Key result
The C-AMI nomogram model effectively predicted 1-year mortality in patients with acute myocardial infarction, achieving a C-index of 0.826 compared to 0.722 for the GRACE risk score.
Why the study?
The study aimed to develop and independently validate nomograms based on pre-operative parameters to predict short-term mortality in patients with acute myocardial infarction treated invasively.
Does a nomogram based on pre-operative parameters improve the prediction of short-term mortality compared to the GRACE risk score in acute myocardial infarction patients treated invasively?
Cohort (n=1,229)
Yes
Does a nomogram based on pre-operative parameters improve the prediction of short-term mortality compared to the GRACE risk score in acute myocardial infarction patients treated invasively?
Effect estimate: C-index 0.826 (95% CI 0.780-0.872)
Absolute Event Rate: 0.826% vs 0.722%
A newly developed nomogram based on pre-operative parameters effectively predicts 30-day and 1-year mortality in AMI patients treated invasively, demonstrating improved accuracy over the GRACE risk score.
Nomograms show good AMI mortality discrimination; hypothesis-generating and should not yet change practice.
Objective Our aim was to develop and independently validate nomograms to predict short-term mortality in acute myocardial infarction (AMI) patients. Results There were 1229 AMI patients enrolled in this study. In the training cohort (n=534), 69 deaths occurred during a median follow-up period of 375 days. The C-index for 1-year mortality in the training group and the validation cohort was 0.826 (95%CI: 0.780 - 0.872) and 0.775 (95%CI: 0.695 - 0.855), respectively. Integrated Discrimination Improvement (IDI) and net reclassification improvement (NRI) also showed a significant improvement in the accuracy of the new model compared with the Global Registry of Acute Coronary Events (GRACE) risk score. Furthermore, C-index of the prospective cohort (n=309) achieved 0.817 (95%CI: 0.754 - 0.880) for 30-day mortality and 0.790 (95%CI: 0.718 - 0.863) for 1-year mortality. Conclusions Collectively, our simple-to-use nomogram effectively predicts short-term mortality in AMI patients. Methods AMI patients who had undergone invasive intervention between January 2013 and Jan 2018 were enrolled. Cox regression analysis was used on the training cohort to develop nomograms for predicting 30-day and 1-year mortality. Model performance was then evaluated in the validation cohort and another independent prospective cohort.
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Wang et al. (2020) conducted a cohort in Acute myocardial infarction (n=1,229). C-AMI nomogram model vs. GRACE risk score was evaluated on 1-year mortality prediction (C-index) (C-index 0.826, 95% CI 0.780-0.872). The C-AMI nomogram model effectively predicted 1-year mortality in patients with acute myocardial infarction, achieving a C-index of 0.826 compared to 0.722 for the GRACE risk score.
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