Objective  To analyze the influencing factors of major adverse cardiovascular events (MACE) within 6 months after primary percutaneous coronary intervention (pPCI) in patients with acute ST segment elevation myocardial infarction (STEMI), and to build a risk prediction Nomogram model.

Methods  The clinical data of 519 patients with acute STEMI who underwent pPCI admitted to The People's Hospital of Anyang City from June 2020 to December 2022 were retrospectively analyzed, and they were divided into a model group (n=346) and a validation group (n=173) according to the ratio of 2 ∶ 1. The model group patients were divided into the occurrence group and the non-occurrence group based on the occurrence of MACE within 6 months after pPCI. The influencing factors of MACE within 6 months after pPCI in acute STEMI patients were screened through logistic regression analysis, and the risk prediction Nomogram model was constructed and validated.

Results  Killip's cardiac function class III/IV, postoperative TIMI grade≤2 grade, no-reflow after surgery, N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF), fragmented QRS wave (fQRS wave) and high-sensitivity C reactive protein (hs-CRP) were the influencing factors of MACE within 6 months after pPCI in acute STEMI patients (P<0.05). The calibration curve of the model group and the validation group showed good consistency between the calibration curve and ideal curve of the Nomogram model, and the Hosmer-Lemeshow test results for both groups were χ²=2.135, P=0.977 and χ²=3.756, P=0.878. The receiver operating characteristic showed that the area under the curve of the model group and validation group patients with MACE within 6 months after pPCI by the model were 0.827 and 0.811 respectively. The decision curve analysis showed that acute STEMI patients had higher net return on predicting the risk of MACE within 6 months after pPCI based on this model.

Conclusion  Killip's cardiac function class III/IV, postoperative TIMI grade≤2 grade, no-reflow after surgery, NT-proBNP, LVEF, fQRS wave and hs-CRP are influencing factors for MACE within 6 months after pPCI in acute STEMI patients, and the risk prediction Nomogram model constructed based on them has good predictive efficiency and applicability, and it can be used to predict the prognosis of acute STEMI patients.

1.Kopparam R, Liu B, Mallidi J. Incorrect electrocardiogram lead placement in ST-segment-elevation myocardial infarction[J]. JAMA Intern Med, 2023, 183(10): 1156-1157. DOI: 10.1001/jamainternmed.2023.2254.

2.Kheifets M, Vaknin-Assa H, Greenberg G, et al. Trends in ST-elevation myocardial infarction[J]. Coron Artery Dis, 2022, 31(1): 1-8. DOI: 10.1097/MCA.0000000000001058.

3.Kulick N, Friede KA, Stouffer GA. Safety and efficacy of intracoronary thrombolytic agents during primary percutaneous coronary intervention for STEMI[J]. Expert Rev Cardiovasc Ther, 2023, 21(3): 165-175. DOI: 10.1080/14779072.2023.2184353.

4.Huang L, Zhang J, Huang Q, et al. 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[J]. BMC Cardiovasc Disord, 2023, 23(1): 198. DOI: 10.1186/s12872-023-03214-x.

5.Liu Y, Liu J, Liu L, et al. Association of systemic inflammatory response index and pan-immune-inflammation-value with long-term adverse cardiovascular events in ST-segment elevation myocardial infarction patients after primary percutaneous coronary intervention[J]. J Inflamm Res, 2023, 16(1): 3437-3454. DOI: 10.2147/JIR.S421491.

6.Shah JA, Kumar R, Solangi BA, et al. One-year major adverse cardiovascular events among same-day discharged patients after primary percutaneous coronary intervention at a tertiary care cardiac centre in Karachi, Pakistan: a prospective observational study[J]. BMJ Open, 2023, 13(4): e067971. DOI: 10.1136/bmjopen-2022-067971.

7.Akhtar Z, Aleem MA, Ghosh PK, et al. In-hospital and 30-day major adverse cardiac events in patients referred for ST-segment elevation myocardial infarction in Dhaka, Bangladesh[J]. BMC Cardiovasc Disord, 2021, 21(1): 85. DOI: 10.1186/s12872-021-01896-9.

