In-hospital major adverse cardiovascular events after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction: a retrospective study under the China chest pain center (standard center) treatment system

Abstract

Background: Patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) are at high risk of major adverse cardiovascular events (MACE) despite timely treatment. This study aimed to investigate the independent predictors and their predictive value of in-hospital MACE after primary PCI in patients with acute STEMI under the China chest pain center (standard center) treatment system.

Methods: We performed a single-center, retrospective study of 151 patients with acute STEMI undergoing primary PCI. All patients were treated under the China chest pain center (standard center) treatment system. The data collected included general data, vital signs, auxiliary examination results, data related to interventional therapy, and various treatment delays. The primary endpoint was the in-hospital MACE defined as the composite of all-cause death, stroke, nonfatal recurrent myocardial infarction, new-onset heart failure, and malignant arrhythmias.

Results: In-hospital MACE occurred in 71 of 151 patients with acute STEMI undergoing primary PCI. Logistic regression analysis showed that age, cardiac troponin I (cTnI), serum creatinine (sCr), multivessel coronary artery disease, and Killip class III/IV were risk factors for in-hospital MACE, whereas estimated glomerular filtration rate (eGFR), left ventricular ejection fraction (LVEF), systolic blood pressure (SBP), diastolic blood pressure (DBP), were protective factors, with eGFR, LVEF, cTnI, SBP, and Killip class III/IV being independent predictors of in-hospital MACE. The prediction model had good discrimination with an area under the curve = 0. 778 (95%CI: 0.690-0.865). Good calibration and clinical utility were observed through the calibration and decision curves, respectively.

Conclusions: Our data suggest that eGFR, LVEF, cTnI, SBP, and Killip class III/IV independently predict in-hospital MACE after primary PCI in patients with acute STEMI, and the prediction model constructed based on the above factors could be useful for individual risk assessment and early management guidance.

Keywords: Chest pain center; Major adverse cardiovascular events; Percutaneous coronary intervention; ST-segment elevation myocardial infarction.

Fig. 1

Study population flow chart

Fig. 2

Nomogram for predicting in-hospital MACE. cTnI, cardiac troponin I; eGFR, estimated glomerular filtration rate; LVEF, left ventricular ejection fraction; SBP, systolic blood pressure

Fig. 3

ROC curve for the nomogram. AUC, area under the curve

Fig. 4

Calibration plot of the nomogram. Ideal line represents perfect prediction that nomogram-predicted probability matches actually observed probability

Fig. 5

Decision curves of the nomogram. Net benefit is plotted against various probability threshold