A nomogram risk prediction model for no-reflow after primary percutaneous coronary intervention based on rapidly accessible patient data among patients with ST-segment elevation myocardial infarction and its relationship with prognosis

Abstract

Background: No-reflow occurring after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) can increase the incidence of major adverse cardiovascular events (MACE). The present study aimed to construct a nomogram prediction model that can be quickly referred to before surgery to predict the risk for no-reflow after PCI in STEMI patients, and to further explore its prognostic utility in this patient population.

Methods: Research subjects included 443 STEMI patients who underwent primary PCI between February 2018 and February 2021. Rapidly available clinical data obtained from emergency admissions were collected. Independent risk factors for no-reflow were analyzed using a multivariate logistic regression model. Subsequently, a nomogram for no-reflow was constructed and verified using bootstrap resampling. A receiver operating characteristic (ROC) curve was plotted to evaluate the discrimination ability of the nomogram model and a calibration curve was used to assess the concentricity between the model probability curve and ideal curve. Finally, the clinical utility of the model was evaluated using decision curve analysis.

Results: The incidence of no-reflow was 18% among patients with STEMI. Killip class ≥2 on admission, pre-operative D-dimer and fibrinogen levels, and systemic immune-inflammation index (SII) were independent risk factors for no-reflow. A simple and quickly accessible prediction nomogram for no-reflow after PCI was developed. This nomogram demonstrated good discrimination, with an area under the ROC curve of 0.716. This nomogram was further validated using bootstrapping with 1,000 repetitions; the C-index of the bootstrap model was 0.706. Decision curve analysis revealed that this model demonstrated good fit and calibration and positive net benefits. Kaplan-Meier survival curve analysis revealed that patients with higher model scores were at a higher risk of MACE. Multivariate Cox regression analysis revealed that higher model score(s) was an independent predictor of MACE (hazard ratio 2.062; P = 0.004).

Conclusions: A nomogram prediction model that can be quickly referred to before surgery to predict the risk for no-reflow after PCI in STEMI patients was constructed. This novel nomogram may be useful in identifying STEMI patients at higher risk for no-reflow and may predict prognosis in this patient population.

Keywords: ST-segment elevation myocardial infarction; major adverse cardiovascular events; no-reflow; nomogram risk prediction model; percutaneous coronary intervention; prognosis.

Figure 1

Comparison of Killip class on admission, D-dimer level, fibrinogen level, and SII/100 values between groups.

Figure 2

The nomogram model for predicting the risk of no-reflow after PCI in STEMI patients.

Figure 3

The evaluation of the nomogram model. (A) Receiver operating characteristic curve for assessing the discrimination performance of the nomogram model. (B) Receiver operating characteristic curves of patients with no-reflow predicted by Killip class on admission, D-dimer, fibrinogen, SII/100 and nomogram model. (C) Calibration curve of nomogram model in predicting the risk of no-reflow. (D) The decision curve analysis of the nomogram model.

Figure 4

In-hospital and 1-year post-discharge MACE after primary PCI in patients with STEMI. (A) Comparison of MACE in hospital between groups. (B) Comparison of MACE in 1 year after discharge between groups. (C) Receiver operating characteristic curve of nomogram model for predicting the occurrence of in-hospital MACE. (D) Receiver operating characteristic curve of nomogram model for predicting the occurrence of 1-year post-discharge MACE.

Figure 5

Kaplan–Meier survival analysis. (A) The event-free survival for MACE in reflow and no-reflow group. (B) The event-free survival for MACE in low and high nomogram model scores group.