Work

Establishment and evaluation of predictive model for acute heart failure after PCI in patients with STEMI

Year: 2026

Type: article

Abstract: Objective To establish a predictive model for acute heart failure (AHF) occurrence in patients with ST-segment elevation myocardial infarction (STEMI) following percutaneous coronary intervention (PCI) and evaluate its clinical performance. Methods A retrospective analysis was conducted on 419 STEMI patients treated at the Cardiology Department of Maanshan People's Hospital from January 2018 to December 2024. Patients were divided into AHF group ( n = 100) and non-AHF group ( n = 319) based on AHF occurrence. Logistic regression analysis identified independent risk factors for model construction. Model performance was assessed using receiver operating characteristic (ROC) curves with optimal threshold determination via maximum Youden index. Statistical validation included Omnibus and Hosmer-Lemeshow tests. Results The AHF prediction model was: Logit(P) = 3.084 − 0.026 × systolic blood pressure + 0 .083 × neutrophil count − 0.041 × total bilirubin + 0 .238 × urea nitrogen − 0.045 × left ventricular ejection fraction (LVEF). AHF was predicted when logit(P) > 0.231. Statistical validation showed Omnibus test χ 2 = 7.112, P = 0.008, and Hosmer-Lemeshow test χ 2 = 6.551, P = 0.586, indicating good model fit. The model achieved 74% sensitivity, 86.8% specificity, and 82.4% diagnostic accuracy. Comparative ROC analysis demonstrated superior performance vs. established scores: predictive model + Grace Score 0.902 vs. baseline model 0.715 (Delong test: Z = 0.235, P < 0.0001), with continuous net reclassification index (NRI) 0.7472 ( P < 0.0001) and integrated discrimination index (IDI) 0.2455 ( P < 0.0001); predictive model + CAMI -STEMI Score 0.909 vs. baseline model 0.717 (Delong test: Z = 0.4930, P < 0.0001), with continuous NRI 0.7245 ( P < 0.0001) and IDI 0.2101 ( P < 0.0001). Clinical decision curve analysis demonstrated net clinical benefit when threshold probability ranged from 0.1 to 0.99. Conclusion Systolic blood pressure, total bilirubin, LVEF, neutrophils, and urea nitrogen are independent factors affecting AHF occurrence after PCI in STEMI patients. This exploratory predictive model demonstrates potential for assessing AHF risk in STEMI patients following PCI and may provide valuable clinical decision support for risk stratification and patient management. However, external validation in independent, multicenter populations is essential before clinical implementation.

Source: Frontiers in Cardiovascular Medicine

DOI: 10.3389/fcvm.2026.1648797

Authors: Jun Li, Fachao Shi, Damin Huang, Dongmei Yue

Institutions: Shanghai University of Medicine and Health Sciences, Wannan Medical College

Language: English

Topic: Acute Myocardial Infarction Research

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801