8.中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 急性ST段抬高型心肌梗死诊断和治疗指南(2019)[J]. 中华心血管病杂志, 2019, 47(10): 766-783. [Chinese Society of Cardiology of Chinese Medical Association, Editorial Board of Chinese Journal of Cardiology. 2019 Chinese Society of Cardiology (CSC) guidelines for the diagnosis and management of patients with ST-segment elevation myocardial infarction[J]. Chinese Journal of Cardiology, 2019, 47(10): 766-783.] DOI: 10.3760/cma.j.issn.0253-3758.2019.10.003.

9.Nestelberger T, Boeddinghaus J, Wussler D, et al. Predicting major adverse events in patients with acute myocardial infarction[J]. J Am Coll Cardiol, 2019, 74(7): 842-854. DOI: 10.1016/j.jacc.2019.06.025.

10.刘松年, 荆凌华, 伍星. 微小RNA-150对急性ST段抬高型心肌梗死患者经皮冠状动脉介入术后6月内主要不良心血管事件的预测价值[J]. 中国动脉硬化杂志, 2020, 28(6): 527-532. [Liu SN, Jing LH, Wu X. Predictive value of miR-150 for major adverse cardiovascular events within 6 months after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction[J]. Chinese Journal of Arteriosclerosis, 2020, 28(6): 527-532.] DOI: 10.3969/j.issn.1007-3949.2020.06.013.

11.Zengin A, Karataş MB, Çanga Y, et al. Prognostic performance of controlling nutritional status score in patients with ST segment elevation myocardial infarction treated with primary percutaneous coronary intervention[J]. Anatol J Cardiol, 2022, 26(1): 23-28. DOI: 10.5152/AnatolJCardiol.2021.190.

12.Zhuo MF, Zhang KL, Shen XB, et al. Postoperative adverse cardiac events in acute myocardial infarction with high thrombus load and best time for stent implantation[J]. World J Clin Cases, 2022, 10(7): 2106-2114. DOI: 10.12998/wjcc.v10.i7.2106.

13.Refaat H, Tantawy A, Gamal AS, et al. Novel predictors and adverse long-term outcomes of no-reflow phenomenon in patients with acute ST elevation myocardial infarction undergoing primary percutaneous coronary intervention[J]. Indian Heart J, 2021, 73(1): 35-43. DOI: 10.1016/j.ihj.2020.12.008.

14.Qin Z, Du Y, Zhou Q, et al. NT-proBNP and major adverse cardiovascular events in patients with ST-segment elevation myocardial infarction who received primary percutaneous coronary intervention: a prospective cohort study[J]. Cardiol Res Pract, 2021, 2021: 9943668. DOI: 10.1155/2021/9943668.

15.Gavara J, Marcos-Garces V, Lopez-Lereu MP, et al. Magnetic resonance assessment of left ventricular ejection fraction at any time post-infarction for prediction of subsequent events in a large multicenter STEMI registry[J]. J Magn Reson Imaging, 2022, 56(2): 476-487. DOI: 10.1002/jmri.27789.

16.Xu Y, Yu Y, He L, et al. Predicting efficacy of combined assessment with fragmented QRS and severely depressed heart rate variability on outcome of patients with acute myocardial infarction[J]. Heart Vessels, 2022, 37(2): 239-249. DOI: 10.1007/s00380-021-01930-y.

17.Ye L, Bai HM, Jiang D, et al. Combination of eosinophil percentage and high-sensitivity C-reactive protein predicts in-hospital major adverse cardiac events in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention[J]. J Clin Lab Anal, 2020, 34(9): e23367. DOI: 10.1002/jcla.23367.

18.Zan Y, Song W, Wang Y, et al. Nomogram for predicting in-hospital mortality of nonagenarians with community-acquired pneumonia[J]. Geriatr Gerontol Int, 2022, 22(8): 635-641. DOI: 10.1111/ggi.14430.