Nomogram Predicting In-Hospital Mortality in Patients with Myocardial Infarction Treated with Primary Coronary...

Area of Science:

• Cardiology
• Medical Informatics
• Clinical Risk Prediction

Background:

• Existing risk assessment tools for in-hospital death in myocardial infarction (MI) primarily rely on angiographic, electrocardiographic, and laboratory data.
• There is a lack of risk systems incorporating contemporary angiographic data and logistic variables.
• This study addresses the need for a risk assessment system based on modern predictors for MI patients undergoing primary percutaneous coronary intervention (PCI).

Purpose of the Study:

• To develop and validate a novel risk assessment system for in-hospital mortality in patients with myocardial infarction (MI).
• To identify modern angiographic and logistic predictors of in-hospital death in MI patients treated with primary PCI.
• To create a clinical nomogram for predicting in-hospital mortality after primary PCI across the full spectrum of MI.

Main Methods:

• A multivariate logistic regression model was developed using a subgroup of 603 patients from a single-center MI registry treated with primary PCI (February 2019 - January 2020).
• The patient cohort was divided into a 60% derivation set for model development and a 40% validation set for internal validation.
• The model predicted in-hospital mortality based on logistic and angiographic variables.

Main Results:

• Coronary angiography findings and suboptimal post-PCI flow were significant predictors of in-hospital mortality.
• The timing of PCI and the patient's presentation mode were also identified as contributors to in-hospital mortality.
• The model demonstrated good discrimination (C-statistic = 0.848) and calibration in the derivation set, with satisfactory discrimination (C-statistic = 0.6438) in the validation set.

Conclusions:

• A novel clinical nomogram integrating four logistic and angiographic variables has been developed and validated.
• This tool effectively predicts in-hospital mortality risk in a broad range of myocardial infarction patients undergoing primary PCI.
• The nomogram provides a valuable method for assessing mortality risk in contemporary MI management.