Currently submitted to: Journal of Medical Internet Research
Date Submitted: Aug 1, 2020
Open Peer Review Period: Aug 1, 2020 - Sep 26, 2020
(currently open for review)
Development and External Validation of Diagnostic Model for Coronary Microvascular Obstruction: Algorithm Development and Validation
Prevention of coronary microvascular obstruction /no-reflow phenomenon(CMVO/NR) is a crucial step in improving prognosis of patients with acute ST segment elevation myocardial infarction (STEMI )during primary percutaneous coronary intervention (PPCI).
The objective of our study was to develop and externally validate a diagnostic model of CMVO/NR in patients with acute STEMI underwent PPCI.
Design: Multivariate logistic regression of a cohort of acute STEMI patients. Setting: Emergency department ward of a university hospital. Participants: Diagnostic model development: Totally 1232 acute STEMI patients who were consecutively treated with PPCI from November 2007 to December 2013. External validation: Totally 1301 acute STEMI patients who were treated with PPCI from January 2014 to June 2018. Outcomes: CMVO/NR during PPCI. We used logistic regression analysis to analyze the risk factors of CMVO/NR in the development data set. We developed a diagnostic model of CMVO/NR 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).
A total of 147 out of 1,232 participants (11.9%) presented CMVO/NR in the development dataset.The strongest predictors of CMVO/NR were age, periprocedural bradycardia, using thrombus aspiration devices during procedure and total occlusion of culprit vessel. Logistic regression analysis showed that the differences between two group with and without CMVO/NR in age( odds ratios (OR)1.031; 95% confidence interval(CI), 1.015 ~1.048 ; P <.001), periprocedural bradycardia (OR 2.151;95% CI,1.472~ 3.143 ; P <.001) , total occlusion of the culprit vessel (OR 1.842;95% CI, 1.095~ 3.1 ; P =.021) , and using thrombus aspirationdevices during procedure (OR 1.631; 95% CI, 1.029~ 2.584 ; P =.037).We developed a diagnostic model of CMVO/NR. The area under the receiver operating characteristic curve (AUC) was .6833±.023. We constructed a nomogram. CMVO/NR occurred in 120 out of 1,301 participants (9.2%) in the validation data set. The AUC was .6547±.025. Discrimination, calibration, and DCA were satisfactory. Date of approved by ethic committee:16 May 2019. Date of data collection start: 1 June 2019. Numbers recruited as of submission of the manuscript:2,533.
We developed and externally validated a diagnostic model of CMVO/NR during PPCI. Clinical Trial: We registered this study with WHO International Clinical Trials Registry Platform on 16 May 2019. Registration number: ChiCTR1900023213. http://www.chictr.org.cn/edit.aspx?pid=39057&htm=4.
Request queued. Please wait while the file is being generated. It may take some time.
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.