Frontiers in Cardiovascular Medicine (Nov 2022)

Prediction of major adverse cardiovascular events in patients with acute coronary syndrome: Development and validation of a non-invasive nomogram model based on autonomic nervous system assessment

  • Jun Wang,
  • Jun Wang,
  • Jun Wang,
  • Jun Wang,
  • Jun Wang,
  • Jun Wang,
  • Xiaolin Wu,
  • Ji Sun,
  • Ji Sun,
  • Ji Sun,
  • Ji Sun,
  • Ji Sun,
  • Ji Sun,
  • Tianyou Xu,
  • Tianyou Xu,
  • Tianyou Xu,
  • Tianyou Xu,
  • Tianyou Xu,
  • Tianyou Xu,
  • Tongjian Zhu,
  • Fu Yu,
  • Fu Yu,
  • Fu Yu,
  • Fu Yu,
  • Fu Yu,
  • Fu Yu,
  • Shoupeng Duan,
  • Shoupeng Duan,
  • Shoupeng Duan,
  • Shoupeng Duan,
  • Shoupeng Duan,
  • Shoupeng Duan,
  • Qiang Deng,
  • Qiang Deng,
  • Qiang Deng,
  • Qiang Deng,
  • Qiang Deng,
  • Qiang Deng,
  • Zhihao Liu,
  • Zhihao Liu,
  • Zhihao Liu,
  • Zhihao Liu,
  • Zhihao Liu,
  • Zhihao Liu,
  • Fuding Guo,
  • Fuding Guo,
  • Fuding Guo,
  • Fuding Guo,
  • Fuding Guo,
  • Fuding Guo,
  • Xujun Li,
  • Xujun Li,
  • Xujun Li,
  • Xujun Li,
  • Xujun Li,
  • Xujun Li,
  • Yijun Wang,
  • Yijun Wang,
  • Yijun Wang,
  • Yijun Wang,
  • Yijun Wang,
  • Yijun Wang,
  • Lingpeng Song,
  • Lingpeng Song,
  • Lingpeng Song,
  • Lingpeng Song,
  • Lingpeng Song,
  • Lingpeng Song,
  • Hui Feng,
  • Xiaoya Zhou,
  • Xiaoya Zhou,
  • Xiaoya Zhou,
  • Xiaoya Zhou,
  • Xiaoya Zhou,
  • Xiaoya Zhou,
  • Hong Jiang,
  • Hong Jiang,
  • Hong Jiang,
  • Hong Jiang,
  • Hong Jiang,
  • Hong Jiang

DOI
https://doi.org/10.3389/fcvm.2022.1053470
Journal volume & issue
Vol. 9

Abstract

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BackgroundDisruption of the autonomic nervous system (ANS) can lead to acute coronary syndrome (ACS). We developed a nomogram model using heart rate variability (HRV) and other data to predict major adverse cardiovascular events (MACEs) following emergency coronary angiography in patients with ACS.MethodsACS patients admitted from January 2018 to June 2020 were examined. Holter monitors were used to collect HRV data for 24 h. Coronary angiograms, clinical data, and MACEs were recorded. A nomogram was developed using the results of Cox regression analysis.ResultsThere were 439 patients in a development cohort and 241 in a validation cohort, and the mean follow-up time was 22.80 months. The nomogram considered low-frequency/high-frequency ratio, age, diabetes, previous myocardial infarction, and current smoking. The area-under-the-curve (AUC) values for 1-year MACE-free survival were 0.790 (95% CI: 0.702–0.877) in the development cohort and 0.894 (95% CI: 0.820–0.967) in the external validation cohort. The AUCs for 2-year MACE-free survival were 0.802 (95% CI: 0.739–0.866) in the development cohort and 0.798 (95% CI: 0.693–0.902) in the external validation cohort. Development and validation were adequately calibrated and their predictions correlated with the observed outcome. Decision curve analysis (DCA) showed the model had good discriminative ability in predicting MACEs.ConclusionOur validated nomogram was based on non-invasive ANS assessment and traditional risk factors, and indicated reliable prediction of MACEs in patients with ACS. This approach has potential for use as a method for non-invasive monitoring of health that enables provision of individualized treatment strategies.

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