Development of a risk nomogram model for prediction of in-hospital mortality in elderly patients with acute ST-elevation myocardial infarction

doi:10.3877/cma.j.issn.2095-9133.2022.03.003

Abstract

Abstract:

Objective

To develop a nomogram model to predict risk of in-hospital mortality in elderly patients with acute ST-elevation myocardial infarction(STEMI).

Methods

Clinical data of 252 elderly patients with STEMI hospitalized to the First People’s Hospital of Kashgar Prefecture were collected. Paitents were randomly divided into primary cohort and validation cohort in a ratio of 7∶3. Variables that were significantly associated with in-hospital mortality screened by Logistic regression were used to establish a nomogram model with R software.

Results

Serum creatinine, heart failure, PCI therapy and e used to establish Variables that were significantly associated with in-hospital mortality screened by Logistrction syndrharacteristic curve (AUC) of the primary cohort and validation cohort was 0.927(95% CI 0.846-0.947) and 0.885 (95% CI 0.816-0.893) respectively.

Conclusions

The nomogram model consisting of 4 factors (serum creatinine, heart failure, PCI therapy and β blocker) could predict risk of in-hospital mortality for elderly patients with STEMI accurately. This model is a strong predictor, simple and easily being used for the disease.

Key words: Acute ST-elevation myocardial infarction, Elderly, Nomogram

Guangwu Zhang, Yuping Feng, Liyi Mo, Jiaxuan Liu, Qunying Zhang. Development of a risk nomogram model for prediction of in-hospital mortality in elderly patients with acute ST-elevation myocardial infarction[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2022, 08(03): 141-146.

