Development of a multidimensional prediction model for long-term prognostic risk in patients with acute coronary syndromes after percutaneous coronary intervention: A retrospective observational cohort study

Abstract

Background The aim of this study is to examine the critical variables that impact the long-term prognosis of patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) and to create a multidimensional predictive risk assessment model that can serve as a theoretical basis for accurate cardiac rehabilitation. Methods The study involved ACS patients who received PCI at the First Hospital of Jilin University from June 2020 to March 2021. Participants were categorized into two groups: acute myocardial infarction (AMI) and unstable angina (UA), according to clinical data and angiographic findings. Hospitalization data, physical performance, exercise tolerance prior to discharge, average daily steps, major adverse cardiac events (MACE), and a follow-up period of 36 months were documented. The dates for accessing data for research purposes are February 10, 2022 (10/2/2022) to December 10, 2023 (10/12/2023). Results We observed substantial increases in weight, fasting plasma glucose (FPG), total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), white blood cell (WBC) count, neutrophil granulocyte count, monocyte count, hemoglobin (Hb) levels, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels in the acute myocardial infarction (AMI) cohort relative to the unstable angina (UA) cohort. We found white blood cell count (WBC) (OR: 4.110) and the effective average number of daily steps (ANS) (OR: 2.689) as independent prognostic risk factors for acute myocardial infarction (AMI). The independent risk factors for unstable angina prognosis were white blood cell count (OR: 6.257), VO2 at anaerobic threshold (OR: 4.294), and effective autonomic nervous system function (OR: 4.097). The whole prognostic risk assessment score for acute myocardial infarction (AMI) is 5 points, with 0 points signifying low risk, 2–3 points representing intermediate risk, and 5 points indicating high risk. The overall prognostic risk assessment score for UA is 7 points, with 0–3 classified as low risk, 4–5 as intermediate risk, and 6–7 as high risk. Conclusion This study developed a multimodal predictive model that integrates the inflammatory response after onset, physical performance and exercise tolerance before discharge, and daily activity after discharge to predict the long-term prognosis of patients with ACS. The multidimensional model is more effective than the single-factor model for assessing risk in ACS patients. This work also establishes a theoretical basis for improving the prognosis of potentially high-risk individuals with accurate and reasonable exercise prescriptions.