scholarly journals Development and External Validation of a Diagnostic Model for in-Hospital Mortality in Patient with Acute ST Elevation Myocardial Infarction

2020 ◽  
Author(s):  
Yong Li
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
External Validation ◽  
Hospitalized Patients ◽  
St Elevation Myocardial Infarction ◽  
University Hospital ◽  
Validation Dataset ◽  
Diagnostic Model ◽  
Acute Stemi ◽  
St Elevation

AbstractObjectiveTo develop and externally validate a diagnostic model of in-hospital mortality in the population of unselected real-world patients with acute ST elevation myocardial infarction (STEMI).DesignMultivariable logistic regression of a cohort of hospitalized patients with acute STEMI.SettingEmergency department ward of a university hospital.ParticipantsDiagnostic model development: Totally 2183 hospitalized patients with acute STEMI from January 2002 to December 2011. External validation: Totally 7485 hospitalized patients with acute STEMI from January 2012 to August 2019.OutcomesIn-hospital mortality.ResultsTotally 61 (2.8%) patient died in the development dataset and 127(1.7%) patient died in the validation dataset. The strongest predictors of in-hospital mortality were age and Killip classification. We developed a diagnostic model of in-hospital mortality. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.9126+0.0166, 95% confidence ±interval(CI)= 0.88015 ~ 0.94504 in the development set. We constructed a nomograms using the development database based on age and Killip classification. The AUC was 0.9305+0.0113,95% CI= 0.90827 ~ 0.95264 in the validation set. Discrimination, calibration, and decision curve analysis were satisfactory.ConclusionsWe developed and externally validated a strong diagnostic model of in-hospital mortality in patient with acute STEMI.We registered this study with WHO International Clinical Trials Registry Platform (ICTRP) (registration number: ChiCTR1900027129; registered date: 1 November 2019). http://www.chictr.org.cn/edit.aspx?pid=44888&htm=4.

Development and External Validation of Diagnostic Model for in-Hospital Mortality in Patient with Acute ST Elevation Myocardial Infarction: Algorithm Development and Validation (Preprint)

2020 ◽  
Author(s):  
Yong Li
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
External Validation ◽  
Hospitalized Patients ◽  
Diagnostic Model ◽  
Validation Data ◽  
Data Set ◽  
Acute Stemi ◽  
Development Data ◽  
St Elevation

BACKGROUND Coronary heart disease, including ST elevation myocardial infarction(STEMI), was still the leading cause of mortality. OBJECTIVE The objective of our study was to develop and externally validate a diagnostic model of in-hospital mortality in the patients with acute STEMI . METHODS Design: Multivariable logistic regression of a cohort of hospitalized patients with acute STEMI. Setting: Emergency department ward of a university hospital. Participants: Diagnostic model development: A total of 2,183 hospitalized patients with acute STEMI from January 2002 to December 2011.External validation: A total of 7,485 hospitalized patients with acute STEMI from January 2012 to August 2019. Outcomes: In-hospital mortality. All cause in-hospital mortality was defined as cardiac or non-cardiac death during hospitalization. We used logistic regression analysis to analyze the risk factors of in-hospital mortality in the development data set. We developed a diagnostic model of in-hospital mortality and constructed a nomogram.We assessed the predictive performance of the diagnostic model in the validation data sets by examining measures of discrimination, calibration, and decision curve analysis (DCA). RESULTS In-hospital mortality occurred in 61out of 2,183 participants (2.8%) in the development data set. The strongest predictors of in-hospital mortality were age and Killip classification. We developed a diagnostic model of in-hospital mortality .The area under the receiver operating characteristic (ROC) curve (AUC) was .9126±.0166, 95% confidence interval(CI)= .88015 ~ .94504 in the development set .We constructed a nomogram based on age and Killip classification. In-hospital mortality occurred in 127 out of 7,485 participants(1.7%) in the validation data set. The AUC was .9305±.0113, 95% CI= .90827 ~ .95264 in the validation set . Discrimination, calibration ,and DCA were satisfactory. Date of approved by ethic committee:25 October 2019. Date of data collection start: 6 November 2019. Numbers recruited as of submission of the manuscript:9,668. CONCLUSIONS Conclusions: We developed and externally validated a diagnostic model of in-hospital mortality in patient with acute STEMI . CLINICALTRIAL We registered this study with WHO International Clinical Trials Registry Platform (ICTRP) (registration number: ChiCTR1900027129; registered date: 1 November 2019). http://www.chictr.org.cn/edit.aspx?pid=44888&htm=4.

