Readily accessible risk model to predict in-hospital major adverse cardiac events in patients with acute myocardial infarction: a retrospective study of Chinese patients. Issue 7 (1st July 2021)

• Record Type: Journal Article
• Authors: Hou, Xiaoxia; Du, Xin; Wang, Guohong; Zhao, Xiaoyan; Zheng, Yang; Li, Yingxue; Xia, Eryu; Qin, Yong; Dong, Jianzeng; Ma, Chang-Sheng
• Is Part Of: BMJ open. Volume 11:Issue 7(2021)
• Publication Date: 2021-07-01
• Subjects: myocardial infarction -- risk management -- adverse events; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2020-044518
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objective: Rapid, accurate identification of patients with acute myocardial infarction (AMI) at high risk of in-hospital major adverse cardiac events (MACE) is critical for risk stratification and prompt management. This study aimed to develop a simple, accessible tool for predicting in-hospital MACE in Chinese patients with AMI. Design: Retrospective review of deidentified medical records. Setting: 38 urban and rural hospitals across diverse economic and geographic areas in China (Beijing, Henan Province and Jilin Province). Participants: 15 009 patients discharged from hospital with a diagnosis of AMI. Main outcome measure: The primary outcome was MACE occurrence during index hospitalisation. A multivariate logistic regression model (China AMI Risk Model, CHARM) derived using patient data from Beijing (n=7329) and validated with data from Henan (n=4247) and Jilin (n=3433) was constructed to predict the primary outcome using variables of age, white cell count (WCC) and Killip class. C-statistics evaluated discrimination in the derivation and validation cohorts, with goodness-of-fit assessed using Hosmer-Lemeshow statistics. Results: The CHARM model included age (OR: 1.06 per 1-year increment, 95% CI 1.05 to 1.07, p<0.001), WCC (OR per 10 9 /L increment: 1.10 (95% CI 1.07 to 1.13), p<0.001) and Killip class (class II vs class I: OR 1.34 (95% CI 0.99 to 1.83), p=0.06; class III vs class I: OR 2.74 (95% CI 1.86 to 3.97), p<0.001; class IV vs class I: OR 14.12 (95% CI 10.35 to 19.29), p<0.001). C-statistics were similar between the derivation and validation datasets. CHARM had a higher true positive rate than the Thrombolysis In Myocardial Infarction score and similar to the Global Registry of Acute Coronary Events (GRACE). Hosmer-Lemeshow statistics were 5.5 (p=0.703) for derivation, 41.1 (p<0.001) for Henan, and 103.2 for Jilin (p<0.001) validation sets with CHARM, compared with 119.6, 34.0 and 459.1 with GRACE (all p<0.001). Conclusions: The CHARM model provides an inexpensive, accurate and readily accessible tool for predicting in-hospital MACE in Chinese patients with AMI.