Development and Validation of a Risk Nomogram Model for Predicting Revascularization After Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome

Figures & data

Figure 1 Study flow diagram.

Abbreviations: ACS, acute coronary syndrome; CABG, coronary artery bypass grafting.

Table 1 Participant Characteristics

Variable	Cohort, No. (%)		P-value
	Training (N=758)	Validation (N=325)
Follow-up time, months	22.27(13.142)	23.174(13.884)	0.489
Age, years	64.14(10.092)	63.91(9.466)	0.726
Sex			0.963
Male	491	211
Female	267	114
DM			0.917
Yes	182	79
No	576	246
Hypertension			0.408
Yes	476	196
No	282	129
Smoke			0.246
Yes	379	175
No	379	150
Drink			0.662
Yes	318	142
No	440	183
CHD			0.247
Yes	11	2
No	747	323
MI			0.625
Yes	4	1
No	754	324
TIA			0.068
Yes	72	43
No	686	282
FBG, mmol/L	6.42(2.14)	6.6(2.49)	0.358
Glycosylated hemoglobin, %	6.61(1.30)	6.70(1.30)	0.331
SCr, umol/L	69.25(19.92)	67.06(16.25)	0.082
SUA, umol/L	302.46(83.63)	299.57(73.98)	0.59
TC, mmol/L	4.67(1.23)	4.74(1.14)	0.363
TC2, mmol/L	4.00(1.16)	4.05(1.13)	0.502
Triglyceride, mmol/L	1.67(1.09)	1.74(1.06)	0.511
Triglyceride2, mmol/L	1.47(1.00)	1.53(0.94)	0.292
HDL-C, mmol/L	1.26(0.33)	1.28(0.34)	0.46
HDL-C2, mmol/L	1.25(0.31)	1.26(0.33)	0.53
LDL-C, mmol/L	2.61(0.95)	2.65(0.91)	0.532
LDL-C2, mmol/L	2.08(0.90)	2.12(0.88)	0.431
Lp(a), mg/L	254.66(226.67)	258.06(259.02)	0.828
WBC, ×10^9/L	7.03(2.26)	6.89(1.91)	0.316
Neutrophile	4.61(2.10)	4.46(1.80)	0.275
Granulocyte, ×10^9/L
Lymphocyte, ×10^9/L	1.82(0.61)	1.84(0.65)	0.581
Hemoglobin, g/L	137.38(38.96)	136.56(14.87)	0.715
NLR, %	2.93(2.21)	2.82(1.99)	0.429
LDH, U/L	445.9(466.21)	408.60(455.43)	0.667
CK, U/L	485.9(596.32)	488.90(607.22)	0.762
CKMB, ng/mL	54.79(79.72)	54.63(87.84)	0.724
hsTn T, ng/L	689.99(752.47)	730.57(780.89)	0.821
NT-proBNP, pg/mL	631.74(656.10)	656.39(694.62)	0.257
Multivessel disease			0.905
Yes	604	260
No	154	65
Calcified lesions			0.33
Yes	184	88
No	574	237
Bifurcation lesions			0.658
Yes	136	62
No	622	263
Ostial lesions			0.773
Yes	50	23
No	708	302
Angular distortion lesions			0.999
Yes	14	6
No	744	319
Target LM			0.106
Yes	25	5
No	738	320
Target LAD			0.428
Yes	480	214
No	278	111
Target LCX			0.602
Yes	262	107
No	496	218
Target RCA			0.856
Yes	322	140
No	436	185
Emergency PCI			0.249
Yes	54	17
No	704	308
CTO			0.187
Yes	83	27
No	675	398
Number of stents implanted	1.9631(1.1299)	1.92(1.0510)	0.555
Stent length, mm	53.3232(34.6590)	49.3692(30.4145)	0.075
Stent diameter, mm	2.9581(0.4178)	2.9436(0.3826)	0.592
IVUS			0.039
Yes	19	2
No	739	323

