A diagnostic prediction model for the early detection of heart failure following primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction.

IF 1.3 American journal of cardiovascular disease Pub Date : 2024-08-25 eCollection Date: 2024-01-01 DOI:10.62347/SHPZ1673
Lingling Zhang, Zhican Liu, Yunlong Zhu, Jianping Zeng, Haobo Huang, Wenbin Yang, Ke Peng, Mingxin Wu
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Abstract

Background: In this study, we aimed to construct a robust diagnostic model that can predict the early onset of heart failure in patients with ST-elevation myocardial infarction (STEMI) following a primary percutaneous coronary intervention (PCI). This diagnostic model can facilitate the early stratification of high-risk patients, thereby optimizing therapeutic management.

Methods: We performed a retrospective analysis of 664 patients with STEMI who underwent their inaugural PCI. We performed logistic regression along with optimal subset regression and identified important risk factors associated with the early onset of heart failure during the time of admission. Based on these determinants, we constructed a predictive model and confirmed its diagnostic precision using a receiver operating characteristic (ROC) curve.

Results: The logistic and optimal subset regression analyses revealed the following three salient risk factors crucial for the early onset of heart failure: the Killip classification, the presence of renal insufficiency, and increased troponin T levels. The constructed prognostic model exhibited excellent discriminative ability, which was indicated by an area under the curve value of 0.847. The model's 95% confidence interval following 200 Bootstrap iterations was found to be between 0.767 and 0.925. The Hosmer-Lemeshow test revealed a chi-square value of 3.553 and a p-value of 0.938. Notably, the calibration of the model remained stable even after 500 Bootstrap evaluations. Furthermore, decision curve analysis revealed a substantial net benefit of the model.

Conclusion: We have successfully constructed a diagnostic prediction model to predict the incipient stages of heart failure in patients with STEMI following primary PCI. This diagnostic model can revolutionize patient care, allowing clinicians to quickly identify and create individualized interventions for patients at a higher risk.

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ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后早期发现心力衰竭的诊断预测模型。
研究背景在这项研究中,我们旨在构建一个强大的诊断模型,该模型可以预测ST段抬高型心肌梗死(STEMI)患者在接受一次经皮冠状动脉介入治疗(PCI)后心力衰竭的早期发生。该诊断模型有助于对高危患者进行早期分层,从而优化治疗管理:我们对 664 名接受首次 PCI 的 STEMI 患者进行了回顾性分析。我们进行了逻辑回归和最优子集回归,并确定了与入院时心衰早发相关的重要风险因素。根据这些决定因素,我们构建了一个预测模型,并通过接收者操作特征曲线(ROC)确认了其诊断精确度:逻辑回归分析和最优子集回归分析显示,以下三个突出的风险因素对心力衰竭的早期发病至关重要:Killip 分级、肾功能不全和肌钙蛋白 T 水平升高。所构建的预后模型具有出色的判别能力,其曲线下面积值为 0.847。经过 200 次 Bootstrap 迭代,发现该模型的 95% 置信区间介于 0.767 和 0.925 之间。Hosmer-Lemeshow 检验显示,卡方值为 3.553,P 值为 0.938。值得注意的是,即使经过 500 次 Bootstrap 评估,模型的校准仍保持稳定。此外,决策曲线分析表明,该模型具有显著的净效益:我们成功地构建了一个诊断预测模型,用于预测初级 PCI 后 STEMI 患者心力衰竭的萌芽阶段。该诊断模型可彻底改变患者护理,使临床医生能够快速识别高危患者并为其制定个性化干预措施。
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来源期刊
American journal of cardiovascular disease
American journal of cardiovascular disease CARDIAC & CARDIOVASCULAR SYSTEMS-
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