Establishment of a Nomogram model for risk prediction based on myocardial markers to predict complicated heart failure in elderly STEMI
Objective To investigate the predictive value of myocardial markers for the risk of heart failure complicating ST-segment elevation myocardial infarction(STEMI)in the elderly and to develop a No-mogram model for the prediction of the risk of heart failure complicating STEMI.Methods A retrospective a-nalysis of the clinical data of 531 elderly STEMI patients who underwent percutaneous coronary artery(coro-nary)intervention(PCI)admitted to the hospital from May 2020 to May 2023 was performed,and they were randomly divided into a training set(354 patients)and a validation set(177 patients)in a 2∶1 ratio.Patients in the training set were categorized into a concomitant heart failure group(82 cases)and an uncomplicated heart failure group(272 cases)according to the complication of heart failure at 6-month follow-up after PCI.The predictive value of myocardial markers for heart failure complicated by STEMI in the elderly was assessed by receiver operating characteristic(ROC)curves,and the risk factors for heart failure complicated by STEMI in the elderly were analyzed by multifactorial logistic regression model.A risk prediction Nomogram model was established and validated based on the results of the multifactorial analysis.Results The sensitivity of post-PCI creatine kinase isoenzyme(CK-MB),troponin T(cTnT),cTnⅠ,and myoglobin(MYO)assays for predicting STEMI-complicated heart failure in the elderly was 78.05％,76.83％,78.05％,and 75.61％,re-spectively,and the specificity was 75.37％,79.04％,79.74％,75.74％,respectively,area under the ROC curve was 0.761,0.797,0.804,0.778;anterior wall infarction,multibranch vasculopathy,infarct area,coronary Gensini score,and pre-PCI neutrophil/lymphocyte ratio,platelet count,blood uric acid,amino-terminal B-type brain natriuretic peptide precursor(NT-proBNP)and post-PCI CK-MB,cTnT,cTnⅠ,MYO,and slow/no reen-try were all risk factors for concomitant heart failure after PCI in elderly STEMI patients(P＜0.05).The consistency indices of the constructed Nomogram model for risk prediction of complicated heart failure in eld-erly STEMI were 0.854 and 0.833 for the training and validation sets,respectively,and the calibration curves fit the ideal curves well;the sensitivity,specificity,and area under the ROC curve for the training set were 85.71％,83.85％,and 0.874,and those for the validation set were 82.86％,81.54％,and 0.858;the Nomo-gram model predicts the risk of heart failure complicated by STEMI in the elderly with a high net gain when the threshold probability were 0-0.85 for the training set and 0-0.90 for the validation set.Conclusion CK-MB,cTnT,cTnⅠ,and MYO after PCI have a certain predictive value for post-PCI heart failure in elderly STE-MI patients,and these four indexes,together with the anterior wall infarction,multibranch vascular lesions,in-farct area,coronary Gensini score,as well as pre-PCI neutrophil/lymphocyte ratio,platelet count,blood urea,NT-proBNP,and slow/no reentry after PCI are all risk factors for heart failure complication after PCI in elder-ly STEMI patients,and the risk prediction Nomogram model constructed based on this has good predictive ef-ficacy,which can help clinicians to screen the high-risk population at an early stage.
ST segment elevation myocardial infarctionElderlyMyocardial markersHeart failureNomogram modelPredict
万方数据
维普