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References 20

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组别	例数	女性[例(%)]	年龄(岁)	BMI(kg/m²)	静息心率(次/min)	肌酐(μmol/L)	D-二聚体(mg/L)
建模队列	177	42(23.7)	67.00(63.00，72.00)	24.43(22.79，28.12)	88.00(78.00，98.00)	62.75(52.73，75.68)	0.47(0.25，1.06)
验证队列	75	19(25.3)	69.00(64.00，73.00)	24.98(23.41，27.68)	84.00(71.00，96.00)	63.70(56.30，80.00)	0.42(0.32，0.88)
t/U/χ²值		0.07	1.19	0.05	0.91	0.75	0.06
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
组别	例数	总胆固醇(mmol/L)	甘油三酯(mmol/L)	高密度脂蛋白胆固醇(mmol/L)	低密度脂蛋白胆固醇(mmol/L)	肌钙蛋白峰值(μg/L)	BNP峰值(pg/mL)
建模队列	177	3.999±1.041	1.258±0.700	0.997±0.242	2.623±0.954	22.315(5.116，50.000)	394.350(154.908，976.525)
验证队列	75	3.796±0.987	1.376±1.105	0.944±0.226	2.431±0.941	42.177(4.339，50.000)	248.300(88.700，1123.100)
t/U/χ²值		1.40	0.99	1.61	1.44	1.34	0.15
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
组别	例数	心功能级别KillIP2级及以上[例(%)]	LVEF[M(Q₁，Q₃)，×100%]	高血压[例(%)]	糖尿病[例(%)]	吸烟[例(%)]	未PCI治疗[例(%)]
建模队列	177	57(32.2)	0.599(0.462，0.635)	80(45.2)	34(19.2)	58(32.8)	65(36.7)
验证队列	75	29(38.7)	0.615(0.475，0.645)	35(46.7)	18(24.0)	28(37.3)	33(44.0)
t/U/χ²值		0.98	0.14	0.05	0.74	0.49	1.17
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
组别	例数	未用β受体阻滞剂[例(%)]	未用他汀[例(%)]	未用双抗[例(%)]	院内新发心衰[例(%)]	院内病死率[例(%)]
建模队列	177	57(32.2)	37(20.9)	19(10.7)	18(10.2)	24(13.6)
验证队列	75	25(33.3)	15(20.0)	8(10.7)	10(13.3)	12(16.0)
t/U/χ²值		0.97	0.03	0.00	0.53	0.26
P值		<0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	女性[例(%)]	年龄(岁)	BMI(kg/m²)	静息心率(次/min)	肌酐(μmol/L)	D-二聚体(mg/L)
建模队列	177	42(23.7)	67.00(63.00，72.00)	24.43(22.79，28.12)	88.00(78.00，98.00)	62.75(52.73，75.68)	0.47(0.25，1.06)
验证队列	75	19(25.3)	69.00(64.00，73.00)	24.98(23.41，27.68)	84.00(71.00，96.00)	63.70(56.30，80.00)	0.42(0.32，0.88)
t/U/χ²值		0.07	1.19	0.05	0.91	0.75	0.06
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
组别	例数	总胆固醇(mmol/L)	甘油三酯(mmol/L)	高密度脂蛋白胆固醇(mmol/L)	低密度脂蛋白胆固醇(mmol/L)	肌钙蛋白峰值(μg/L)	BNP峰值(pg/mL)
建模队列	177	3.999±1.041	1.258±0.700	0.997±0.242	2.623±0.954	22.315(5.116，50.000)	394.350(154.908，976.525)
验证队列	75	3.796±0.987	1.376±1.105	0.944±0.226	2.431±0.941	42.177(4.339，50.000)	248.300(88.700，1123.100)
t/U/χ²值		1.40	0.99	1.61	1.44	1.34	0.15
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
组别	例数	心功能级别KillIP2级及以上[例(%)]	LVEF[M(Q₁，Q₃)，×100%]	高血压[例(%)]	糖尿病[例(%)]	吸烟[例(%)]	未PCI治疗[例(%)]
建模队列	177	57(32.2)	0.599(0.462，0.635)	80(45.2)	34(19.2)	58(32.8)	65(36.7)
验证队列	75	29(38.7)	0.615(0.475，0.645)	35(46.7)	18(24.0)	28(37.3)	33(44.0)
t/U/χ²值		0.98	0.14	0.05	0.74	0.49	1.17
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
组别	例数	未用β受体阻滞剂[例(%)]	未用他汀[例(%)]	未用双抗[例(%)]	院内新发心衰[例(%)]	院内病死率[例(%)]
建模队列	177	57(32.2)	37(20.9)	19(10.7)	18(10.2)	24(13.6)
验证队列	75	25(33.3)	15(20.0)	8(10.7)	10(13.3)	12(16.0)
t/U/χ²值		0.97	0.03	0.00	0.53	0.26
P值		<0.05	>0.05	>0.05	>0.05	>0.05

因素	单因素分析			多因素分析
因素	OR值	95%CI	P值	OR值	95%CI	P值
肌酐	1.028	1.015~1.041	<0.001	1.017	1.007~1.028	<0.05
心功能Killip 2级及以上	3.818	1.089~13.385	<0.05	1.051	0.298~3.706	>0.05
未用β受体阻滞剂	5.544	2.602~11.810	<0.001	6.399	2.206~18.567	<0.05
院内新发心衰	11.712	4.891~28.046	<0.001	22.032	6.829~71.082	<0.001
未行PCI介入术	4.769	1.364~16.680	<0.05	5.367	1.493~19.286	<0.05

因素	单因素分析			多因素分析
因素	OR值	95%CI	P值	OR值	95%CI	P值
肌酐	1.028	1.015~1.041	<0.001	1.017	1.007~1.028	<0.05
心功能Killip 2级及以上	3.818	1.089~13.385	<0.05	1.051	0.298~3.706	>0.05
未用β受体阻滞剂	5.544	2.602~11.810	<0.001	6.399	2.206~18.567	<0.05
院内新发心衰	11.712	4.891~28.046	<0.001	22.032	6.829~71.082	<0.001
未行PCI介入术	4.769	1.364~16.680	<0.05	5.367	1.493~19.286	<0.05

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