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Published on: January 28, 2020
Development and validation of a nomogram for major adverse cardiovascular events after chronic total occlusion
Jiaqi Du1, Lulu Yang1, Zhengyang Hao1
1Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Insights
A new nomogram helps predict major adverse cardiovascular events (MACE) after chronic total occlusion percutaneous coronary intervention (CTO-PCI) in patients with ischemic heart failure (IHF). This tool aids in early risk stratification and optimizing postoperative management for better patient outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Heart Failure Management
Background:
- Chronic total occlusion percutaneous coronary intervention (CTO-PCI) is a revascularization option for ischemic heart failure (IHF) patients.
- Prognosis after CTO-PCI in IHF patients is uncertain due to a lack of predictive tools.
Purpose of the Study:
- To develop and validate a nomogram for predicting major adverse cardiovascular events (MACE) in IHF patients undergoing CTO-PCI.
Main Methods:
- Least absolute shrinkage and selection operator regression screened 67 variables in 560 IHF patients.
- A multivariable Cox regression model constructed the nomogram, evaluated by C-index, timeROC curves, calibration curves, and decision curve analysis (DCA).
Main Results:
- Seven variables (age, LVEF, LVEDD, NT-proBNP, bending, intravascular ultrasound, beta-blockers) were identified for the nomogram.
- The nomogram demonstrated good predictive performance with a C-index of 0.715 and acceptable calibration and clinical applicability via DCA.
Conclusions:
- A simple and effective nomogram for MACE prediction after CTO-PCI in IHF patients was developed.
- This tool facilitates early risk stratification and optimization of postoperative management.
Background:
Chronic total occlusion percutaneous coronary intervention (CTO-PCI) is an available means of revascularization in patients with ischemic heart failure (IHF). However, the prognosis of IHF patients undergoing CTO-PCI remains unclear due to the lack of reliable clinical predictive tools.
Aim:
This study aimed to establish a nomogram for major adverse cardiovascular events (MACE) after CTO-PCI in IHF patients.
Methods:
Sixty-seven potential predictive variables for MACE in 560 IHF patients undergoing CTO-PCI were screened using least absolute shrinkage and selection operator regression. A nomogram was constructed based on multivariable Cox regression to visualize the risk of MACE, and then evaluation was carried out using the concordance index (C-index), time-independent receiver operating characteristic (timeROC) curves, calibration curves, and decision curve analysis (DCA).
Results:
During a median follow-up of 32.0 months, there were 208 MACE occurrences. Seven variables were selected for nomogram construction: age, left ventricular ejection fraction, left ventricular end-diastolic diameter, N-terminal precursor B-type diuretic peptide, bending, and use of intravascular ultrasound and beta-blockers. The C-index was 0.715 (0.680-0.750) and the internal validation result was 0.715 (0.676-0.748). The timeROC area under the curve at 6 months, 1 year, and 2 years was 0.750 (0.653-0.846), 0.747 (0.690-0.804), and 0.753 (0.708-0.798), respectively. The calibration curves and DCA showed the nomogram had acceptable calibration and clinical applicability.
Conclusions:
We developed a simple and efficient nomogram for MACE after CTO-PCI in IHF patients, which helps in early risk stratification and postoperative management optimization.
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