Previously submitted to: Journal of Medical Internet Research (no longer under consideration since Aug 21, 2020)
Date Submitted: Jul 17, 2020
Open Peer Review Period: Jul 17, 2020 - Aug 21, 2020
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Development and External Validation of Diagnostic Model for in-Hospital Mortality in Patient with Acute ST Elevation Myocardial Infarction: Algorithm Development and Validation
ABSTRACT
Background:
Coronary heart disease, including ST elevation myocardial infarction(STEMI), was still the leading cause of mortality.
Objective:
The objective of our study was to develop and externally validate a diagnostic model of in-hospital mortality in the patients with acute STEMI .
Methods:
Design: Multivariable logistic regression of a cohort of hospitalized patients with acute STEMI. Setting: Emergency department ward of a university hospital. Participants: Diagnostic model development: A total of 2,183 hospitalized patients with acute STEMI from January 2002 to December 2011.External validation: A total of 7,485 hospitalized patients with acute STEMI from January 2012 to August 2019. Outcomes: In-hospital mortality. All cause in-hospital mortality was defined as cardiac or non-cardiac death during hospitalization. We used logistic regression analysis to analyze the risk factors of in-hospital mortality in the development data set. We developed a diagnostic model of in-hospital mortality 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).
Results:
In-hospital mortality occurred in 61out of 2,183 participants (2.8%) in the development data set. The strongest predictors of in-hospital mortality were age and Killip classification. We developed a diagnostic model of in-hospital mortality .The area under the receiver operating characteristic (ROC) curve (AUC) was .9126±.0166, 95% confidence interval(CI)= .88015 ~ .94504 in the development set .We constructed a nomogram based on age and Killip classification. In-hospital mortality occurred in 127 out of 7,485 participants(1.7%) in the validation data set. The AUC was .9305±.0113, 95% CI= .90827 ~ .95264 in the validation set . Discrimination, calibration ,and DCA were satisfactory. Date of approved by ethic committee:25 October 2019. Date of data collection start: 6 November 2019. Numbers recruited as of submission of the manuscript:9,668.
Conclusions:
Conclusions:
We developed and externally validated a diagnostic model of in-hospital mortality in patient with acute STEMI . Clinical Trial: We registered this study with WHO International Clinical Trials Registry Platform (ICTRP) (registration number: ChiCTR1900027129; registered date: 1 November 2019). http://www.chictr.org.cn/edit.aspx?pid=44888&htm=4.
Citation
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