Development and validation of a nomogram to predict in-hospital cardiac arrest among patients admitted with acute coronary syndrome

Wang, Tingting; Yang, Dongliang; Li, Hong; Guo, Yujin

doi:10.1016/j.ajem.2021.05.082

Cited by 9 publications

(4 citation statements)

References 32 publications

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“…Moreover, emergency physicians and cardiologists collaborate on resuscitation efforts before admission to the hospital. Upon arrival, patients are promptly provided with oxygen therapy, vital sign monitoring, cardiac surveillance, intravenous access, laboratory blood draws, and treatments for arrhythmias and heart failure, along with rapid assessment and intervention for high-risk patients [18,19]. These steps enhance the potential for positive patient outcomes, as shown by improved cardiac function in the observation group compared to the control group one month after percutaneous coronary intervention (PCI).…”

Section: Discussionmentioning

confidence: 99%

Investigating the efficacy of pre-hospital and in-hospital collaborative treatment platform connected with 120-ambulance in the treatment of patients with acute myocardial infarction

2024

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This study aimed to examine the effectiveness of an integrated pre-hospital and in-hospital collaborative treatment platform connected with 120-ambulance in treating patients with acute myocardial infarction (AMI). 114 patients with AMI who were treated at our hospital within one year of the collaborative treatment model’s implementation were selected as the observation group (January 2022 to December 2022). A random selection of 114 cases treated using the conventional model from January 2020 to December 2020 was chosen as the control group. Control patients received conventional treatment, while observation patients received an integrated pre-hospital and in-hospital treatment. Comparisons of effects were made between the two treatment models for AMI patients. The observation group showed significantly lower first medical contact (FMC) to balloon dilation (FMC-to-B), door-to-balloon (D-to-B), and chest pain onset to admission times than the control group. Across both groups, 99.12% of pre-hospital electrocardiography (ECGs) were completed (113/114), and a significantly higher proportion of patients with Killip class ≥II at immediate admission was observed in the observation group (p < 0.05). Observation group showed significantly higher Left Ventricular End-Systolic Volume (LVESV) and Left Ventricular End-Diastolic Volume (LVEDV) than control group (p < 0.05) one month after surgery. The 6-minute walking distance (6MWD) of the observation group was significantly longer than the control group, and the time taken for the 10-meter walking test was significantly shorter (p < 0.05). A significantly lower incidence rate of hospitalization complications occurred in the observation group (p < 0.05). The integrated pre-hospital and in-hospital treatment platform connected with 120-ambulance showed beneficial outcomes for AMI patients, significantly reducing treatment delay, improving postoperative cardiac function, and reducing postoperative complications, making it worthwhile for promotion in AMI clinical treatment.

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Section: Discussionmentioning

confidence: 99%

Investigating the efficacy of pre-hospital and in-hospital collaborative treatment platform connected with 120-ambulance in the treatment of patients with acute myocardial infarction

2024

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“…There are several nomograms to predict mortality in IHCA patients, but those tools were either designed as complicated scoring system with too many variables9 10 17 or designed mostly for patients with chronic cardiovascular disease 28 29. These predictions were too complicated to be suitable for bedside decision making, regarding on the subsequent treatment.…”

Section: Discussionmentioning

confidence: 99%

How to predict the death risk after an in-hospital cardiac arrest (IHCA) in intensive care unit? A retrospective double-centre cohort study from a tertiary hospital in China

