Abstract
BackgroundPostoperative risk stratification is challenging in patients with ST-segment elevation myocardial infarction (STEMI) who undergo percutaneous coronary intervention. This study aimed to characterize the metabolic fingerprints of patients with STEMI with different inhospital outcomes in the early stage of morbidity and to integrate the clinical baseline characteristics to develop a prognostic prediction model.MethodsPlasma samples were collected retrospectively from two propensity score-matched STEMI cohorts from May 6, 2020 to April 20, 2021. Cohort 1 consisted of 48 survivors and 48 non-survivors. Cohort 2 included 48 patients with unstable angina pectoris, 48 patients with STEMI, and 48 age- and sex-matched healthy controls. Metabolic profiling was generated based on ultra-performance liquid chromatography and a mass spectrometry platform. The comprehensive metabolomic data analysis was performed using MetaboAnalyst version 5.0. The hub metabolite biomarkers integrated into the model were tested using multivariate linear support vector machine (SVM) algorithms and a generalized estimating equation (GEE) model. Their predictive capabilities were evaluated using areas under the curve (AUCs) of receiver operating characteristic curves.ResultsMetabonomic analysis from the two cohorts showed that patients with STEMI with different outcomes had significantly different clusters. Seven differentially expressed metabolites were identified as potential candidates for predicting inhospital outcomes based on the two cohorts, and their joint discriminative capabilities were robust using SVM (AUC = 0.998, 95% CI 0.983–1) and the univariate GEE model (AUC = 0.981, 95% CI 0.969–0.994). After integrating another six clinical variants, the predictive performance of the updated model improved further (AUC = 0.99, 95% CI 0.981–0.998).ConclusionA survival prediction model integrating seven metabolites from non-targeted metabonomics and six clinical indicators may generate a powerful early survival prediction model for patients with STEMI. The validation of internal and external cohorts is required.
Highlights
MATERIALS AND METHODSThe popularity of primary percutaneous coronary intervention (PCI) and shorter reperfusion times has given rise to substantial number of patients with ST-segment elevation myocardial infarction (STEMI) who undergo timely coronary revascularization and obtain improved outcomes
Extensive studies have been carried out regarding models predicting outcomes in patients with myocardial infarction, the vast majority of them are based on a single clinical or traditional biochemical index (Eitel et al, 2010; Zhang et al, 2018; Huang et al, 2019)
quality control (QC) samples that were inserted into the test samples were qualified, and the qualified ratio was 83.3%, which means that the analytical results are reliable
Summary
The popularity of primary percutaneous coronary intervention (PCI) and shorter reperfusion times has given rise to substantial number of patients with ST-segment elevation myocardial infarction (STEMI) who undergo timely coronary revascularization and obtain improved outcomes. Extensive studies have been carried out regarding models predicting outcomes in patients with myocardial infarction, the vast majority of them are based on a single clinical or traditional biochemical index (Eitel et al, 2010; Zhang et al, 2018; Huang et al, 2019). Given that ischemia-reperfusion injury after STEMI involves multiple pathways and pathological processes, a multifactor prediction model integrating clinical and biochemical indexes might better stratify early risk after onset. This study aimed to characterize the metabolic fingerprints of patients with STEMI with different inhospital outcomes in the early stage of morbidity and to integrate the clinical baseline characteristics to develop a prognostic prediction model
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