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A Prediction Nomogram for No-Reflow in Acute Myocardial Infarction Patients after Primary Percutaneous Coronary
Bowen Lou1,2, Kejia Kan3, Hui Liu4
1Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, 710061 Xi'an, Shaanxi, China.
Insights
A new nomogram predicts coronary no-reflow (NR) in acute myocardial infarction (AMI) patients after primary percutaneous coronary intervention (pPCI). This tool aids in risk assessment and clinical decisions to prevent impaired reperfusion.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- The coronary no-reflow (NR) phenomenon is a significant predictor of major adverse cardiac events (MACEs).
- Predicting NR is crucial for managing patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (pPCI).
Purpose of the Study:
- To develop and validate a clinical nomogram for predicting NR in AMI patients post-pPCI.
- To improve risk stratification and clinical decision-making for NR events.
Main Methods:
- Multivariable logistic regression analysis identified NR-related factors.
- A nomogram was constructed using clinical and biochemical parameters.
- Performance was assessed using discrimination and calibration metrics.
Main Results:
- The study included 3041 AMI patients; 238 (training set) and 87 (validation set) experienced NR.
- Significant differences in NT-proBNP, BASO, NEUBC, D-dimer, Hb, and RDW.CV were observed in NR patients.
- The nomogram achieved a C-index of 0.712 (training) and 0.663 (validation).
Conclusions:
- A validated nomogram for predicting NR in AMI patients after pPCI was successfully established.
- This tool can aid in NR risk assessment and clinical decision-making.
- The nomogram aims to prevent impaired reperfusion associated with NR.
Background:
The coronary no-reflow (NR) phenomenon is an independent predictor of major adverse cardiac events (MACEs). This study aimed to establish a clinical and comprehensive nomogram for predicting NR in acute myocardial infarction (AMI) patients after primary percutaneous coronary intervention (pPCI).
Methods:
The multivariable logistic regression analysis was performed to determine the NR-related factors. A nomogram was established via several clinical and biochemical factors, and the performance was evaluated via discrimination, calibration, and clinical factors.
Results:
The study consisted of 3041 AMI patients after pPCI, including 2129 patients in the training set (70%) and 912 patients in the validation set (30%). The NR event was 238 in the training set and 87 in the validation set. The level of N-terminal prohormone B-type natriuretic peptide (NT-proBNP), basophil count (BASO), neutrophil count (NEUBC), D-dimer, hemoglobin (Hb), and red blood cell distribution width (RDW.CV) in NR patients showed statistically significant differences. In the training set, the C-index was 0.712, 95% CI 0.677 to 0.748. In the validation set, the C-index was 0.663, 95% CI 0.604 to 0.722.
Conclusions:
A nomogram that may predict NR in AMI patients undergoing pPCI was established and validated. We hope this nomogram can be used for NR risk assessment and clinical decision-making and significantly prevent potentially impaired reperfusion associated with NR.
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