Currently submitted to: JMIR Medical Informatics
Date Submitted: Nov 10, 2020
Open Peer Review Period: Nov 10, 2020 - Jan 5, 2021
(currently open for review)
Diagnostic Model of in-Hospital Mortality in Patients with Acute ST-Segment Elevation Myocardial Infarction: Algorithm Development and Validation
Coronary heart disease, including ST-segment elevation myocardial infarction (STEMI), remains the main cause of death.
The objective of our research was to develop and externally validate a diagnostic model of in-hospital mortality in acute STEMI patients.
We performed multiple logistic regression analysis on a cohort of hospitalized acute STEMI patients. Participants: From January 2002 to December 2011, a total of 2,183 inpatients with acute STEMI were admitted for development.The external validation data set of this model comes 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 evaluated the predictive performance of the diagnostic model in the validation data set by examining the measures of discrimination, calibration, and decision curve analysis (DCA).
In the development data set, 61 of the 2,183 participants (2.8%) experienced in-hospital mortality. The strongest predictors of in-hospital mortality were advanced age and high Killip classification. Logistic regression analysis showed the difference between the two groups with and without in-hospital mortality (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 had 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).
We had developed and externally validated a diagnostic model of in-hospital mortality in acute STEMI patients. It was found that the discrimination, calibration and DCA of this model were satisfactory. Clinical Trial: ChiCTR.org ChiCTR1900027129; http://www.chictr.org.cn/edit.aspx?pid=44888&htm=4.
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