An Easy-to-Use Risk Stratification System for NSTE-ACS Patients Combining Autonomic Nervous System and Coronary Physiology

Figures

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  Figure 1. Hazard ratios for major adverse cardiovascular events (MACEs) in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) who underwent percutaneous coronary intervention (PCI). The blue line represents the 95% confidence intervals for hazard ratio, the blue dots represent the hazard ratio values of each variable, and there is a vertical line at x=1. The blue line does not intersect the dashed line representing that the 95% confidence intervals for the hazard ratio of the variables do not contain 1, the p-value was less than 0.05 and the variables were statistically significant for patient outcomes. nLF/nHF, ratio of normalized low-frequency to normalized high-frequency; DC, deceleration capacity; PCI, percutaneous coronary intervention; QFR, quantitative flow ratio; cTnI, cardiac troponin I.

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  Figure 2. Nomogram for predicting the probability of MACEs in NSTE-ACS patients after PCI. (A) Each of the five clinical characteristics (diabetes, nLF/nHF, DC, cTnI, post-PCI QFR of target vessel) was assigned points by drawing a vertical line from its value to the top row. Number of points for each clinical characteristic is in the first line. The presence of characteristics is associated with a number of points generated employing the nomogram. The points for each characteristic are summed together to generate a total-points score. The total points correspond to the 1-year and 2-year probabilities of MACEs-free survival by drawing a vertical line to the bottom two rows. (B) A simple-to-use online dynamic nomogram for real-time calculation of Balance Score (https://nste-acs.shinyapps.io/BalanceS/). nLF/nHF, ratio of normalized low-frequency to normalized high-frequency; DC, deceleration capacity; QFR, quantitative flow ratio; cTnI, cardiac troponin I; MACEs, Major adverse cardiovascular events.

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  Figure 3. ROC analysis was performed to assess the accuracy of the nomogram for predicting 1- and 2- year MACEs-free survival in the training cohort and testing cohort. (A) 1-year ROC analysis of the accuracy of the nomogram in predicting MACEs-free survival in the training cohort; (B) 1-year ROC analysis of the accuracy of the nomogram in predicting MACEs-free survival in the testing cohort; (C) 2-year ROC analysis of the accuracy of the nomogram in predicting MACEs-free survival in the training cohort; (D) 2-year ROC analysis of the accuracy of the nomogram in predicting MACEs-free survival in the testing cohort.

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  Figure 4. Calibration curves for the prediction of the risk for 1- and 2- year MACEs-free survival in the training cohort and testing cohort. (A)Calibration plot of the 1-year MACEs-free survival in the training cohort; (B)Calibration plot of the 1-year MACEs-free survival in the testing cohort; (C)Calibration plot of the 2-year MACEs-free survival in the training cohort; (D)Calibration plot of the 2-year MACEs-free survival in the testing cohort.

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  Figure 5. DCA for predicting 1- and 2- year MACEs-free survival in the training cohort and testing cohort. (A) DCA for predicting 1-year MACEs-free survival in the training cohort; (B) DCA for predicting 1-year MACEs-free survival in the testing cohort; (C) DCA for predicting 2-year MACEs-free survival in the training cohort; (D) DCA for predicting 2-year MACEs-free survival in the testing cohort.

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  Figure 6. Central illustration. The integrated approach that incorporates multiple-modality data from baseline characteristics (Clinical text data, laboratory analyses and imaging data) and autonomic nervous system assessment were linked to risk stratification and non-invasively predict cardiovascular events. This model is easy-to-use and straightforward provides clinicians with a non-invasive and simple method for assessing the risk of MACEs in patients with NSTE-ACS.