Development and validation of an AMR-based predictive model for post-PCI upper gastrointestinal bleeding in NSTEMI
Zhaokai Wang1, Shuping Yang2, Chunxue Zhou1
1Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
Insights
A new nomogram accurately predicts upper gastrointestinal bleeding (UGIB) in non-ST-segment elevation myocardial infarction (NSTEMI) patients after percutaneous coronary intervention (PCI). This tool aids in identifying high-risk individuals for timely intervention.
Area of Science:
- Cardiology
- Gastroenterology
- Medical Informatics
Background:
- Upper gastrointestinal bleeding (UGIB) is a significant complication for patients with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI).
- Predictive tools are crucial for managing UGIB risk in this vulnerable patient population.
Purpose of the Study:
- To develop and validate a predictive nomogram for UGIB occurrence within one year post-PCI in NSTEMI patients.
- To identify key independent risk factors contributing to UGIB in this cohort.
Main Methods:
- A retrospective study involving 784 NSTEMI patients post-PCI (training group) and 336 (validation group).
- Integration of classical regression and machine learning to identify independent risk factors.
- Development of a nomogram based on identified predictors and performance evaluation using AUC, calibration plots, and DCA.
Main Results:
- The nomogram incorporated six predictors: HASBLED, triglyceride glucose index, alcohol consumption, red blood cell count, proton pump inhibitor use, and angiographic microvascular resistance.
- High predictive accuracy was achieved in both training (AUC: 0.936) and validation (AUC: 0.910) groups.
- The nomogram demonstrated good calibration and clinical applicability via decision curve analysis.
Conclusions:
- A simple, effective nomogram was developed for predicting 1-year UGIB risk in NSTEMI patients post-PCI.
- Angiographic microvascular resistance emerged as a key predictor, highlighting its importance in UGIB risk assessment.
Background:
Upper gastrointestinal bleeding (UGIB) is a common complication in patients with non-ST-segment elevation myocardial infarction (NSTEMI) after percutaneous coronary intervention (PCI), and the aim of our study is to construct a nomogram for predicting the occurrence of UGIB within 1 year after PCI in NSTEMI patients.
Methods:
In this study, 784 patients with NSTEMI after PCI in the Affiliated Hospital of Xuzhou Medical University between September 1, 2017 and August 31, 2019 were included as the training group, and 336 patients from the East Affiliated Hospital of Xuzhou Medical University were included as the external validation group. Classical regression methods were combined with a machine learning model to identify the independent risk factors. These factors based on multivariate logistic regression analysis were then utilized to develop a nomogram. The performance of the nomogram was evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis (DCA).
Results:
The nomogram consisted of six independent predictors, including HASBLED, triglyceride glucose index, alcohol drinking, red blood cell count, use of proton pump inhibitor, and angiographic microvascular resistance of culprit vessel. Training and validation groups accurately predicted the occurrence of UGIB (AUC, 0.936 and 0.910). The calibration curves showed that the nomogram agreed with the actual observations and the DCA also demonstrated that the nomogram was applicable in the clinic.
Conclusion:
We developed a simple and effective nomogram for predicting the occurrence of UGIB within 1 year in NSTEMI patients after PCI based on angiographic microvascular resistance.
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