scholarly journals A Study of Clinical Profile and Complications In Patients with ST-Elevation Myocardial Infarction Attending In College of Medical Sciences Teaching Hospital, Bharatpur (Chitwan), Nepal.

2021 ◽  
Vol 18 (1) ◽  
pp. 33-37
Author(s):  
Pradeep Thapa ◽  
Prakash Aryal ◽  
Rajani Baniya
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Chest Pain ◽  
Hospital Mortality ◽  
Teaching Hospital ◽  
Clinical Profile ◽  
St Elevation Myocardial Infarction ◽  
Medical Sciences ◽  
Acute Stemi ◽  
St Elevation

Background and Aims: ST-Elevation Myocardial Infarction (STEMI) is a leading cause of morbidity and mortality. This study aims to summarize the clinical profile and complications of patients with STEMI in a teaching hospital. Methods: This was a prospective hospital based descriptive and observational study conducted at College of Medical Sciences Teaching Hospital (CoMSTH), Bharatpur from January 2017 to July 2018 in 110 patients with a diagnosis of acute STEMI. Results: Out of 110 patients the mean age of presentation was 59.31 years and 64.5% were male. Typical chest pain (90%) was the most common presenting symptom and 45.5% patients presented within six hours of chest pain. Most common traditional risk factors were hypertension and smoking which were present in 44 (40%) cases, followed by diabetes in 33 (30%), dyslipidemia in 22 (20%). Majority of patients (49.1%) were in killips class I, and only 9 (8.2%) patients were in cardiogenic shock (killips class IV). Inferior wall was the most common in 30% patients followed by anteroseptal wall MI (23.6%), anterior wall MI (11.8%) and combined (anterior and inferior) in 10%. Revascularization with primary Percutaneous Coronary Intervention (PCI) was done in 46 (41.8%) patients, thrombolysis was done in 41 (37.3%) patients. Arrhythmias (39.1%) followed by heart failure (24.5%) were the common complications. The overall in-hospital mortality was 16 (14.5%). Conclusions: Patients with acute STEMI at College of Medical Sciences Teaching Hospital (CoMSTH) were predominantly male with hypertension and smoking as the commonest risk factors. Arrhythmias were the most common complications and in-hospital mortality rate was 14.5%.

scholarly journals Development and External Validation of a Diagnostic Model for Coronary Microvascular Obstruction

2020 ◽  
Author(s):  
Yong Li ◽  
Shuzheng Lyu
Keyword(s):  
Microvascular Obstruction ◽  
Characteristic Curve ◽  
External Validation ◽  
Model Development ◽  
University Hospital ◽  
Validation Dataset ◽  
Diagnostic Model ◽  
Total Occlusion ◽  
St Segment Elevation ◽  
Acute Stemi