Zhang,

Rao,

Ran

et al. 2023

BMJ Open

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ObjectivesOur objective is to develop a prediction tool to predict the death after in-hospital cardiac arrest (IHCA).DesignWe conducted a retrospective double-centre observational study of IHCA patients from January 2015 to December 2021. Data including prearrest diagnosis, clinical features of the IHCA and laboratory results after admission were collected and analysed. Logistic regression analysis was used for multivariate analyses to identify the risk factors for death. A nomogram was formulated and internally evaluated by the boot validation and the area under the curve (AUC). Performance of the nomogram was further accessed by Kaplan-Meier survival curves for patients who survived the initial IHCA.SettingIntensive care unit, Tongji Hospital, China.ParticipantsAdult patients (≥18 years) with IHCA after admission. Pregnant women, patients with ‘do not resuscitation’ order and patients treated with extracorporeal membrane oxygenation were excluded.InterventionsNone.Primary and secondary outcome measuresThe primary outcome was the death after IHCA.ResultsPatients (n=561) were divided into two groups: non-sustained return of spontaneous circulation (ROSC) group (n=241) and sustained ROSC group (n=320). Significant differences were found in sex (p=0.006), cardiopulmonary resuscitation (CPR) duration (p<0.001), total duration of CPR (p=0.014), rearrest (p<0.001) and length of stay (p=0.004) between two groups. Multivariate analysis identified that rearrest, duration of CPR and length of stay were independently associated with death. The nomogram including these three factors was well validated using boot calibration plot and exhibited excellent discriminative ability (AUC 0.88, 95% CI 0.83 to 0.93). The tertiles of patients in sustained ROSC group stratified by anticipated probability of death revealed significantly different survival rate (p<0.001).ConclusionsOur proposed nomogram based on these three factors is a simple, robust prediction model to accurately predict the death after IHCA.

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“…A lower platelet count, thrombocytopenia, has been associated with a higher bleeding risk ( 26 ) and has been associated with worse mortality outcome in patients with acute coronary syndrome ( 28 , 29 ). High or low platelet count as a risk factor for adverse outcome has also been illustrated by a recently developed prediction model of cardiac arrest ( 30 ). In our study, platelet count was a significant variable in the multivariable models for PRU and ticagrelor concentrations but did not change our main conclusions regarding sex differences.…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in Platelet Reactivity in Patients With ST-Elevation Myocardial Infarction: A Sub-Analysis of the ON-TIME 3 Trial

Tavenier

Hermanides

Ottervanger

et al. 2021

Front. Cardiovasc. Med.

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Background: Fast and adequate platelet inhibition is one of the cornerstones in the treatment of patients with ST-elevation myocardial infarction (STEMI). The aim of this analysis is to examine sex differences in platelet inhibition in the acute treatment of STEMI patients.Methods: Platelet reactivity units (PRU) and ticagrelor plasma concentrations of all patients in the ON-TIME 3 were compared according to sex. All patients were pre-treated with crushed ticagrelor, aspirin and heparin. Both univariable and multivariable analyses were performed.Results: In this sub-analysis of the ON-TIME 3 trial, 195 STEMI patients, of which 58 female patients (29.7%) and 137 male patients (70.3%), were analyzed. PRU-values immediately post-PCI were not different in females [median 135 (IQR 47-228)] compared to males [160 (IQR 40-219), P = 0.92]. Ticagrelor plasma concentrations were higher in the females at the start of primary PCI [141 ng/mL (IQR 25-491) vs. 76 ng/mL (IQR 15-245), P = 0.049] and at 6 hours post-primary PCI [495 ng/mL (IQR 283-661) vs. 321 ng/mL (IQR 196-537), P = 0.001] compared to males. However, immediately post-primary PCI and at 1-hour post-primary PCI no significant differences in ticagrelor concentrations were seen between sexes. In multivariable analysis, sex was significantly associated with ticagrelor concentration (P = 0.04), but not with PRU (P = 0.93).Conclusion: Effective platelet inhibition reached by crushed ticagrelor in STEMI patients was similar in both sexes. Females had similar or even higher ticagrelor plasma concentrations up to 6 hours post-primary PCI compared with males.

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Development and validation of a nomogram to predict in-hospital cardiac arrest among patients admitted with acute coronary syndrome

Cited by 9 publications

References 32 publications

Investigating the efficacy of pre-hospital and in-hospital collaborative treatment platform connected with 120-ambulance in the treatment of patients with acute myocardial infarction

Investigating the efficacy of pre-hospital and in-hospital collaborative treatment platform connected with 120-ambulance in the treatment of patients with acute myocardial infarction

How to predict the death risk after an in-hospital cardiac arrest (IHCA) in intensive care unit? A retrospective double-centre cohort study from a tertiary hospital in China

Sex Differences in Platelet Reactivity in Patients With ST-Elevation Myocardial Infarction: A Sub-Analysis of the ON-TIME 3 Trial

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