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

Abstract

Background: Coronary heart disease, including ST-segment elevation myocardial infarction (STEMI), is still the leading cause of death.Objectives: 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: We performed multivariate logistic regression of a cohort for hospitalized patients with acute STEMI. Participants: A set of 2,183 hospitalized patients with acute STEMI from January 2002 to December 2011 were used for development. The model external validation data set was obtained from 7,485 hospitalized patients with acute STEMI from January 2012 to August 2019 .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 61 of 2,183 participants (2.8%) in the development data set. The strongest predictors of in-hospital mortality were advanced age and high Killip classification. Logistic regression analysis showed differences between the groups with and without in-hospital mortality in age (odds ratio [OR] 1.058, 95% CI 1.029-1.088; P<.001), Killip III (OR 8.249, 95% CI 3.502-19.433; P<.001), and Killip IV (OR 39.234, 95% CI 18.178-84.679; P<.001). We developed a diagnostic model of in-hospital mortality. The area under the receiver operating characteristic curve (AUC) was 0. 9126 (SD 0. 0166, 95% CI 0. 88015-0. 94504). We constructed a nomogram based on age and Killip classification. In-hospital mortality occurred in 127 of 7,485 participants (1.7%) in the validation data set. The AUC was 0 .9305 (SD 0.0113, 95% CI 0. 90827-0. 95264). Conclusions: We developed and externally validated a diagnostic model of in-hospital mortality in patient with acute STEMI . The discrimination, calibration, and DCA of the model were found to be satisfactory. Trial Registration: ChiCTR.org ChiCTR1900027129; http://www.chictr.org.cn/edit.aspx?pid=44888&htm=4. Funding Statement: This research received no external funding. Declaration of Interests: None. Ethics Approval Statement: Ethics committee of Beijing Anzhen Hospital Capital Medical University. Approved No. of ethic committee: 2019039X.