Establishment and validation of nomogram model for predicting major adverse cardiac events in patients with acute ST-segment elevation myocardial infarction based on glycosylated hemoglobin A1c to apolipoprotein A1 ratio: An observational study.

The objective of the current study is to assess the usefulness of HbA1cAp ratio in predicting in-hospital major adverse cardiac events (MACEs) among acute ST-segment elevation myocardial infarction (STEMI) patients that have undergone percutaneous coronary intervention (PCI). Further, the study aims to construct a ratio nomogram for prediction with this ratio. The training cohort comprised of 511 STEMI patients who underwent emergency PCI at the Huaibei Miners' General Hospital between January 2019 and May 2023. Simultaneously, 384 patients treated with the same strategy in First People's Hospital of Hefei formed the validation cohort during the study period. LASSO regression was used to screen predictors of nonzero coefficients, multivariate logistic regression was used to analyze the independent factors of in-hospital MACE in STEMI patients after PCI, and nomogram models and validation were established. The LASSO regression analysis demonstrated that systolic blood pressure, diastolic blood pressure, D-dimer, urea, and glycosylated hemoglobin A1c (HbA1c)/apolipoprotein A1 (ApoA1) were significant predictors with nonzero coefficients. Multivariate logistic regression analysis was further conducted to identify systolic blood pressure, D-dimer, urea, and HbA1c/ApoA1 as independent factors associated with in-hospital MACE after PCI in STEMI patients. Based on these findings, a nomogram model was developed and validated, with the C-index in the training set at 0.77 (95% CI: 0.723-0.817), and the C-index in the validation set at 0.788 (95% CI: 0.734-0.841), indicating excellent discrimination accuracy. The calibration curves and clinical decision curves also demonstrated the good performance of the nomogram models. In patients with STEMI who underwent PCI, it was noted that a higher HbA1c of the ApoA1 ratio is significantly associated with in-hospital MACE. In addition, a nomogram is constructed having considered the above-mentioned risk factors to provide predictive information on in-hospital MACE occurrence in these patients. In particular, this tool is of great value to the clinical practitioners in determination of patients with a high risk.

Zhang KP ，Guo QC ，Mu N ，Liu CH ... -  《-》

Establishment and validation of a nomogram model containing a triglyceride-glucose index and neutrophil-to-high-density lipoprotein ratio for predicting major adverse cardiac events in patients with ST-segment elevation myocardial infarction.

Xu ZC ，Pang LM ，Chen M ，Hu GQ ... -  《-》

Construction and evaluation of nomogram model for individualized prediction of risk of major adverse cardiovascular events during hospitalization after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction.

