Development and Validation of Nomogram for the Prediction of Malignant Ventricular Arrhythmia Including Circulating Inflammatory Cells in Patients with Acute ST-Segment Elevation Myocardial Infarction

Abstract

Background

Malignant ventricular arrhythmia (MVA) can seriously affect the hemodynamic changes of the body. In this study, we developed and validated a nomogram to predict the in-hospital MVA risk in patients with STEMI after emergency PCI.

Methods

The multivariable logistic regression analysis included variables with a P<0.05 in the univariate logistic regression analysis and investigated the independent predictors affecting in-hospital MVA after PCI in patients with STEMI in the training cohort. The construction of a nomogram model used independent predictors to predict the risk of in-hospital MVA, and C-index, Hosmer-Lemeshow (HL) test, calibration curves, decision curve analysis (DCA), and receiver operating characteristic (ROC) were used to validate the nomogram.

Results

Killip class [OR=5.034 (95% CI: 1.596–15.809), P=0.005], CK-MB [OR=1.002 (95% CI: 1.001–1.004), P=0.022], serum potassium [OR=0.618 (95% CI: 0.406–0.918), P=0.020], NLR [OR=1.073 (95% CI: 1.034–1.115), P<0.001], and monocyte [OR=1.974 (95% CI: 1.376–2.925), P<0.001] were the independent predictors of in-hospital MVA after PCI in patients with STEMI. A nomogram including the 5 independent predictors was developed to predict the risk of in-hospital MVA. The C-index, equivalent to the area under the ROC curve (AUC), was 0.803 (95% confidence interval [CI]: 0.738–0.868) in the training cohort, and 0.801 (95% CI:0.692–0.911) in the validation cohort, showing that the nomogram had a good discrimination. The HL test (χ²=8.439, P=0.392 in the training cohort; χ²=9.730, P=0.285 in the validation cohort) revealed a good calibration. The DCA suggested an obvious clinical net benefit.

Conclusion

Killip class, CK-MB, serum potassium, NLR, and monocyte were independent factors for in-hospital MVA after PCI in patients with STEMI. The nomogram model constructed based on the above factors to predict the risk of in-hospital MVA had satisfactory discrimination, calibration, and clinical effectiveness, and was an excellent tool for early prediction of the risk of in-hospital MVA after PCI in patients with STEMI.

Keywords:

• ST-segment elevation myocardial infarction
• percutaneous coronary intervention
• nomogram model
• malignant ventricular arrhythmia
• circulating inflammatory cells

Data Sharing Statement

All data generated or analysed during this study are included in this article. Further enquiries can be directed to the corresponding author.

Ethical Approval

This retrospective study was approved by medical ethics committee of Shuyang Hospital of Traditional Chinese Medicine (No. 202303) and conducted in accordance with the Declaration of Helsinki.

Informed Consent

Data collection was performed after written informed consents were obtained from subjects.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors have no conflicts of interest to declare.

Additional information

Funding

This study was funded by the Open Project of Jiangsu Key Laboratory for the Prevention and Treatment of Elderly Diseases through the Integration of Traditional Chinese and Western Medicine (Grant Number 202231).