AbstractBackgroundPrevention of coronary microvascular obstruction /no-reflow phenomenon(CMVO/NR) is a crucial step in improving prognosis of patients with acute ST segment elevation myocardial infarction (STEMI)during primary percutaneous coronary intervention (PPCI). We wanted to develop and externally validate a diagnostic model of CMVO/NR in patients with acute STEMI underwent PPCI.MethodsDesign: Multivariable logistic regression of a cohort of acute STEMI patients. Setting: Emergency department ward of a university hospital. Participants: Diagnostic model development: Totally 1232 acute STEMI patients who were consecutively treated with PPCI from November 2007 to December 2013. External validation: Totally 1301 acute STEMI patients who were treated with PPCI from January 2014 to June 2018. Outcomes: CMVO/NR during PPCI.Results147(11.9%)patients presented CMVO/NR in the development dataset and 120(9.2%) patients presented CMVO/NR in the validation dataset. The strongest predictors of CMVO/NR were age, periprocedural bradycardia, using thrombus aspiration devices during procedure and total occlusion of culprit vessel. We developed a diagnostic model of CMVO/NR.The area under the receiver operating characteristic curve (AUC) was 0.6833 in the development set.We constructed a nomogram using the development database.The AUC was 0.6547 in the validation set. Discrimination, calibration, and decision curve analysis were satisfactory.ConclusionsWe developed and externally validated a diagnostic model of CMVO/NR during PPCI.We registered this study with WHO International Clinical Trials Registry Platform on 16 May 2019. Registration number: ChiCTR1900023213. http://www.chictr.org.cn/edit.aspx?pid=39057&htm=4.

In-hospital outcomes and prevalence of comorbidities in patients with ST-elevation myocardial infarction with and without infective endocarditis: insight from the National Inpatient Sample (2013–2014)

2020 ◽  
pp. jim-2020-001519
Author(s):  
Michael Albosta ◽  
Shakeel M Jamal ◽  
Asim Kichloo ◽  
Farah Wani ◽  
Beth Bailey ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Respiratory Failure ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Valve Replacement ◽  
Hospitalized Patients ◽  
St Elevation Myocardial Infarction ◽  
National Inpatient Sample ◽  
St Elevation

In patients with infective endocarditis (IE), ST-elevation myocardial infarction (STEMI) is an uncommon phenomenon. Due to limited data, we intend to evaluate the clinical outcomes in hospitalized patients with STEMI with and without underlying IE. Mortality and morbidity are exponentially worse in STEMI with concomitant IE when compared with without IE. Patients with primary diagnosis of STEMI with and without IE were identified by querying the Healthcare Cost and Utilization Project database of the National Inpatient Sample for the years 2013 and 2014 based on International Classification of Diseases, Ninth Revision codes. During 2013 and 2014, a total of 117,386 patients were admitted with the principle diagnosis of STEMI, out of whom 305 had comorbid IE. There was a significantly increased in-hospital mortality (27.5% vs 10.8%), length of stay (LOS) (14 days vs 5 days), acute kidney injury (AKI; 44.9% vs 18.7%), stroke (23.6% vs 3%), aortic valve replacement (9.5% vs 0.3%), mitral valve replacement (0.2%–5.2%), sepsis (50% vs 6%) and acute respiratory failure (36.7% vs 16.7%) in patients with STEMI with IE when compared with patients with STEMI and without comorbid IE. STEMI without IE had a higher number of angiographies (58.7% vs 25.9%) and percutaneous coronary interventions (50.7% vs 14.4%) during the hospital course when compared with STEMI with IE. In conclusions, hospitalized patients with STEMI with a concurrent diagnosis of IE are at higher risk of in-hospital mortality, increased LOS, AKI, stroke, valve replacements, and acute respiratory failure.

scholarly journals Development and External Validation of a Diagnostic Model for Intra-Procedural Hypotension during Primary Percutaneous Coronary Intervention

2020 ◽  
Author(s):  
Yong Li
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
External Validation ◽  
Model Development ◽  
Coronary Intervention ◽  
University Hospital ◽  
Validation Dataset ◽  
Diagnostic Model ◽  
Acute Stemi ◽  
Percutaneous Coronary