Abbreviations: DM, diabetes mellitus; CHD, coronary heart disease; MI, myocardial infarction; TIA, transient ischemic attack; FBG, fasting blood glucose; SCr, serum creatinine; SUA, serum uric acid; TC, Total cholesterol; Total cholesterol 2, Total cholesterol at re-admission; Triglyceride2, Triglyceride at re-admission; HDL, High density lipoprotein cholesterol; HDL2, high density lipoprotein cholesterol at re-admission; LDL, Low Density Lipoprotein cholesterol; LDL2, Low Density Lipoprotein cholesterol at re-admission; Lp(a), Lipoprotein-a; WBC, white blood cell; NLR, Neutrophil-to-lymphocyte ratio; LDH, lactate dehydrogenase; CK, creatine kinase; CKMB, creatine kinase MB; hsTn T, hypersensitive troponin T; NT-proBNP, N-terminal pro-brain natriuretic peptide; LM, left main coronary artery; LAD, left anterior descending coronary artery; LCX, left circumflex coronary artery; RCA, right coronary artery; PCI, percutaneous coronary intervention; CTO, chronic total occlusion; IVUS, intravenous ultrasound.

Table 2 Univariate Logistic Regression Analysis of Revascularization Based on Preoperative Data in the Training Cohort

Variables	OR (95% CI)	P-value
Follow-up time, months	1.02(1.00–1.03)	<0.05
Age, years	1.00(0.98–1.02)	0.707
Sex, male vs female	1.08(0.61–1.90)	0.781
DM, yes vs no	2.51(1.54–4.09)	<0.001
Hypertension, yes vs no	0.92(0.64–1.32)	0.669
Smoke, yes vs no	1.31(0.75–2.33)	0.337
Drink, yes vs no	0.83(0.47–1.39)	0.479
CHD, yes vs no	1.52(0.33–7.01)	0.584
MI, yes vs no	0.58(0.03–0.12)	0.727
TIA, yes vs no	0.88(0.47–1.61)	0.684
FBG, mmol/L	1.02(0.89–1.16)	0.812
Glycosylated hemoglobin, %	0.84(0.68–1.04)	0.111
SCr, umol/L	0.98(0.97–1.00)	<0.01
SUA, umol/L	1.00(1.002–1.007)	<0.001
TC, mmol/L	0.78(0.53–1.14)	0.204
TC2, mmol/L	0.69(0.44–1.04)	0.081
Triglyceride, mmol/L	0.98(0.77–1.24)	0.871
Triglyceride2, mmol/L	1.24(0.94–1.62)	0.121
HDL-C, mmol/L	1.00(0.49–2.07)	0.98
HDL-C2, mmol/L	0.77(0.35–1.67)	0.501
LDL-C, mmol/L	0.99(0.63–1.56)	0.975
LDL-C2, mmol/L	2.22(1.40–3.66)	<0.001
Lp(a), mg/L	1.00(1.001–1.003)	<0.001
WBC, ×10^9/L	0.69(0.35–1.28)	0.253
Neutrophile granulocyte, ×10^9/L	1.34(0.68–2.80)	0.407
Lymphocyte, ×10^9/L	1.81(0.83–4.14)	0.147
Hemoglobin, g/L	1.00(0.997–1.008)	0.499
NLR, %	1.01(0.84–1.19)	0.906
LDH, U/L	1.00(0.9835–1.0036)	0.832
CK, U/L	1.01(0.99–1.04)	0.335
CKMB, ng/mL	0.95(0.83–1.060	0.415
hsTn T, ng/L	1.00(0.9953–1.0026)	0.652
NT-proBNP, pg/mL	1.00(0.9981–1.0059)	0.554
Multivessel disease, yes vs no	5.54(3.33–9.46)	<0.001
Calcified lesions, yes vs no	1.7(1.10–2.63)	0.016
Bifurcation lesions, yes vs no	1.89(1.18–3.07)	<0.05
Ostial lesions, yes vs no	0.63(0.29–1.34)	0.241
Angular distortion	0.93(0.25–3.50)	0.917
Lesions, yes vs no
Target LM, yes vs no	1.30(0.46–3.75)	0.611
Target LAD, yes vs no	0.45(0.29–0.73)	0.059
Target LCX, yes vs no	0.65(0.44–0.96)	0.086
Target RCA, yes vs no	0.57(0.37–0.87)	0.072
Emergency PCI, yes vs no	1.96(0.98–3.93)	0.057
CTO, yes vs no	2.66(1.48–4.91)	<0.01
Number of stents implanted	1.19(0.79–1.80)	0.393
Stent length, mm	1.00(0.99–1.01)	0.917
Stent diameter, mm	0.62(0.40–0.97)	0.056
IVUS, yes vs no	0.88(0.25–2.97)	0.838

