Risk Estimation for Infection in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention: Development and Validation of a Predictive Score

Abstract

BackgroundInfection during hospitalization is a serious complication among patients who suffered from acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI); however, there are no suitable and accurate means to assess risk. This study aimed to develop and validate a simple scoring system to predict post-AMI infection in such patients.MethodsAll patients with ST-segment elevation myocardial infarction (STEMI) undergoing PCI consecutively enrolled from January 2010 to May 2016 were served as derivation cohort, and those from June 2016 to May 2018 as validation cohort, respectively. The primary endpoint was post-AMI infection during hospitalization, and all-cause death and major adverse cardiovascular events (MACE) were considered as secondary endpoints. The simplified risk model was established using logistic regression. The area under the receiver operating curve and calibration of predicted and observed infection risk were calculated.ResultsA 24-point risk score was developed, with infection risk ranging from 0.7 to 99.6% for patients with the lowest and highest score. Seven variables including age, Killip classification, insulin use, white blood cell count, serum albumin, diuretic use, and transfemoral approach were included. This model achieved the same high discrimination in the development and validation cohort (C-statistic:0.851) and revealed adequate calibration in both datasets. The incidences of post-AMI infection increased steadily across risk score groups in both development (1.3, 5.1, 26.3, and 69.1%; P < 0.001) and validation (1.8, 5.9, 27.2, and 79.2%; P < 0.001) cohort. Moreover, the risk score demonstrated good performance for infection, in-hospital all-cause death, and MACE among these patients, as well as in patients with the non-ST-elevation acute coronary syndrome.ConclusionThis present risk score established a simple bedside tool to estimate the risk of developing infection and other in-hospital outcomes in patients with STEMI undergoing PCI. Clinicians can use this risk score to evaluate the infection risk and subsequently make evidence-based decisions.

Positive association between stress hyperglycemia ratio and pulmonary infection in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention

“…As an important complication of STEMI, infection during hospitalization is associated with a worse clinical outcome [ 1 – 4 ], and several risk factors [ 24 , 25 ] and scores [ 4 , 26 , 27 ] are utilized for infection prediction and prevention. Unfortunately, these predictive tools are largely complex or unable to be interfered.…”

Stroke and myocardial infarction induce neutrophil extracellular trap release disrupting lymphoid organ structure and immunoglobulin secretion

“…4e). Next, we performed different in vivo experiments to at mucosal barriers 3,4 . Intestinal B cells are the major source of immunoglobulin A (IgA)-producing plasma cells and play a fundamental role in the protection of mucosal barriers.…”

Serum Albumin-to-Creatinine Ratio: A Novel Predictor of Pulmonary Infection in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

“…Pulmonary infections were diagnosed by an experienced clinician according to typical medical imaging, symptoms, clinical signs, or laboratory biomarkers indicative of infection 27) . these patients are pulmonary and are associated with a 10-fold elevated 30-day mortality rate [3][4][5][6] . Therefore, a simple and readily available pathophysiological biomarker of pulmonary infection is required to detect high risk patients as early as possible and ultimately improve their short-and long-term prognoses.…”

“…Therefore, a simple and readily available pathophysiological biomarker of pulmonary infection is required to detect high risk patients as early as possible and ultimately improve their short-and long-term prognoses. Although several risk factors and scores are available to predict infection in patients with STEMI undergoing PCI, they are often complicated and are not easily applied 4,[7][8][9][10] .…”