Influencing factors of all-cause death among patients with acute myocardial infarction complicated with renal insufficiency by nomogram
10.3760/cma.j.cn112434-20211216-00405
- VernacularTitle:列线图预测急性心肌梗死合并肾功能不全患者全因死亡的影响因素
- Author:
Jianbin LI
1
;
Xiaofeng HAN
;
Fengying HU
;
Jing LIU
;
Rong LI
;
Xi GUO
Author Information
1. 北京市心肺血管病研究所 首都医科大学附属北京安贞医院介入诊疗科,北京 100029
- Keywords:
Acute myocardial infarction;
Renal insufficiency;
All-cause death;
Nomogram
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2022;38(11):665-672
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the influencing factors of all-cause death in patients with acute myocardial infarction (AMI) and renal insufficiency(RI), and establish a clinical prediction tool.Methods:Collected 727 patients who were hospitalized in Beijing Anzhen Hospital from January 1st 2014 to April 31th 2019, and diagnosed as AMI with RI. Recorded the patients' baseline characteristics, past medical history, current complications, laboratory and auxiliary examination results, treatment methods (included target vessel reconstruction methods, medications, etc.), and follow-up patients for all-cause deaths. Firstly, multivariate Cox regression analysis was used to construct the model in the training set(485 cases). Secondly, the receiver operating characteristic curve ( ROC), calibration curve and clinical decision curve analysis (DCA) were drawn in the validation set(242 cases) to further verify the effect of the prediction model. Finally, a nomogram was developed based on the verified risk factors. Results:Multivariate Cox regression analysis found that there were nine predictors for the prognosis of all-cause death in patients with AMI & RI, the dangerous factors included women, comorbidities, high direct bilirubin, cardiogenic shock, respiratory failure, co-infection and hemofiltration; the protective factors included PCI and taking aspirin. Model evaluation results showed that the AUC of the validation set was 0.82; the calibration line was close to the ideal calibration line, and the slope≈1, the intercept≈0, and the fitting effect was good. Clinical decision-making when the all-cause mortality rate was 35%, the net benefit of active intervention patients based on the Cox model was 38%. A visual nomogram model was developed based on the prognostic risk factors that have been evaluated and predicted to be good. Conclusion:Women, with a history of comorbidities, direct high bilirubin, combined with cardiogenic shock, combined with respiratory failure, combined infection, hemofiltration, PCI and taking aspirin, these nine factors will affect all causes of AMI & RI. For the probability of death, the model developed in this research has high accuracy.