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Development and Validation of a Risk Score for Predicting Post-acute Myocardial Infarction Infection in Patients
Yuanhui Liu1,2,3, Litao Wang2, Yaowang Lin4
1Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Insights
This study develops a new risk score to predict post-acute myocardial infarction (post-AMI) infection in ST-segment elevation myocardial infarction (STEMI) patients after percutaneous coronary intervention (PCI). Early prediction can guide prevention strategies for this serious complication.
Area of Science:
- Cardiology
- Infectious Diseases
- Clinical Risk Prediction
Background:
- Post-acute myocardial infarction (post-AMI) infection is a serious complication in ST-segment elevation myocardial infarction (STEMI) patients treated with percutaneous coronary intervention (PCI).
- Predicting post-AMI infection is crucial for developing preventive strategies.
- Current knowledge on predicting post-AMI infection in STEMI patients undergoing PCI is limited.
Purpose of the Study:
- To develop and validate a novel clinical risk score for the early prediction of post-AMI infection in STEMI patients undergoing PCI.
- To identify key risk factors associated with post-AMI infection in this patient population.
Main Methods:
- A prospective, multi-center, observational study design.
- Development cohort (January 2010 - May 2016) and validation cohort (June 2016 - May 2018) of STEMI patients undergoing PCI.
- Stepwise logistic regression used to establish the risk score model, with primary endpoint of infection requiring antibiotics and secondary endpoints including all-cause death and MACE.
Main Results:
- The study will establish a validated risk score for predicting post-AMI infection.
- Evidence will be provided on the prognostic property, reliability, and comparative performance of the novel model.
- The model's suitability for clinical screening purposes will be assessed.
Conclusions:
- A new, simple clinical risk score will be developed and validated to predict post-AMI infection in STEMI patients post-PCI.
- This tool has the potential to improve the evaluation of post-AMI infection.
- The findings may enhance future research on infection prevention strategies in this patient group.
Abstract:
Background: Post-acute myocardial infarction (post-AMI) infection is an infrequent but important and serious complication in patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI). Predicting its occurrence is essential for future prevention. However, little is known about the prediction of post-AMI infection in such patients to date. This study aims to develop and validate a new risk score based on risk factors for early prediction of infection in STEMI patients undergoing PCI. Methods: This prospective, multi-center and observational study assesses the predictive value of risk score for post-AMI infection among a cohort of patients hospitalized due to STEMI. The STEMI patients undergoing PCI enrolled between January 1st 2010 and May 31st 2016 were served as a development cohort while those enrolled from June 1st 2016 to May 31st 2018 were served as validation cohort. The primary endpoint was post-AMI infection during hospitalization, defined as infection requiring antibiotics (reflecting the clinical influence of infection compatible with the necessity for additional treatment), and all-cause death and major adverse cardiovascular events (MACE) including all-cause death, recurrent myocardial infarction, target vessel revascularization, and stroke were considered as secondary endpoints. The risk score model based on risk factors was established using stepwise logistic regression, and will be validated in other centers and external patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). Results: This study will provide evidence on prognostic property, reliability of scoring, comparative performance, and suitability of the novel model for screening purpose in order to be recommended for clinical practice. Discussion: Our study is designed to develop and validate a clinical risk score for predicting infection in participants with STEMI who have undergone PCI. This simple tool may therefore improve evaluation of post-AMI infection and enhance future researches into the best practices to prevent or reduce infection in such patients. Clinical Trial Registration: www.chictr.org.cn, identifier: ChiCTR1900028278.
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