Malignant Ventricular Arrhythmia In Early Stage Of Acute Myocardial Infarction Construction And Verification Of Risk Prediction Model

Objective: To study the risk factors related to malignant ventricular arrhythmias(MVA)in the early stage of acute myocardial infarction(AMI)and build a risk prediction model,so as to provide reference for early MVA prediction and clinical diagnosis and treatment of patients with AMI.Methods: The data of patients with AMI diagnosed in the Affiliated Hospital of Guilin Medical College and the Second Affiliated Hospital of Guilin Medical College from October 2018 to October 2021 were collected.There were 44 patients with MVA in the early stage(within 48 hours after AMI symptoms)with complete data(malignant arrhythmia group(MVA group),including 33 males and 11 females,with an average age of 63.02 ± 12.62).154 patients without MVA at the same time(non malignant ventricular arrhythmia group,non MVA group),including 114 males and 40 females,The mean age was(63.66 ± 10.84).Collect baseline and biochemical data.Univariate analysis and logistic regression analysis were used to screen the independent risk factors of early MVA in patients with AMI,and the risk prediction model was displayed by nomogram.The area under the receiver operating characteristic curve(AUC)was used to verify the discrimination of the risk prediction model constructed in this study,the consistency and clinical benefit of the prediction model were evaluated and verified by calibration curve and decision curve analysis(DCA),and the internal verification was carried out by bootstrap self sampling method(B = 1000).Results:(1)MVA group drinking,overweight and high Killip grade more than non MVA group.The pulse,leukocyte count,average platelet volume,creatinine,urea nitrogen,uric acid,blood glucose,D-dimer,creatine kinase isoenzyme(CKMB),NT pro BNP and QRS time limit of MVA group were higher than those of non MVA group.The systolic blood pressure,diastolic blood pressure,erythrocyte,hemoglobin,blood chloride ion and LVEF of MVA group were lower than those of non MVA group.The preoperative TIMI blood flow classification between MVA group and non MVA group was statistically significant(P < 0.05).(2)Multivariate logistic regression analysis showed that drinking,BMI,Killip grade,CKMB and uric acid were independent risk factors for early MVA in patients with AMI(P < 0.05).The nomogram prediction model of early MVA in patients with AMI was constructed based on the above five influencing factors.The identification efficiency of the prediction model was evaluated by ROC curve.The results showed that the AUC of ROC curve was 0.893(95% CI: 0.827-0.943).The calibration curve and decision curve show that the prediction model constructed in this study has good consistency and clinical applicability.Bootstrap self sampling method(b = 1000)is used for internal verification,and the c-index is 0.872,suggesting that the model has good discrimination.Conclusion: 1.MVA in the early stage of AMI may be related to the patient’s past lifestyle.2.In the early stage of AMI,the worse the cardiac function is,the higher the degree of myocardial injury is,and MVA is more likely to occur.3.Drinking history,BMI,Killip grade,CKMB and uric acid are independent influencing factors of early MVA in patients with AMI.The nomogram risk prediction model of early MVA in patients with AMI constructed by the above indicators has good differentiation,consistency and clinical applicability.