AbstractBackgroundIntra-procedural hypotension weaken the benefit of primary percutaneous coronary intervention (PPCI) and worsens the prognosis of acute ST elevation myocardial infarction (STEMI) patients.ObjectivesTo develop and externally validate a diagnostic model of intra-procedural hypotension.MethodsDesign:Multivariable logistic regression of a cohort of acute STEMI patients. Setting: Emergency department ward of a university hospital. Participants: Diagnostic model development: Totally 1239 acute STEMI patients who were consecutively treated with PPCI from November 2007 to December 2013. External validation: Totally 1294 acute STEMI patients who were treated with PPCI from January 2014 to June 2018. Outcomes: Intra-procedural hypotension. Intra-procedural hypotension was defined as pre-procedural systolic blood pressure (SBP) was > 90mmHg, intra-procedural SBP less than or equal to 90 mmHg persistent or transient.ResultsTotally 121(9.8%) patients presented intra-procedural hypotension in the development dataset; 123 (9.5%) patients presented intra-procedural hypotension in the validation dataset. The strongest predictors of intra-procedural hypotension were no-reflow, the culprit vessel was not left anterior descending, complete occlusion of culprit vessel, using thrombus aspiration devices during operation, and without history of diabetes. We developed a diagnostic model of intra-procedural hypotension. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.685 ± 0.022, 95% CI = 0.641 ~ 0.729 in the development set. We constructed a nomogram using the development database based on predictors of intra-procedural hypotension. The AUC was 0.718 ±0.022, 95% CI = 0.674 ~ 0.761 in the validation set. Discrimination, calibration, and decision curve analysis were satisfactory.ConclusionsWe developed and externally validated a diagnostic model of intra-procedural hypotension during PPCI. We can use the formula or nomogram to predict intra-procedural hypotension.This study was registered with WHO International Clinical Trials Registry Platform (ICTRP) on 6 September 2019 (registration number:ChiCTR1900025706). http://www.chictr.org.cn/edit.aspx?pid=42913&htm=4.

scholarly journals Development and external validation of a diagnostic model for in-hospital bleeding in patients with acute ST elevation myocardial infarction

2020 ◽  
Author(s):  
Yong Li
Keyword(s):  
Myocardial Infarction ◽  
External Validation ◽  
Hospitalized Patients ◽  
Bleeding Complications ◽  
Diagnostic Model ◽  
Validation Data ◽  
Data Set ◽  
Acute Stemi ◽  
Increased Risk ◽  
Medical University

AbstractBackgroundBleeding complications in patients with acute ST segment elevation myocardial infarction (STEMI) are associated with an increased risk of subsequent adverse consequences. We want to develop and externally validate a diagnostic model of in-hospital bleeding in the population of unselected real-world patients with acute STEMI.MethodsDesign: Multivariable logistic regression of a cohort for hospitalized patients with acute STEMI. Setting: Emergency department ward of a university hospital. Participants: Diagnostic model development: Totally 4262 hospitalized patients with acute STEMI from January 2002 to December 2013 in Beijing Anzhen Hospital, Capital Medical University. External validation: Totally 6015 hospitalized patients with acute STEMI from January 2014 to August 2019 in Beijing Anzhen Hospital, Capital Medical University. Outcomes: All-cause in-hospital bleeding not related to coronary artery bypass graft surgery or catheterization.ResultsIn-hospital bleeding occurred in 2.6% (112/4262) of patients in the development data set (117/6015) of patients in the validation data set. The strongest predictors of in-hospital bleeding were advanced age and high Killip classification. We developed a diagnostic model of in-hospital bleeding. The area under the receiver operating characteristic ROC curve (AUC) was 0.777±0.021, 95% confidence interval(CI) = 0.73576 ~ 0.81823. We constructed a nomograms using the development database based on age, and Killip classification. The AUC was 0.7234±0.0252,95% CI = 0.67392 ~ 0.77289 in the validation data set. Discrimination, calibration, and decision curve analysis were satisfactory.ConclusionsWe developed and externally validated a moderate diagnostic model of in-hospital bleeding in patients with acute STEMI.We registered this study with WHO International Clinical Trials Registry Platform (ICTRP) (registration number: ChiCTR1900027578; registered date: 19 Novmober 2019). http://www.chictr.org.cn/edit.aspx?pid=45926&htm=4.

