Development and Validation of Prognostic Models for Bleeding and Ischemia in Elderly Patients With Comorbid Acute Coronary Syndrome and Atrial Fibrillation

Figure 1. Predictive model setup procedure. ACS indicates acute coronary syndrome; AF, atrial fibrillation; AUC, area under the receiver operating characteristic curve; BMI, body mass index; CABG, coronary artery bypass graft; C‐index, concordance index; CRF, chronic renal failure; DCA, clinical decision analysis; DTE, distal thrombus embolization; GRACE, Global Registry of Acute Coronary Events, IDI, integrated discrimination improvement; LASSO, least absolute shrinkage and selection operator; MI, myocardial infarction; NRI, net reclassification improvement; PARIS‐CTE, Patterns of Non‐Adherence to Anti‐Platelet Regimen in Stented Patients–Coronary Thrombotic Events; PARIS‐MB, Patterns of Non‐Adherence to Anti‐Platelet Regimen in Stented Patients–Major Bleeding; PRECISE‐DAPT, Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy; and TAT, triple antithrombotic therapy.

Figure 2. Clinical predictor selection using least absolute shrinkage and selection operator analysis with 10‐fold cross‐validation. A, Coefficient profile plot of the LASSO regression model for BARC type 3 or 5 bleeding events. B, Cross‐validated error plot for identifying potential predictors of bleeding. C, Coefficient profile plot for the LASSO regression model for ischemia. D, Cross‐validated error plot for identifying potential predictors of ischemia. BARC indicates Bleeding Academic Research Consortium; and LASSO, least absolute shrinkage and selection operator.

Figure 3. Nomograms, time‐dependent receiver operating characteristic curves, and area under the ROC curve. A, B, Nomogram predicting the probability of bleeding (A) and ischemia (B). C, D, Time‐dependent ROC curves of the bleeding (C) and ischemia (D) models at 3, 6, and 12 mo in the development cohort. AUC indicates area under the receiver operating characteristic curve; BMI, body mass index; CABG, coronary artery bypass graft; CRF, chronic renal failure; DTE, distal thrombus embolization; MI, myocardial infarction; NSTEMI, non‐ST‐segment–elevation myocardial infarction; ROC, receiver operating characteristic; STEMI, ST‐segment–elevation myocardial infarction; and TAT, triple antithrombotic therapy.

Figure 4. One‐year Kaplan–Meier cumulative event curves for bleeding and ischemia in the development cohort. A, BARC type 3 or 5 bleeding. B, Ischemia. BARC indicates Bleeding Academic Research Consortium.