Development and External Validation of a Diagnostic Model for Intra-Procedural Hypotension during Primary Percutaneous Coronary Intervention

Background Intra-procedural hypotension weaken the benefit of primary percutaneous coronary intervention (PPCI) and worsens the prognosis of acute ST elevation myocardial infarction (STEMI) patients. Objectives To develop and externally validate a diagnostic model of intra-procedural hypotension. Methods Design:Multivariable logistic regression of a cohort of acute STEMI patients. Setting: Emergency department ward of a university hospital. Participants: Diagnostic model development: Totally 1239 acute STEMI patients who were consecutively treated with PPCI from November 2007 to December 2013. External validation: Totally 1294 acute STEMI patients who were treated with PPCI from January 2014 to June 2018. Outcomes: Intra-procedural hypotension. Intra-procedural hypotension was defined as pre-procedural systolic blood pressure (SBP) was > 90mmHg, intra-procedural SBP less than or equal to 90 mmHg persistent or transient. Results Totally 121(9.8%) patients presented intra-procedural hypotension in the development dataset; 123 (9.5%) patients presented intra-procedural hypotension in the validation dataset. The strongest predictors of intra-procedural hypotension were no-reflow, the culprit vessel was not left anterior descending, complete occlusion of culprit vessel, using thrombus aspiration devices during operation, and without history of diabetes. We developed a diagnostic model of intra-procedural hypotension. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.685 ± 0.022, 95% CI = 0.641 ~ 0.729 in the development set. We constructed a nomogram using the development database based on predictors of intra-procedural hypotension. The AUC was 0.718 ±0.022, 95% CI = 0.674 ~ 0.761 in the validation set. Discrimination, calibration, and decision curve analysis were satisfactory. Conclusions We developed and externally validated a diagnostic model of intra-procedural hypotension during PPCI. We can use the formula or nomogram to predict intra-procedural hypotension. This study was registered with WHO International Clinical Trials Registry Platform (ICTRP) on 6 September 2019 (registration number:ChiCTR1900025706). http://www.chictr.org.cn/edit.aspx?pid=42913&htm=4 .