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Published on: June 12, 2021
A Novel ApoB/ApoA1 Ratio-Integrated Nomogram to Predict Cardiogenic Shock After Acute Myocardial Infarction
Xinying Zhang1, Liwen Chen1, Nailiang Tian2
1Department of Emergency, Nanjing First Hospital, Nanjing Medical University, 210006 Nanjing, Jiangsu, China.
Insights
A new nomogram accurately predicts cardiogenic shock risk in acute myocardial infarction patients using key biomarkers like the apolipoprotein B/A1 ratio. This tool aids early identification of high-risk individuals for improved outcomes.
Area of Science:
- Cardiology
- Biomarkers
- Risk Stratification
Background:
- Cardiogenic shock (CS) following acute myocardial infarction (AMI) has a high mortality rate (>40%).
- Current risk-stratification tools for CS lack precision.
- Novel biomarkers, like the apolipoprotein B/A1 (ApoB/A1) ratio, show promise in predicting cardiovascular disease risk.
Purpose of the Study:
- To develop and validate a precise predictive nomogram for cardiogenic shock risk in acute myocardial infarction patients.
- To assess the added prognostic value of the apolipoprotein B/A1 ratio in cardiogenic shock risk stratification.
Main Methods:
- Retrospective cohort study of patients admitted with acute coronary syndrome.
- Development of a predictive nomogram using least absolute shrinkage and selection operator (LASSO) regression.
- Inclusion of eight independent predictors: heart rate, respiratory rate, systolic blood pressure, white blood cell count, D-dimer, albumin, glucose, and the ApoB/A1 ratio.
Main Results:
- The developed nomogram demonstrated strong discriminatory performance with an area under the curve (AUC) of 0.839 (training) and 0.832 (validation).
- Calibration and decision curve analyses confirmed the nomogram's clinical utility.
- The apolipoprotein B/A1 ratio was identified as an independent predictor, adding significant value.
Conclusions:
- The novel nomogram offers a practical tool for early and accurate risk stratification of cardiogenic shock in AMI patients.
- Incorporation of the ApoB/A1 ratio enhances prognostic capability beyond traditional markers.
- This tool may guide timely interventions and improve patient outcomes in high-risk AMI populations.
Background:
Despite advances in treatment, cardiogenic shock (CS) remains a highly lethal complication of acute myocardial infarction (AMI), with mortality rates still exceeding 40%. Early identification of high-risk patients is critical, yet existing risk-stratification tools lack precision, particularly in integrating novel biomarkers such as the apolipoprotein B/A1 (ApoB/ApoA1) ratio, which reflects atherogenic lipid imbalance and has shown predictive value in cardiovascular disease.
Methods:
This retrospective cohort study included patients admitted with an acute coronary syndrome between December 2022 and July 2025.
Results:
Using the least absolute shrinkage and selection operator (LASSO) regression, a predictive nomogram was developed incorporating eight independent predictors: heart rate, respiratory rate, systolic blood pressure, white blood cell count, D-dimer, albumin, glucose, and the ApoB/ApoA1 ratio. The model demonstrated strong discriminatory performance, with an area under the curve (AUC) of 0.839 in the training cohort and 0.832 in the validation cohort. Calibration and decision curve analyses further supported the clinical utility of the nomogram.
Conclusions:
The inclusion of the ApoB/ApoA1 ratio, a marker associated with endothelial dysfunction, plaque instability, and metabolic dysregulation, adds significant prognostic value beyond conventional parameters. This nomogram provides a practical tool for early risk stratification, potentially guiding timely interventions and improving outcomes in high-risk patients with AMI.
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