A nomogram for predicting the risk of no-reflow after primary percutaneous coronary intervention in elderly patients
Li Yang1, Hongliang Cong1, Yali Lu2
1Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.
Insights
This study developed a nomogram to predict no-reflow after percutaneous coronary intervention in elderly patients with ST-segment elevation myocardial infarction, aiding clinical decisions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Medicine
Background:
- No-reflow phenomenon is a complication of percutaneous coronary intervention (PCI).
- Predicting no-reflow is crucial for managing ST-segment elevation myocardial infarction (STEMI) in elderly patients.
- Current predictive models for no-reflow in this population require further refinement.
Purpose of the Study:
- To identify predictive factors for no-reflow post-PCI in elderly STEMI patients.
- To develop and validate a nomogram model for predicting no-reflow risk.
- To guide clinical treatment strategies for elderly STEMI patients undergoing PCI.
Main Methods:
- A cohort of 551 elderly STEMI patients undergoing direct PCI was analyzed.
- Patients were divided into training (n=386) and validation (n=165) groups.
- Logistic regression and decision curve analysis were used to develop and assess a nomogram model based on clinical, angiographic, ECG, and biochemical data.
Main Results:
- Five key predictors of no-reflow were identified: preoperative TIMI blood flow, target lesion diameter, collateral circulation, pulse pressure, and ST-segment elevation leads.
- The nomogram demonstrated good discrimination and calibration, with AUCs of 0.71 (training), 0.64 (validation), and 0.69 (entire cohort).
- Decision curve analysis confirmed the clinical utility of the developed nomogram.
Conclusions:
- A validated nomogram accurately predicts the risk of no-reflow after primary PCI in elderly STEMI patients.
- The nomogram provides a valuable tool for clinical decision-making in this patient group.
- Further research may refine the nomogram for improved patient outcomes.
Background:
The purpose of this study was to screen the predictive factors of no-reflow after a percutaneous coronary intervention (PCI) in elderly patients with ST-segment elevation myocardial infarction (STEMI), and to construct a nomogram model, to guide clinical treatment.
Methods:
A total of 551 elderly STEMI patients (age >65) underwent direct PCI were randomly classified into training group (n=386, 70%) and validation group (n=165, 30%). All patients in the two groups were divided into a no-reflow group and a normal blood flow group according to whether there was a no-reflow phenomenon. Univariable and multivariable logistic regression analysis was used to analyze the relevant data, including demographic characteristics, clinical characteristics, coronary angiography results, electrocardiogram (ECG) results, and biochemical indicators. Then, a nomogram model was constructed on the screened risk factors. The performance of the nomogram was evaluated in terms of discrimination and calibration. The nomogram was further confirmed in the internal validation group. Additionally, decision curve analysis (DCA) was applied to assess the clinical usefulness of the nomogram.
Results:
Five remarkable risk factors were determined: preoperative TIMI blood flow, the diameter of the target lesion, collateral circulation, pulse pressure, and the number of leads for ST-segment elevation. The nomogram involving these five risk factors showed full calibration and discrimination in the training group, with an AUC of 0.71 (95% CI: 0.66-0.77). It was confirmed in the validation group, and the entire cohort and the AUC were 0.64 (95% CI: 0.56-0.73) and 0.69 (95% CI: 0.65-0.74), respectively. Whether in the training group or the verification group, the calibration curve for the probability of no-reflow phenomenon all showed considerable consistency between prediction by nomogram and actual observation. The decision curve revealed a specific role in our nomogram in clinical practice.
Conclusions:
We set up a nomogram that showed absolute accuracy for the prediction of the risk of no-reflow after primary PCI in elderly STEMI patients.
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