Prediction Score Project for the Incidence of Cerebrovascular Events in Patients With Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Abstract BackgroundWe sought to develop and validate a novel marker-based risk score to improve stroke prognostication in patients with myocardial infarction (MI) undergoing primary percutaneous coronary intervention (PCI).MethodsA retrospective study was conducted and internally validated a new biomarker-based risk score for the incidence of stroke in 4103 patients with MI undergoing primary PCI who were randomized into a derivation and a validation cohort. Predictive values of markers and clinical variables were evaluated using Cox regression models and least absolute shrinkage and selection operator regression. The most important variables were included in the score, with weight proportional to the model coefficients.ResultsSignificant predictors of the incidence of cerebrovascular events were age, history of atrial fibrillation, history of hypertension, Killip class, blood pressure group, target lesion involving branches, percutaneous transluminal coronary angioplasty, and thrombus aspiration. The models had good calibration and discrimination in derivation and internal validation. The areas under the curve (AUC) of the receiver operating characteristic (ROC) curve analysis for predicting cerebrovascular events were 0.773 and 0.766 for the derivation and validation cohorts, respectively, at 5-year follow-up. Survival ROC curves exported the best cut-off values and divided them into low-risk and high-risk groups using the R language. We conducted Kaplan–Meier survival analysis for the two groups. Both groups displayed significant difference in the derivation and validation cohorts (P=0.00003 and P=0.009, respectively). We compared the new prediction model to the CHADS-VASc score; the AUCs were 0.773 and 0.754, respectively.ConclusionThe prediction model was internally validated and calibrated in large cohorts of patients with MI receiving primary PCI therapy. This risk score incorporates allows re-evaluation of the risk of cerebrovascular events after undergoing primary PCI.