Yaqian Zhang, Yan Liu, Mingming Fu, Zhiqian Wang, Zhiyong Hou
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The prediction model was constructed by using Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analyses. In addition, the constructed prediction model was transformed into a nomogram. The performance of the model was evaluated using the area under receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA). Bootstrapping was used for validation.</p><p><strong>Results: </strong>There are 40 (4.2%) cases developed AMI in all 958 patients. There were 685 (71.5%) female patients and 273 (28.5%) male patients. Among 40 AMI patients, 38 (95.0%) had Type 2 myocardial infarction (T2MI) and 2 (5.0%) had Type 1 myocardial infarction (T1MI). The majority of these ECG were ST segment depression (57.5%). Most elderly AMI patients (67.5%) presented asymptomatic. Predictors for preoperative AMI were higher age (OR 2.386, 95% CI 1.126-5.057), diabetes (OR 5.863, 95% CI 2.851-12.058), Hb≤100 g/L (OR 3.976, 95% CI 1.478-10.695), CRP≥40 mg/L (OR 6.998, 95% CI 2.875-17.033), and ALB≤35 g/L (OR 2.166, 95% CI 1.049-4.471). Good discrimination and calibration effect of the model was showed. Interval validation could still achieve the C-index value of 0.771. DCA demonstrated this nomogram has good clinical utility.</p><p><strong>Conclusion: </strong>This model has a good predictive effect on preoperative AMI in elderly patients with hip fracture, which can help to better plan clinical evaluation.</p>","PeriodicalId":48841,"journal":{"name":"Clinical Interventions in Aging","volume":"18 ","pages":"1985-1994"},"PeriodicalIF":3.5000,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10693827/pdf/","citationCount":"0","resultStr":"{\"title\":\"Characteristics of Preoperative Acute Myocardial Infarction in Elderly Hip Fracture Patients and Construction of a Clinical Prediction Model: A Retrospective Cohort Study.\",\"authors\":\"Yaqian Zhang, Yan Liu, Mingming Fu, Zhiqian Wang, Zhiyong Hou\",\"doi\":\"10.2147/CIA.S428092\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The prognosis of elderly patients with acute myocardial infarction (AMI) is poor, and this study aimed to investigate the characteristics and predictors of preoperative AMI in elderly hip fracture patients and to propose a valid clinical prediction model.</p><p><strong>Methods: </strong>We collected clinical data of older hip fracture patients from January 2019 to December 2020. The data collected include demographic and clinical characteristics, underlying diseases and laboratory results. In AMI patients, we further collected type of myocardial infarctions, clinical symptoms, electrocardiogram (ECG), Killip class and diagnosis method. The prediction model was constructed by using Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analyses. In addition, the constructed prediction model was transformed into a nomogram. The performance of the model was evaluated using the area under receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA). Bootstrapping was used for validation.</p><p><strong>Results: </strong>There are 40 (4.2%) cases developed AMI in all 958 patients. There were 685 (71.5%) female patients and 273 (28.5%) male patients. Among 40 AMI patients, 38 (95.0%) had Type 2 myocardial infarction (T2MI) and 2 (5.0%) had Type 1 myocardial infarction (T1MI). 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引用次数: 0
摘要
背景:老年急性心肌梗死(AMI)患者预后较差，本研究旨在探讨老年髋部骨折患者术前AMI的特点及预测因素，提出一种有效的临床预测模型。方法:收集2019年1月至2020年12月老年髋部骨折患者的临床资料。收集的数据包括人口统计和临床特征、潜在疾病和实验室结果。对AMI患者进一步收集心肌梗死类型、临床症状、心电图、Killip分级及诊断方法。采用最小绝对收缩和选择算子(LASSO)回归和多元逻辑回归分析，构建了预测模型。此外，将构建的预测模型转化为模态图。采用受试者工作特征曲线(AUC)下面积、校准曲线和决策曲线分析(DCA)对模型的性能进行评价。使用引导进行验证。结果:958例患者中有40例(4.2%)发生AMI。女性685例(71.5%)，男性273例(28.5%)。40例AMI患者中，38例(95.0%)合并2型心肌梗死(T2MI)， 2例(5.0%)合并1型心肌梗死(T1MI)。以ST段下陷居多(57.5%)。大多数老年AMI患者(67.5%)无症状。术前AMI的预测因子为年龄较高(OR 2.386, 95% CI 1.126-5.057)、糖尿病(OR 5.863, 95% CI 2.851-12.058)、Hb≤100 g/L (OR 3.976, 95% CI 1.478-10.695)、CRP≥40 mg/L (OR 6.998, 95% CI 2.875-17.033)、ALB≤35 g/L (OR 2.166, 95% CI 1.049-4.471)。结果表明，该模型具有良好的判别和标定效果。区间验证仍然可以达到0.771的C-index值。DCA证明该图具有良好的临床应用价值。结论:该模型对老年髋部骨折患者术前AMI有较好的预测效果，有助于更好地规划临床评价。
Characteristics of Preoperative Acute Myocardial Infarction in Elderly Hip Fracture Patients and Construction of a Clinical Prediction Model: A Retrospective Cohort Study.
Background: The prognosis of elderly patients with acute myocardial infarction (AMI) is poor, and this study aimed to investigate the characteristics and predictors of preoperative AMI in elderly hip fracture patients and to propose a valid clinical prediction model.
Methods: We collected clinical data of older hip fracture patients from January 2019 to December 2020. The data collected include demographic and clinical characteristics, underlying diseases and laboratory results. In AMI patients, we further collected type of myocardial infarctions, clinical symptoms, electrocardiogram (ECG), Killip class and diagnosis method. The prediction model was constructed by using Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analyses. In addition, the constructed prediction model was transformed into a nomogram. The performance of the model was evaluated using the area under receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA). Bootstrapping was used for validation.
Results: There are 40 (4.2%) cases developed AMI in all 958 patients. There were 685 (71.5%) female patients and 273 (28.5%) male patients. Among 40 AMI patients, 38 (95.0%) had Type 2 myocardial infarction (T2MI) and 2 (5.0%) had Type 1 myocardial infarction (T1MI). The majority of these ECG were ST segment depression (57.5%). Most elderly AMI patients (67.5%) presented asymptomatic. Predictors for preoperative AMI were higher age (OR 2.386, 95% CI 1.126-5.057), diabetes (OR 5.863, 95% CI 2.851-12.058), Hb≤100 g/L (OR 3.976, 95% CI 1.478-10.695), CRP≥40 mg/L (OR 6.998, 95% CI 2.875-17.033), and ALB≤35 g/L (OR 2.166, 95% CI 1.049-4.471). Good discrimination and calibration effect of the model was showed. Interval validation could still achieve the C-index value of 0.771. DCA demonstrated this nomogram has good clinical utility.
Conclusion: This model has a good predictive effect on preoperative AMI in elderly patients with hip fracture, which can help to better plan clinical evaluation.
期刊介绍：
Clinical Interventions in Aging, is an online, peer reviewed, open access journal focusing on concise rapid reporting of original research and reviews in aging. Special attention will be given to papers reporting on actual or potential clinical applications leading to improved prevention or treatment of disease or a greater understanding of pathological processes that result from maladaptive changes in the body associated with aging. This journal is directed at a wide array of scientists, engineers, pharmacists, pharmacologists and clinical specialists wishing to maintain an up to date knowledge of this exciting and emerging field.
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