Emergency percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) helps to reduce the occurrence of major adverse cardiovascular events (MACEs) such as death, cardiogenic shock, and malignant arrhythmia, but in-hospital MACEs may still occur after emergency PCI, and their mortality is significantly increased once they occur. The aim of this study was to investigate the risk factors associated with MACE during hospitalization after PCI in STEMI patients, construct a nomogram prediction model and evaluate its effectiveness. A retrospective analysis of 466 STEMI patients admitted to our hospital from January 2018 to June 2022. According to the occurrence of MACE during hospitalization, they were divided into MACE group (n = 127) and non-MACE group (n = 339), and the clinical data of the two groups were compared; least absolute shrinkage and selection operator (LASSO) regression was used to screen out the predictors with non-zero coefficients, and multivariate Logistic regression was used to analyze STEMI Independent risk factors for in-hospital MACE in patients after emergency PCI; a nomogram model for predicting the risk of in-hospital MACE in STEMI patients after PCI was constructed based on predictive factors, and the C-index was used to evaluate the predictive performance of the prediction model; the Bootstrap method was used to repeat sampling 1,000 Internal validation was carried out for the second time, the Hosmer-Lemeshow test was used to evaluate the model fit, and the calibration curve was drawn to evaluate the calibration degree of the model. Receiver operating characteristic (ROC) curves were drawn to evaluate the efficacy of the nomogram model and thrombolysis in myocardial infarction (TIMI) score in predicting in-hospital MACE in STEMI patients after acute PCI. The results of LASSO regression showed that systolic blood pressure, diastolic blood pressure, Killip grade II-IV, urea nitrogen and left ventricular ejection fraction (LVEF), IABP, NT-ProBNP were important predictors with non-zero coefficients, and multivariate logistic regression analysis was performed to analyze that Killip grade II-IV, urea nitrogen, LVEF, and NT-ProBNP were independent factors for in-hospital MACE after PCI in STEMI patients; a nomogram model for predicting the risk of in-hospital MACE after PCI in STEMI patients was constructed with the above independent predictors, with a C-index of 0.826 (95% CI: 0.785-0.868) having a good predictive power; the results of H-L goodness of fit test showed χ2 = 1.3328, P = 0.25, the model calibration curve was close to the ideal model, and the internal validation C-index was 0.818; clinical decision analysis also showed that the nomogram model had a good clinical efficacy, especially when the threshold probability was 0.1-0.99, the nomogram model could bring clinical net benefits to patients. The nomogram model predicted a greater AUC (0.826) than the TIMI score (0.696) for in-hospital MACE after PCI in STEMI patients. Urea nitrogen, Killip class II-IV, LVEF, and NT-ProBNP are independent factors for in-hospital MACE after PCI in STEMI patients, and nomogram models constructed based on the above factors have high predictive efficacy and feasibility.

Fang C ，Chen Z ，Zhang J ，Jin X ，Yang M ... -  《Frontiers in Cardiovascular Medicine》

The relationship of glycosylated hemoglobin A1c and Apolipoprotein A‑1 ratio on short-term prognosis in STEMI patients following PCI: a retrospective study.

The ST segment elevation myocardial infarction (STEMI) patients tend to experience cardiovascular events following percutaneous coronary intervention (PCI), and the prognosis remains suboptimal. The objective of this investigation was to examine the correlation between the ratio of glycosylated hemoglobin A1c/Apolipoprotein A1 (HbA1c/ApoA-1) and the short-term prognosis in STEMI patients following PCI. This study conducted a retrospective analysis of the clinical data of 182 patients diagnosed with STEMI following PCI and admitted to our hospital between January 2022 and June 2023. The patients were categorized into two groups based on the occurrence of major adverse cardiovascular events (MACEs), and a comparative analysis of baseline characteristics was performed. The significant correlation between HbA1c/ApoA-1 with short-term MACEs in STEMI patients post-PCI were determined through univariate and multivariate logistic regression analysis. Different models and Subgroup analysis demonstrated that HbA1c/ApoA-1 was independent risk factor for MACEs in STEMI patients post-PCI and exhibited high stability. Receiver operating characteristic (ROC) curve and area under curve (AUC) value were utilized to validate the predictive value of HbA1c/ApoA-1 in forecasting outcomes among STEMI patients post-PCI, with an AUC of 0.752 (95% CI: 0.68-0.86), sensitivity of 85.7%, and specificity of 56.8%. Restricted cubic spline (RCS) was employed to evaluate the potential non-linear relationship between HbA1c/ApoA-1 levels and MACEs in STEMI patients post-PCI. Our results demonstrated high and significant correlation between HbA1c/ApoA-1 and short-term prognosis, and indicated that HbA1c/ApoA-1 was independent risk factor for MACEs in STEMI patients following PCI and possessed significant predictive value, facilitating the early identification of high-risk cohorts and the anticipation of MACEs.

Li D ，Sun Y ，Han J ，Guo C ，Xia L ，Dou J ，Jiang W ，Deng J ，Wei J ... -  《-》

Predictive value of triglyceride glucose index combined with neutrophil-to-lymphocyte ratio for major adverse cardiac events after PCI for acute ST-segment elevation myocardial infarction.

Wang L ，Wang Y ，Wang W ，Wang Z ... -  《Scientific Reports》