Predicting stroke-heart syndrome: a nomogram for time-point-specific prediction of in-hospital major adverse cardiovascular events after acute ischemic stroke

Q: What are the key findings of this study?

A seven-predictor nomogram predicted in-hospital MACEs after acute ischemic stroke with AUCs of 0.839, 0.764, and 0.698 at 3, 7, and 14 days in derivation (0.862, 0.760, and 0.754 in validation).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute ischemic stroke (AIS) (n=1244). Intervention: Seven-predictor clinical nomogram (age, admission NIHSS score, carotid artery stenosis, D-dimer, PLR, creatinine, LDH) vs. Low-risk vs intermediate- and high-risk strata (or observed vs predicted MACE risk). Primary outcome: In-hospital major adverse cardiovascular events (MACEs: composite of acute coronary syndrome, clinically significant arrhythmia, new-onset heart failure, cardiopulmonary arrest, and all-cause in-hospital death) (AUC 0.839 (3-day derivation); AUC 0.862 (3-day validation), p=<0.05).

Q: What does this research mean for the field?

Age, admission NIHSS score, carotid artery stenosis, D-dimer, platelet-to-lymphocyte ratio, creatinine, and lactate dehydrogenase independently predict time-specific risk of in-hospital major adverse cardiovascular events after acute ischemic stroke. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

Develop and validate a nomogram for time-point-specific prediction of in-hospital major adverse cardiovascular events in patients with acute ischemic stroke using routinely available clinical variables.

Mengzhen Qin; Xia Xu; Yuying Dong; Yun Xie; Yao Sun; M. Qiao; Haiyan Wang

doi:10.1186/s12872-026-06980-6

November 7, 2026BMC Cardiovascular DisordersOpen Access

Predicting stroke-heart syndrome: a nomogram for time-point-specific prediction of in-hospital major adverse cardiovascular events after acute ischemic stroke

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Key result

Seven-predictor nomogram predicts in-hospital MACE after acute ischemic stroke with an AUC of ~0.84.

AUC 0.839 (3-day derivation); AUC 0.862 (3-day validation)
P<0.05
n=1,244

Why the study?

Stroke-heart syndrome significantly affects prognosis in patients with acute ischemic stroke, yet risk stratification tools for in-hospital MACEs remain limited.

Does a clinical nomogram incorporating seven routine admission variables accurately predict time-point-specific in-hospital major adverse cardiovascular events in patients with acute ischemic stroke without prior heart disease?

Key Points

Develop and validate a nomogram for time-point-specific prediction of in-hospital major adverse cardiovascular events in patients with acute ischemic stroke using routinely available clinical variables.
Analyzed 871 acute ischemic stroke patients admitted between 2020 and 2023 for model derivation and 373 patients admitted between 2023 and 2024 for temporal validation at a tertiary hospital in Urumqi.
Used LASSO-Cox and multivariable Cox regression to select predictors from admission variables and construct nomograms predicting events at 3 days, 7 days, and during hospitalization.
Evaluated model performance using discrimination (AUC), calibration curves, decision curve analysis, and X-tile-derived risk stratification.
In the derivation cohort, 124 of 871 patients (14.2%) developed major adverse cardiovascular events, with 52.4% occurring within the first 3 days.
Identified seven independent predictors: age, admission NIHSS score, carotid artery stenosis, D-dimer, platelet-to-lymphocyte ratio, creatinine, and lactate dehydrogenase.
Nomogram AUCs were 0.839, 0.764, and 0.698 at 3 days, 7 days, and during hospitalization in derivation, and 0.862, 0.760, and 0.754 in validation, effectively stratifying patients into three risk tiers (log-rank P < 0.05).

Study Design

Type

Cohort (n=1,244)

Multicenter

No

Structured PICO

Does a clinical nomogram incorporating seven routine admission variables accurately predict time-point-specific in-hospital major adverse cardiovascular events in patients with acute ischemic stroke without prior heart disease?

P

Population

1,244 adults (871 derivation, 373 validation; 29.2% female in derivation cohort) hospitalized with acute ischemic stroke and free of prior heart disease, followed during hospitalization (mean 9.44 days).

E

Exposure

Time-point-specific prognostic nomogram and X-tile-derived risk stratification model based on 7 routinely available clinical variables at admission: age, admission NIHSS score, carotid artery stenosis, D-dimer, platelet-to-lymphocyte ratio (PLR), creatinine (Cr), and lactate dehydrogenase (LDH).

O

Outcome

In-hospital major adverse cardiovascular events (MACEs) predicted at 3 days, 7 days, and during hospitalization (14-day timeframe), defined as a composite of: (1) acute coronary syndrome (unstable angina, NSTEMI, STEMI), (2) clinically significant arrhythmia (newly detected atrial fibrillation/flutter, sustained VT/VF, second-degree AV block, sick sinus syndrome, sinus arrest, frequent multifocal PVCs Lown grade ≥III), (3) new-onset heart failure, (4) cardiopulmonary arrest requiring resuscitation, and (5) all-cause in-hospital death.composite

Main Result

Effect estimate: AUC 0.839 (3-day derivation); AUC 0.862 (3-day validation)

Absolute Event Rate: 14.2% vs 13.7%

p-value: p=<0.05

A novel nomogram using seven routine admission variables provides high discriminative ability (AUC 0.839–0.862 at 3 days) to identify acute ischemic stroke patients without prior heart disease who are at elevated risk of early in-hospital major adverse cardiovascular events.

