Predictive value of a nomogram based on Gensini score,NT-proBNP,and NLR for microvascular obstruction after PCI in STEMI patients

Zhou Haixin; Kang Shuang; Jia Shuangyue; Liu Jixuan

doi:10.3969/j.issn.1674-4055.2025.08.08

Abstract：Objective To analyze the value of a nomogram based on the Gensini score,N-terminal pro-B-type natriuretic peptide(NT-proBNP),and neutrophil-to-lymphocyte ratio(NLR)in predicting microvascular obstruction(MVO)after percutaneous coronary intervention(PCI)in patients with ST-segment elevation myocardial infarction(STEMI).Methods A total of 323 STEMI patients who underwent PCI at Beijing Friendship Hospital,Capital Medical University from January 2021 to October 2024 were enrolled.Patients were divided into MVO and non-MVO groups according to the presence of MVO post-PCI.Clinical data were collected,including Gensini scores,NLR,and serum NT-proBNP levels.Independent predictors of MVO were identified using multivariate unconditional logistic regression analysis to construct a prediction model.Model calibration was assessed using the Hosmer-Lemeshow test.Predictive performance was evaluated via the receiver operating characteristic(ROC)curve and the area under the curve(AUC).Discrimination was assessed using the concordance index(C-index),calibration via calibration plots,and clinical utility via decision curve analysis(DCA).Results The incidence of MVO after PCI in 323 STEMI patients was 39.32%(127/323).Multivariate logistic regression analysis showed that Killip class Ⅲ～Ⅳ,Gensini score,NT-proBNP,NLR,and symptom onset-to-balloon time were independent risk factors for MVO after PCI in STEMI patients,while thrombolysis in myocardial infarctiongrade 3 flow was an independent protective factor(P＜0.05).A nomogram model for predicting MVO after PCI in STEMI patients was established based on these independent factors:Logit(P)=-7.429+0.769×Killip class-0.584×thrombolysis in myocardial infarction flow grade+0.034×Gensini score+0.001×NT-proBNP+0.191×NLR+0.300×symptom onset-to-balloon time,with an Hosmer-Lemeshow test P＞0.05.The ROC curve analysis demonstrated that the AUC for predicting MVO after PCI in STEMI patients was 0.905,with a C-index of 0.905,a sensitivity of 0.906,and a specificity of 0.821.The calibration curve showed that the predicted probability of the nomogram was consistent with the ideal curve,and decision curve analysis indicated that when the threshold probability was＞0.05,the net clinical benefit of the nomogram was＞0.Conclusion Elevated Gensini score,NT-proBNP,and NLR are closely associated with the occurrence of MVO after PCI in STEMI patients.The nomogram constructed based on these factors has high predictive value for MVO after PCI in STEMI patients.