Abbreviations: DM, diabetes mellitus; CHD, Coronary heart disease; MI, Myocardial infarction; TIA, transient ischemic attack; FBG, fasting blood glucose; SCr, serum creatinine; SUA, serum uric acid; TC, total cholesterol; Total cholesterol 2, Total cholesterol at re-admission; Triglyceride2, Triglyceride at re-admission; HDL, High density lipoprotein cholesterol; HDL2, High density lipoprotein cholesterol at re-admission; LDL, Low Density Lipoprotein cholesterol; LDL2, Low Density Lipoprotein cholesterol at re-admission; Lp(a), Lipoprotein-a; WBC, white blood cell; NLR, Neutrophil-to-lymphocyte ratio; LDH, lactate dehydrogenase; CK, creatine kinase; CKMB, creatine kinase MB; hsTn T, Hypersensitive troponin T; NT-proBNP, N-terminal pro-brain natriuretic peptide; LM, left main coronary artery; LAD, left anterior descending coronary artery; LCX, left circumflex coronary artery; RCA, right coronary artery; PCI, Percutaneous coronary intervention; CTO, chronic total occlusion; IVUS, intravenous ultrasound.

Table 3 Multivariate Logistic Regression Analysis of Revascularization Based on Preoperative Data in the Training Cohort

Variable	OR (95% CI)	P-value
Follow-up time, months	1.01(1.00–1.03)	<0.01
DM, yes vs no	1.83(1.25–2.69)	<0.01
SCr, umol/L	0.99(0.98–1.00)	0.02
SUA, umol/L	1.005(1.002–1.007)	<0.001
LDL-C2, mmol/L	1.28(1.07–1.54)	<0.01
Lp(a), mg/L	1.0021(1.0013–1.0029)	<0.001
Multivessel disease, yes vs no	4.48(2.85–7.28)	<0.001
CTO, yes vs no	3.30(1.93–5.80)	<0.001
Calcified lesions, yes vs no	1.63(1.11–2.39)	0.01
Bifurcation lesions, yes vs no	1.82(1.20–2.77)	<0.01

Abbreviations: DM, diabetes mellitus; SCr, serum creatinine; SUA, serum uric acid; LDL-C2, Low Density Lipoprotein cholesterol at re-admission; Lp(a), Lipoprotein-a; CTO, chronic total occlusion.

Figure 2 Nomogram used for predicting revascularization after PCI in ACS patients. The final score (ie, total points) is calculated as the sum of the individual scores of each of the ten variables included in the nomogram.

Abbreviations: PCI, percutaneous transluminal coronary intervention; ACS, acute coronary syndrome; DM, diabetes mellitus; SCr, serum creatinine; SUA, serum uric acid; LDL-C2, low-density lipoprotein cholesterol at re-admission; Lp(a), Lipoprotein-a; CTO, chronic total occlusion.

Figure 3 ROC curve of the nomogram for predicting revascularization after PCI in ACS patients. (A) ROC curve in the training set; (B) ROC curve in the validation set.

Abbreviations: AUC, area under the ROC curve; ROC, receiver operating characteristic; PCI, percutaneous transluminal coronary intervention; ACS, acute coronary syndrome.

Figure 4 Calibration curve of the nomogram for the training set (A) and the validation set (B). The X-axis represents the overall predicted probability of revascularization after PCI and the Y-axis represents the actual probability. Model calibration is indicated by the degree of fitting of the curve and the diagonal.

Figure 5 Decision curve analysis for the training set (A) and the validation set (B). A horizontal line indicates that all samples are negative and not treated, with a net benefit of zero. An oblique line indicates that all samples are positive. The net benefit has a negative slope.