Accepted for/Published in: JMIR Medical Informatics
Date Submitted: Jun 2, 2020
Open Peer Review Period: Jun 2, 2020 - Jun 29, 2020
Date Accepted: Jul 14, 2020
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Development and external validation of a diagnostic model for in-hospital bleeding in patients with acute ST elevation myocardial infarction
ABSTRACT
Background:
Bleeding complications in patients with acute ST segment elevation myocardial infarction (STEMI) are associated with an increased risk of subsequent adverse consequences.
Objective:
We want to develop and externally validate a diagnostic model of in-hospital bleeding.
Methods:
Design: Multivariable logistic regression of a cohort for hospitalized patients with acute STEMI . Setting: Emergency department ward of a university hospital. Participants: Diagnostic model development: Totally 4262 hospitalized patients with acute STEMI from January 2002 to December 2013. External validation: Totally 6015 hospitalized patients with acute STEMI from January 2014 to August 2019. Outcomes: All-cause in-hospital bleeding not related to coronary artery bypass graft surgery or catheterization.
Results:
In-hospital bleeding occurred in 2.6%（112/4262）of patients in the development data set and 1.9%（117/6015）of patients in the validation data set. The strongest predictors of in-hospital bleeding were advanced age and high Killip classification. We developed a diagnostic model of in-hospital bleeding. The area under the receiver operating characteristic （ROC）curve (AUC) was 0.777±0.021, 95% confidence interval(CI)= 0.73576 ~ 0.81823. We constructed a nomograms using the development database based on age , and Killip classification. The AUC was 0.7234±0.0252, 95% CI= 0.67392 ~ 0.77289 in the validation data set . Discrimination, calibration, and decision curve analysis were satisfactory.
Conclusions:
We developed and externally validated a moderate diagnostic model of in-hospital bleeding in patients with acute STEMI . Clinical Trial: We registered this study with WHO International Clinical Trials Registry Platform (ICTRP) (registration number: ChiCTR1900027578; registered date: 19 Novmober 2019). http://www.chictr.org.cn/edit.aspx?pid=45926&htm=4.
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