Limitations

Only in-hospital MACEs were studied, leaving post-discharge predictive value unknown.
Non-fatal outcome components were ascertained from ICD-10 codes without independent adjudication, potentially misclassifying events and underestimating MACE incidence.
Continuous cardiac rhythm monitoring was not protocolized, so arrhythmic events represent newly detected rather than truly incident arrhythmias.
Single-center retrospective design requiring recalibration (due to 3-day risk overestimation in temporal validation) and external validation before clinical use.
Low numbers of fatal events and heart failure events meant the model primarily reflects early arrhythmic risk.
3-day risk was systematically overestimated in the temporal validation cohort (calibration-in-the-large 0.85, calibration slope 1.35)
Recalibration and external validation are required before clinical use
Continuous Holter monitoring was not applied systematically, so atrial fibrillation or flutter was classified as newly detected rather than incident
At the 14-day horizon, 74.6% of the derivation cohort and 75.1% of the validation cohort had been discharged event-free, making 14-day estimates largely exploratory

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Answers are grounded in this paper and cite their sources.

Implication

May aid time-specific MACE risk stratification in acute ischemic stroke; leaves open prospective validation before clinical use.

Abstract

Stroke-heart syndrome (SHS) significantly affects prognosis in patients with acute ischemic stroke (AIS). Risk stratification tools for in-hospital major adverse cardiovascular events (MACEs) remain limited. This study aimed to develop and validate a nomogram for time-point-specific prediction of in-hospital MACEs in AIS patients using routinely available clinical variables. A total of 871 AIS patients admitted to a tertiary hospital in Urumqi (2020–2023) formed the derivation cohort, and 373 patients (2023–2024) the validation cohort. LASSO-Cox and multivariate Cox regression were used to select predictors and construct a nomogram for predicting MACEs at 3 days, 7 days, and during hospitalization. Discrimination (area under the receiver operating characteristic curve [AUC]), calibration, and decision curve analysis were assessed. X-tile-derived total risk scores defined three risk strata, validated by Kaplan-Meier curves. In the derivation cohort, 124 of 871 patients (14.2%) developed in-hospital MACEs, with 52.4% occurring within the first three days. Seven independent predictors were identified: age, admission National Institutes of Health Stroke Scale (NIHSS) score, carotid artery stenosis, D-dimer, platelet-to-lymphocyte ratio (PLR), creatinine, and lactate dehydrogenase (LDH). The nomogram achieved AUCs of 0.839, 0.764, and 0.698 at 3 days, 7 days, and during hospitalization in the derivation cohort and 0.862, 0.760, and 0.754 in the validation cohort; optimism-corrected AUCs were 0.823, 0.750, and 0.689. Calibration was acceptable in the derivation cohort, but 3-day risk was overestimated in temporal validation (calibration-in-the-large 0.85, calibration slope 1.35); decision curve analysis indicated net benefit across a range of thresholds. Total risk scores stratified patients into low- (0-131), intermediate- (131–184), and high-risk (184–292) groups with significantly different MACE incidence (log-rank P < 0.05). This study developed and temporally validated a nomogram for time-point-specific prediction of in-hospital MACEs in AIS patients at 3 days, 7 days, and during hospitalization, based on seven routinely available predictors. The derived risk stratification system may aid tiered monitoring, but recalibration and external validation are required before clinical use. Not applicable.

Discussion

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Cite This Study

Qin et al. (2026) conducted a cohort in Acute ischemic stroke (AIS) (n=1,244). Seven-predictor clinical nomogram (age, admission NIHSS score, carotid artery stenosis, D-dimer, PLR, creatinine, LDH) vs. Low-risk vs intermediate- and high-risk strata (or observed vs predicted MACE risk) was evaluated on In-hospital major adverse cardiovascular events (MACEs: composite of acute coronary syndrome, clinically significant arrhythmia, new-onset heart failure, cardiopulmonary arrest, and all-cause in-hospital death) (AUC 0.839 (3-day derivation); AUC 0.862 (3-day validation), p=<0.05). A seven-predictor nomogram predicted in-hospital MACEs after acute ischemic stroke with AUCs of 0.839, 0.764, and 0.698 at 3, 7, and 14 days in derivation (0.862, 0.760, and 0.754 in validation).

synapsesocial.com/papers/6af0e9a6de503f3774140ab8 https://doi.org/10.1186/s12872-026-06980-6

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Predicting stroke-heart syndrome: a nomogram for time-point-specific prediction of in-hospital major adverse cardiovascular events after acute ischemic stroke

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Predicting stroke-heart syndrome: a nomogram for time-point-specific prediction of in-hospital major adverse cardiovascular events after acute ischemic stroke

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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