Key result
Female gender was identified as a significant predictor of in-hospital mortality in STEMI patients (OR 1.71), and was incorporated into a 10-variable predictive nomogram that demonstrated excellent discriminatory ability with an AUC of 0.91.
Why the study?
Identifying predictors of in-hospital mortality in patients with STEMI remains a major concern in cardiology.
Cohort (n=2,568)
No
Odds Ratio: 1.71 (95% CI 1.22–2.41)
Absolute Event Rate: 14.1% vs 6.4%
p-value: p=<0.001
A predictive nomogram incorporating 10 routine clinical and laboratory variables demonstrated excellent discrimination (AUC 0.91) for predicting in-hospital mortality in STEMI patients.
Nomogram may aid STEMI mortality risk stratification; leaves open clinical adoption pending external validation.
BACKGROUND: Identifying predictors of in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) is a major concern in cardiology. The aim of this study was to identify risk factors and develop a nomogram to predict in-hospital mortality in STEMI patients. MATERIALS AND METHODS: This single-center study was a retrospective cohort analysis of all STEMI patients consecutively referred to Farshchian Hospital (Hamadan Province-Iran) from April 2021 to August 2024. Four different feature selection methods were used to select common important variables in the prediction model: Boruta, Recursive Feature Elimination (RFE), Random Forest (RF) and LASSO. The uneven distribution of the different classes 2,356 (91.7%) alive and 212 (8.3%) dead) was dealt with using the SMOTE method. After splitting the data into a training (70%) and a test (30%) dataset, a multiple logistic regression model was formulated using the significant variables identified. A nomogram predicting in-hospital mortality was then constructed and validated. RESULTS: The findings indicate that age (OR = 1.05: 95% CI: 1.03–1.06), gender (female OR = 1.71: 95% CI: 1.22–2.41), length of stay (OR = 0.89: 95% CI: 0.83–0.96), blood urea nitrogen level (OR = 1.02: 95% CI: 1.00-0.03), white blood cell count (OR = 1.07: 95% CI: 1.03–1.1), Creatinine (OR = 1.74: 95% CI: 1.36–2.22), fasting blood glucose (OR = 1.007: 95% CI: 1.005–1.009), uric acid (OR = 1.07: 95% CI: 1.02–1.12), potassium (OR = 1.2: 95% CI: 0.95–1.52) and systolic blood pressure (OR = 0.98: 95% CI: 0.97–0.99) are pivotal factor in predicting in-hospital mortality in STEMI patients. The predictive model demonstrated high accuracy (84%) and excellent discriminatory ability with an AUC of 0.91. The calibration plot demonstrated the model’s strong discriminatory performance in distinguishing between the two classes. CONCLUSIONS: The development of a nomogram for reliably predicting in-hospital mortality in STEMI patients provides clinicians with a practical visual aid for identifying high-risk patients. By enabling tailored care strategies, this tool improves therapeutic precision and ultimately leads to better clinical outcomes. CLINICAL TRIAL NUMBER: Not applicable.
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Roostami et al. (2025) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=2,568). Female gender vs. Male gender was evaluated on In-hospital mortality (OR 1.71, 95% CI 1.22-2.41, p=<0.001). Female gender was identified as a significant predictor of in-hospital mortality in STEMI patients (OR 1.71), and was incorporated into a 10-variable predictive nomogram that demonstrated excellent discriminatory ability with an AUC of 0.91.
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