Abstract
BackgroundThis study aimed to develop and validate a nomogram to predict probability of in-stent restenosis (ISR) in patients undergoing percutaneous coronary intervention (PCI).MethodsPatients undergoing PCI with drug-eluting stents between July 2009 and August 2011 were retrieved from a cohort study in a high-volume PCI center, and further randomly assigned to training and validation sets. The least absolute shrinkage and selection operator (LASSO) regression model was used to screen out significant features for construction of nomogram. Multivariable logistic regression analysis was applied to build a nomogram-based predicting model incorporating the variables selected in the LASSO regression model. The area under the curve (AUC) of the receiver operating characteristics (ROC), calibration plot and decision curve analysis (DCA) were performed to estimate the discrimination, calibration and utility of the nomogram model respectively.ResultsA total of 463 patients with DES implantation were enrolled and randomized in the development and validation sets. The predication nomogram was constructed with five risk factors including prior PCI, hyperglycemia, stents in left anterior descending artery (LAD), stent type, and absence of clopidogrel, which proved reliable for quantifying risks of ISR for patients with stent implantation. The AUC of development and validation set were 0.706 and 0.662, respectively, indicating that the prediction model displayed moderate discrimination capacity to predict restenosis. The high quality of calibration plots in both datasets demonstrated strong concordance performance of the nomogram model. Moreover, DCA showed that the nomogram was clinically useful when intervention was decided at the possibility threshold of 9%, indicating good utility for clinical decision-making.ConclusionsThe individualized prediction nomogram incorporating 5 commonly clinical and angiographic characteristics for patients undergoing PCI can be conveniently used to facilitate early identification and improved screening of patients at higher risk of ISR.
Highlights
This study aimed to develop and validate a nomogram to predict probability of in-stent restenosis (ISR) in patients undergoing percutaneous coronary intervention (PCI)
Full list of author information is available at the end of the article
This study aimed to identify factors correlated to the risk of ISR for individual patients undergoing PCI, using data from an observational singlecenter registry study
Summary
This study aimed to develop and validate a nomogram to predict probability of in-stent restenosis (ISR) in patients undergoing percutaneous coronary intervention (PCI). Revascularization with percutaneous coronary intervention (PCI) is a well-established He et al BMC Cardiovasc Disord (2021) 21:435 and effective therapeutic strategy for advanced coronary heart disease, following the introduction of drug-eluting stents (DES) [1]. Most studies have only focused on comprehensively identifying the predictors of ISR or developing prediction models without an individual risk prediction tool, while the simplicity and ease of use for the clinicians and patients were not well considered [7,8,9]. A more solid, well-validated and easy-to-use clinical ISR prediction model for all patients with stent implantation, especially for clinical decision in primary prevention, is urgently needed for accurate prognostication of future events
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