Work

Development and Validation of a Prediction Model for Acute Coronary Occlusion in Patients With Non‐ST‐Segment Elevation Myocardial Infarction

Year: 2026

Type: article

Abstract: BACKGROUND: Acute coronary occlusion (ACO) occurs in approximately one-quarter of patients with non-ST-segment elevation myocardial infarction (NSTEMI) and is associated with adverse outcomes. This study aimed to develop and validate a prediction model for ACO. METHODS: Consecutive patients admitted with NSTEMI between January 2016 and June 2023 who underwent coronary angiography were enrolled. Demographic, electrocardiographic, laboratory, and echocardiographic data were collected. Patients admitted during 2016-2020 were assigned to the training cohort (n = 670), and those admitted during 2021-2023 were assigned to the validation cohort (n = 334). Predictors were selected using least absolute shrinkage and selection operator regression, and a nomogram was constructed based on multivariable logistic regression. Model performance was assessed by receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). RESULTS: Among 1,004 patients, 262 (26.1%) had ACO. Seven predictors, including smoking history, ST-segment depression ≥ 1 mm, regional wall motion abnormality, left ventricular ejection fraction, admission cardiac troponin I, interleukin-6, and high-sensitivity C-reactive protein, were incorporated into the model. The area under the ROC curve was 0.731 (95% CI, 0.688-0.773) in the training cohort and 0.715 (95% CI, 0.654-0.776) in the validation cohort. Calibration curves showed good agreement between predicted and observed probabilities, and DCA demonstrated favorable clinical utility. CONCLUSION: This study developed and validated a multidimensional prediction model for ACO in patients with NSTEMI. The model showed acceptable performance and may aid early identification before coronary angiography, although reliance on IL-6, which is not routinely available in all centers, may limit its generalizability.

Source: Clinical Cardiology

DOI: 10.1002/clc.70492