Development and validation of a prognostic model for predicting post-discharge mortality risk in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI)
Abstract Background Accurately predicting post-discharge mortality risk in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) remains a complex and critical challenge. The primary objective of this study was to develop and va...
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | Journal of Cardiothoracic Surgery |
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| Online Access: | https://doi.org/10.1186/s13019-024-02665-3 |
| _version_ | 1797233254795837440 |
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| author | Lingling Zhang Zhican Liu Yunlong Zhu Mingxin Wu Haobo Huang Wenbin Yang Ke Peng Jianping Zeng |
| author_facet | Lingling Zhang Zhican Liu Yunlong Zhu Mingxin Wu Haobo Huang Wenbin Yang Ke Peng Jianping Zeng |
| author_sort | Lingling Zhang |
| collection | DOAJ |
| description | Abstract Background Accurately predicting post-discharge mortality risk in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) remains a complex and critical challenge. The primary objective of this study was to develop and validate a robust risk prediction model to assess the 12-month and 24-month mortality risk in STEMI patients after hospital discharge. Methods A retrospective study was conducted on 664 STEMI patients who underwent PPCI at Xiangtan Central Hospital Chest Pain Center between 2020 and 2022. The dataset was randomly divided into a training cohort (n = 464) and a validation cohort (n = 200) using a 7:3 ratio. The primary outcome was all-cause mortality following hospital discharge. The least absolute shrinkage and selection operator (LASSO) regression model was employed to identify the optimal predictive variables. Based on these variables, a regression model was constructed to determine the significant predictors of mortality. The performance of the model was evaluated using receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA). Results The prognostic model was developed based on the LASSO regression results and further validated using the independent validation cohort. LASSO regression identified five important predictors: age, Killip classification, B-type natriuretic peptide precursor (NTpro-BNP), left ventricular ejection fraction (LVEF), and the usage of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors (ACEI/ARB/ARNI). The Harrell's concordance index (C-index) for the training and validation cohorts were 0.863 (95% CI: 0.792–0.934) and 0.888 (95% CI: 0.821–0.955), respectively. The area under the curve (AUC) for the training cohort at 12 months and 24 months was 0.785 (95% CI: 0.771–0.948) and 0.812 (95% CI: 0.772–0.940), respectively, while the corresponding values for the validation cohort were 0.864 (95% CI: 0.604–0.965) and 0.845 (95% CI: 0.705–0.951). These results confirm the stability and predictive accuracy of our model, demonstrating its reliable discriminative ability for post-discharge all-cause mortality risk. DCA analysis exhibited favorable net benefit of the nomogram. Conclusion The developed nomogram shows potential as a tool for predicting post-discharge mortality in STEMI patients undergoing PPCI. However, its full utility awaits confirmation through broader external and temporal validation. |
| first_indexed | 2024-04-24T16:13:15Z |
| format | Article |
| id | doaj.art-63e2460bbe2c4aaeba5ccbb2f748e62c |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-04-24T16:13:15Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-63e2460bbe2c4aaeba5ccbb2f748e62c2024-03-31T11:35:11ZengBMCJournal of Cardiothoracic Surgery1749-80902024-03-0119111510.1186/s13019-024-02665-3Development and validation of a prognostic model for predicting post-discharge mortality risk in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI)Lingling Zhang0Zhican Liu1Yunlong Zhu2Mingxin Wu3Haobo Huang4Wenbin Yang5Ke Peng6Jianping Zeng7Department of Cardiology, Xiangtan Central HospitalDepartment of Cardiology, Xiangtan Central HospitalDepartment of Cardiology, Xiangtan Central HospitalDepartment of Cardiology, Xiangtan Central HospitalDepartment of Cardiology, Xiangtan Central HospitalMedical Department, Xiangtan Central HospitalDepartment of Scientific Research, Xiangtan Central HospitalDepartment of Cardiology, Xiangtan Central HospitalAbstract Background Accurately predicting post-discharge mortality risk in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) remains a complex and critical challenge. The primary objective of this study was to develop and validate a robust risk prediction model to assess the 12-month and 24-month mortality risk in STEMI patients after hospital discharge. Methods A retrospective study was conducted on 664 STEMI patients who underwent PPCI at Xiangtan Central Hospital Chest Pain Center between 2020 and 2022. The dataset was randomly divided into a training cohort (n = 464) and a validation cohort (n = 200) using a 7:3 ratio. The primary outcome was all-cause mortality following hospital discharge. The least absolute shrinkage and selection operator (LASSO) regression model was employed to identify the optimal predictive variables. Based on these variables, a regression model was constructed to determine the significant predictors of mortality. The performance of the model was evaluated using receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA). Results The prognostic model was developed based on the LASSO regression results and further validated using the independent validation cohort. LASSO regression identified five important predictors: age, Killip classification, B-type natriuretic peptide precursor (NTpro-BNP), left ventricular ejection fraction (LVEF), and the usage of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors (ACEI/ARB/ARNI). The Harrell's concordance index (C-index) for the training and validation cohorts were 0.863 (95% CI: 0.792–0.934) and 0.888 (95% CI: 0.821–0.955), respectively. The area under the curve (AUC) for the training cohort at 12 months and 24 months was 0.785 (95% CI: 0.771–0.948) and 0.812 (95% CI: 0.772–0.940), respectively, while the corresponding values for the validation cohort were 0.864 (95% CI: 0.604–0.965) and 0.845 (95% CI: 0.705–0.951). These results confirm the stability and predictive accuracy of our model, demonstrating its reliable discriminative ability for post-discharge all-cause mortality risk. DCA analysis exhibited favorable net benefit of the nomogram. Conclusion The developed nomogram shows potential as a tool for predicting post-discharge mortality in STEMI patients undergoing PPCI. However, its full utility awaits confirmation through broader external and temporal validation.https://doi.org/10.1186/s13019-024-02665-3ST-segment elevation myocardial infarction (STEMI)All-cause mortality riskPredictive modelLeast Absolute Shrinkage and Selection Operator (LASSO)Decision Curve Analysis (DCA) |
| spellingShingle | Lingling Zhang Zhican Liu Yunlong Zhu Mingxin Wu Haobo Huang Wenbin Yang Ke Peng Jianping Zeng Development and validation of a prognostic model for predicting post-discharge mortality risk in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) Journal of Cardiothoracic Surgery ST-segment elevation myocardial infarction (STEMI) All-cause mortality risk Predictive model Least Absolute Shrinkage and Selection Operator (LASSO) Decision Curve Analysis (DCA) |
| title | Development and validation of a prognostic model for predicting post-discharge mortality risk in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) |
| title_full | Development and validation of a prognostic model for predicting post-discharge mortality risk in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) |
| title_fullStr | Development and validation of a prognostic model for predicting post-discharge mortality risk in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) |
| title_full_unstemmed | Development and validation of a prognostic model for predicting post-discharge mortality risk in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) |
| title_short | Development and validation of a prognostic model for predicting post-discharge mortality risk in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) |
| title_sort | development and validation of a prognostic model for predicting post discharge mortality risk in patients with st segment elevation myocardial infarction stemi undergoing primary percutaneous coronary intervention ppci |
| topic | ST-segment elevation myocardial infarction (STEMI) All-cause mortality risk Predictive model Least Absolute Shrinkage and Selection Operator (LASSO) Decision Curve Analysis (DCA) |
| url | https://doi.org/10.1186/s13019-024-02665-3 |
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