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. 2022 Apr 15:9:845307.
doi: 10.3389/fcvm.2022.845307. eCollection 2022.

Risk Estimation for Infection in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention: Development and Validation of a Predictive Score

Yuanhui Liu  1   2 , Litao Wang  1   3 , Pengyuan Chen  4 , Yining Dai  1   2 , Yaowang Lin  5 , Wei Chen  6 , Zhengrong Xu  7 , Lihuan Zeng  1   2 , Hualin Fan  1   2 , Ling Xue  1   2 , Simin Liu  8 , Jiyan Chen  1   2 , Ning Tan  1   2   9 , Pengcheng He  1   2   9 , Chongyang Duan  10
Affiliations

Risk Estimation for Infection in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention: Development and Validation of a Predictive Score

Yuanhui Liu et al. Front Cardiovasc Med. .

Abstract

Background: Infection during hospitalization is a serious complication among patients who suffered from acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI); however, there are no suitable and accurate means to assess risk. This study aimed to develop and validate a simple scoring system to predict post-AMI infection in such patients.

Methods: All patients with ST-segment elevation myocardial infarction (STEMI) undergoing PCI consecutively enrolled from January 2010 to May 2016 were served as derivation cohort, and those from June 2016 to May 2018 as validation cohort, respectively. The primary endpoint was post-AMI infection during hospitalization, and all-cause death and major adverse cardiovascular events (MACE) were considered as secondary endpoints. The simplified risk model was established using logistic regression. The area under the receiver operating curve and calibration of predicted and observed infection risk were calculated.

Results: A 24-point risk score was developed, with infection risk ranging from 0.7 to 99.6% for patients with the lowest and highest score. Seven variables including age, Killip classification, insulin use, white blood cell count, serum albumin, diuretic use, and transfemoral approach were included. This model achieved the same high discrimination in the development and validation cohort (C-statistic:0.851) and revealed adequate calibration in both datasets. The incidences of post-AMI infection increased steadily across risk score groups in both development (1.3, 5.1, 26.3, and 69.1%; P < 0.001) and validation (1.8, 5.9, 27.2, and 79.2%; P < 0.001) cohort. Moreover, the risk score demonstrated good performance for infection, in-hospital all-cause death, and MACE among these patients, as well as in patients with the non-ST-elevation acute coronary syndrome.

Conclusion: This present risk score established a simple bedside tool to estimate the risk of developing infection and other in-hospital outcomes in patients with STEMI undergoing PCI. Clinicians can use this risk score to evaluate the infection risk and subsequently make evidence-based decisions.

Keywords: ST-elevation myocardial infarction; infection; observational study; percutaneous coronary intervention; risk score.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram of the included population.
FIGURE 2
FIGURE 2
Receiver operating characteristic curve and calibration plot of the risk score for post-acute myocardial infarction (AMI) infection.
FIGURE 3
FIGURE 3
The observed and predicted incidences of post-AMI infection in the development and validation cohorts based on different risk scores.
See this image and copyright information in PMC

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