Objective To establish a nomogram for predicting clinical prognosis of major adverse cardiovascular events(MACE)in patients with ST-segment elevation myocardial infarction(STEMI)2 y after emergency percutaneous coronary intervention(PCI).Methods The data was retrospectively analyzed in STEMI patients undergone PCI(n=393)in Central Hospital of Xinxiang City from Jan.2018 to May 2021.The patients were divided,according to whether MACE occurred 2 y after PCI or not,into MACE group(n=66)and non-MACE group(n=327).The clinical data was compared between 2 groups.The minimum absolute value convergence and selection operator(LASSO)regression was used to screen the predictive factors with non-zero coefficients,and the multivariate Cox regression was used to analyze the independent risk factors of MACE 2 y after emergency PCI.A nomograph model was established based on prediction factors,and prediction performance of the model was reviewed by using C index.The effectiveness of nomogram model and risk scores of thrombolysis in myocardial infarction(TIMI)in predicting MACE was reviewing by using ROC curve and clinical decision curve analysis(DCA).Results The results of LASSO regression analysis showed that admission systolic blood pressure(SBP),grades Ⅲ to Ⅳ of Killip,left ventricular ejection fraction(LVEF),D-dimer(D-D),homocysteine(Hcy),N-terminal pro-brain natriuretic peptide(NT-proBNP)and intra-aortic balloon pumps(IABP)all were important predictive factors with non-zero coefficients.The grades Ⅲ to Ⅳ of Killip,LVEF,Hcy and NT-proBNP were independent risk factors of MACE in STEMI patients after PCI for 2 y(P<0.05).The nomograph was established with the above independent predictors.The internal validation C index was 0.714(95%CI:0.647～0.781,P<0.001),and area of ROC curve(0.758,95%CI:0.697～0.820,P<0.001)was greater than TIMI risk index(0.669,95%CI:0.544～0.765,P<0.001)and GRACE scores(0.633,95%CI:0.521～0.736,P<0.001).The results of H-L goodness of fit-test showed(χ2=0.44,P=0.51),indicated that calibration curve of the model was close to ideal model.The results of DCA showed that the nomogram model had more significant positive net benefit for predicting MACE in the total cohort compared with TIMI risk index or GRACE scores.Conclusion The grades Ⅲ to Ⅳ of Killip,LVEF,Hcy and NT-proBNP are independent risk factors of MACE in STEMI patients 2 y after PCI.The nomograph model based on these factors has high predictive power and feasibility.
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