scholarly journals Cardiogenic shock and radial access in patients with an acute ST elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Zahn ◽  
M Hochadel ◽  
B Schumacher ◽  
M Pauschinger ◽  
C Stellbrink ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
St Elevation Myocardial Infarction ◽  
Strong Variation ◽  
Access Site ◽  
Femoral Access ◽  
Radial Access ◽  
St Elevation ◽  
The Difference

Abstract Background Cardiogenic shock (CS) in patients (pts) with acute ST elevation myocardial infarction (STEMI) is the strongest predictor of hospital mortality. Radial in contrast to femoral access in STEMI pts might be associated with a lower mortality. However, little is known on radial access in CS pts. Methods We retrospectively analysed all STEMI pts between 2009 and 2015 who sufferend from CS and who were included into the ALKK PCI registry. Pts treated via a radial access were compared to those treated via a femoral access. Results Between 2009 and 2015 23796 STEMI pts were included in the registry. 1763 (7.4%) of pts were in CS. The proportion of radial access was 6.6%: in 2009 4.0% and in 2015 19.6%, p for trend <0.0001 with a strong variation between the participating centres (0% to 37%). Conclusions Radial access was only used in 6.6% of STEMI pts presenting in CS. However, a significant increase in the use of radial access was observed over time (2009: 4%, 2015 19.6%, p<0.001), with a great variance in its use between the participating hospitals. Despite similar pt characteristics the difference in hospital mortality according to access site has to be interpretated with caution. Funding Acknowledgement Type of funding source: None

scholarly journals Circulating Levels of Dephosphorylated-Uncarboxylated Matrix Gla Protein in Patients with Acute Coronary Syndrome

Molecules ◽  
2021 ◽  
Vol 26 (4) ◽  
pp. 1108
Author(s):  
Admira Bilalic ◽  
Tina Ticinovic Kurir ◽  
Marko Kumric ◽  
Josip A. Borovac ◽  
Andrija Matetic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
High Risk ◽  
Hospital Mortality ◽  
Vascular Calcification ◽  
Matrix Gla Protein ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
St Elevation

Vascular calcification contributes to the pathogenesis of coronary artery disease while matrix Gla protein (MGP) was recently identified as a potent inhibitor of vascular calcification. MGP fractions, such as dephosphorylated-uncarboxylated MGP (dp-ucMGP), lack post-translational modifications and are less efficient in vascular calcification inhibition. We sought to compare dp-ucMGP levels between patients with acute coronary syndrome (ACS), stratified by ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) status. Physical examination and clinical data, along with plasma dp-ucMGP levels, were obtained from 90 consecutive ACS patients. We observed that levels of dp-ucMGP were significantly higher in patients with NSTEMI compared to STEMI patients (1063.4 ± 518.6 vs. 742.7 ± 166.6 pmol/L, p < 0.001). NSTEMI status and positive family history of cardiovascular diseases were only independent predictors of the highest tertile of dp-ucMGP levels. Among those with NSTEMI, patients at a high risk of in-hospital mortality (adjudicated by GRACE score) had significantly higher levels of dp-ucMGP compared to non-high-risk patients (1417.8 ± 956.8 vs. 984.6 ± 335.0 pmol/L, p = 0.030). Altogether, our findings suggest that higher dp-ucMGP levels likely reflect higher calcification burden in ACS patients and might aid in the identification of NSTEMI patients at increased risk of in-hospital mortality. Furthermore, observed dp-ucMGP levels might reflect differences in atherosclerotic plaque pathobiology between patients with STEMI and NSTEMI.

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