A nomogram for predicting in-hospital major adverse events and analysis of risk factors in transferred STEMI patients undergoing percutaneous coronary intervention
Liu Yujian
Jia Li
Pan Shanshan
Wang Daowen
Zeng Hesong
Zhou Qiang
Abstract：Objective It is planned to build a prediction model of adverse events in hospital for patients with acute ST-segment elevation myocardial infarction(STEMI)who are transported to percutaneous coronary intervention(PCI),which plays a role in rapid risk stratification and is conducive to the integration of regional collaborative treatment systems,thus improving the treatment effect of patients.Methods The clinical data of 1076 STEMI patients who were admitted to the Department of Cardiology,tongji hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology from January 1,2015 to December 31,2019 were selected,and a simple and convenient prediction model was constructed to evaluate the incidence of serious adverse events risk in the hospital.Calibration curve was used to evaluate consistency,Hosmer-Lemeshow was used to test goodness of fit,and decision analysis curve was used to evaluate clinical effectiveness.Results Among 1076 cases of STEMI,86 cases developed serious adverse events in hospital(53 cases suffered from acute left heart failure and 33 cases died in hospital).The results showed that compared with the group without serious adverse events,the patients in serious adverse events group were older(66.26 11.20 years vs.58.74±11.43 years,P＜0.001),with a higher proportion of abnormal consciousness(P＜0.001),higher respiratory rate(P=0.021)and faster heart rate(P=Preoperative TIMI blood flow grading was worse(P=0.030),Killip grading was worse(P＜0.001),abnormal creatinine rate was higher(P＜0.001),early anticoagulant administration rate was lower at the first medical contact(FMC),and the time from FMC to guidewire passage(FMC-to-W)was lower.After LASSO and multivariate Logistic regression analysis,we found that age,systolic blood pressure,Killip grade,serum creatinine,anticoagulants given early in FMC and FMC-to-W were effective predictors of the incidence of serious adverse events in hospital.When the patient's FMC-to-W≥90 min,the risk of adverse events in the hospital increased significantly.Conclusions In the regional cooperative rescue mode,besides the severity of the disease,FMC medical treatment also has an important impact on the prognosis of STEMI patients who are transferred to PCI.Early use of anticoagulants in FMC and PCI transfer as soon as possible(shortening FMC-to-W)are the key factors to reduce hospital serious adverse events and improve prognosis.
Keywords：Chest pain centerST-segment elevation myocardial infarctionPredictorsNomogramIn-hospital adverse events
Publication Date：2025-08-20
Online Publishing Date：2025-10-24(First online date of this platform, not the publication date of the document)
Pages：6( 1001-1006 )