Early Warning Model Of Major Adverse Cardiovascular Events In Patients With Acute Myocardial Infarction During Hospitalization

BACKGROUND AND OBJECTIVE:Coronary heart disease(CHD)is currently one of the most threatening diseases to human health worldwide,among which acute myocardial infarction(AMI)is the most dangerous.With the current popularity of interventional therapy,the mortality rate of AMI has been effectively controlled,but patients still have the possibility of cardiovascular adverse events after the onset.The aim of this study was to use commonly used clinical indicators in the emergency room to predict adverse outcomes during hospitalization.Methods:The clinical data of 709 patients with acute ST-segment elevation myocardial infarction who were treated in the The First Affiliated Hospital of Suzhou University from January 1,2018 to January 1,2019 were retrospectively collected.According to whether major adverse cardiovascular events occurred during hospitalization,patients were divided into MACE group and non-MACE group,and the differences of clinical indicators between the two groups were analyzed.The independent risk factors affecting the occurrence of MACE during hospitalization were screened by logistic regression analysis,and the ROC curve was drawn by integrating the indicators into joint indicators.The early warning scoring model was established using the CHAID model,and the ROC curve was drawn to verify the accuracy of the early warning scoring model,and the correlation between the model and Gensini score and GRACE score was analyzed.RESULTS:(1)Patients in the MACE group had higher median age,significantly higher inflammatory markers,significantly impaired liver and kidney function,higher levels of myocardial necrosis markers,and lower left ventricular ejection fraction.(2)WBC,age,LVEF,albumin and creatinine can be independent influencing factors of MACE in AMI patients during hospitalization.WBC was the most important independent risk factor(OR=1.172,95%CI:1.116-1.232),and LVEF and albumin levels were independent protective factors for MACE in AMI patients during hospitalization.The regression equation was Y=0.159*white blood cell count+0.026*age-0.063*LVEF-0.05*albumin+0.014*creatinine-0.290.(3)The ROC curve predicting the occurrence of MACE in AMI patients during hospitalization was drawn using the combined index composed of independent influencing factors,and the AUC was 0.828(95%CI 0.794-0.861,P<0.001),which had good predictive significance.(4)The AUC of early warning scoring model for predicting MACE was 0.844(95%CI:0.805-0.863,P<0.001),with high accuracy,and the critical value was score=16.5._There was a significant positive correlation between the early warning score model and Gensini score(r=0.385,p<0.001),and a significant positive correlation with GRACE score(r=0.611,p<0.001),and the AUC of the early warning score model was significantly greater than that of GRACE score(0.781,95%CI:0.740-0.821,P<0.001)and Gensini score(0.612,95%CI:0.556-0.658,P<0.001).Conclusion:The early warning scoring model has certain accuracy in judging whether MACE occurs during hospitalization in AMI patients,but due to the limitations of single-center study and retrospective study,further clinical studies are needed to confirm it.