment of nomogram pre-dictive model

Sun Yang; Li Jingfeng; Li Yin

doi:10.3969/j.issn.1674-4055.2024.11.13

Abstract：Objective To investigate the risk factors for occurrence of major adverse cardiovascular events(MACE)within one year in patients with ST-segment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI),and to establish a nomogram predictive model.Methods This study was a retrospective one.STEMI patients(n=52)with MACE after emergency PCI during 1-y follow-up were chosen into MACE group,and patients without MACE during 1-y follow-up were chosen into non-MACE group from the First People's Hospital of Chuzhou City from June 2022 to June 2024.The baseline materials were statistical analyzed and compared between 2 groups.The influence of blood routine indexes and level of serum matrix metalloproteinase-9(MMP-9)on MACE occurrence after emergency PCI by using Cox regression analysis before and after covariate adjustment,and a nomogram predictive model was established.The predictive value of nomogram predictive model to MACE occurrence by using ROC curve in STEMI patients after emergency PCI.Results The average occurrence time of MACE was(7.50±2.43)months in MACE group.Gensini scores,gradeⅢ of Killip classification,complicated hypertension,smoking percentage,white blood cell count(WBC),neutrophil count(NEUT),neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR)and MMP-9 level were higher in MACE group than those in Non-MACE group(P＜0.05).The optimal penalty coefficient(λ)was determined by using three-fold cross-validation of LASSO regression model,and finally 8 potential relative factor were screened including Gensini scores,preoperative Killip classification,complicated hypertension,smoking,NEUT,NLR,PLR and MMP-9.The results of Cox regression analysis showed that the higher expressions of NLR,PLR and MMP-9 were risk factors for MACE occurrence(HR=1.818,HR=1.032,HR=1.004,P＜0.05)in STEMI patients after emergency PCI.The nomogram predictive model was verified by using Bootstrap internal verification method and C-index value was 0.932.The predictive value of nomogram predictive model to MACE occurrence was analyzed by using ROC curve analysis,and results showed that AUC was 0.932(95％CI:0.887～0.976),sensitivity was 0.865,specificity was 0.885 and Youden index was 0.750.The results of decision curve analysis showed that,when threshold value was from 0.005 to 1.000,the net income ratio of combination of NLR,PLR and MMP-9 was higher than that of along NLR,PLR or MMP-9 respectively in predicting MACE occurrence in STEMI patients after emergency PCI.Conclusion The blood routine indexes-NLR,PLR and MMP-9 are closely correlated to MACE occurrence,and nomogram predictive model has a higher predictive value to MACE occurrence in STEMI patients after emergency PCI.