Development and validation of a nomogram for major adverse cardiovascular events after chronic total occlusion percutaneous coronary intervention for ischemic heart failure

Abstract

AbstractBackgroundChronic total occlusion percutaneous coronary intervention (CTO‐PCI) is an available means of revascularization in patients with ischemic heart failure (IHF). However, the prognosis of IHF patients undergoing CTO‐PCI remains unclear due to the lack of reliable clinical predictive tools.AimThis study aimed to establish a nomogram for major adverse cardiovascular events (MACE) after CTO‐PCI in IHF patients.MethodsSixty‐seven potential predictive variables for MACE in 560 IHF patients undergoing CTO‐PCI were screened using least absolute shrinkage and selection operator regression. A nomogram was constructed based on multivariable Cox regression to visualize the risk of MACE, and then evaluation was carried out using the concordance index (C‐index), time‐independent receiver operating characteristic (timeROC) curves, calibration curves, and decision curve analysis (DCA).ResultsDuring a median follow‐up of 32.0 months, there were 208 MACE occurrences. Seven variables were selected for nomogram construction: age, left ventricular ejection fraction, left ventricular end‐diastolic diameter, N‐terminal precursor B‐type diuretic peptide, bending, and use of intravascular ultrasound and beta‐blockers. The C‐index was 0.715 (0.680–0.750) and the internal validation result was 0.715 (0.676–0.748). The timeROC area under the curve at 6 months, 1 year, and 2 years was 0.750 (0.653–0.846), 0.747 (0.690–0.804), and 0.753 (0.708–0.798), respectively. The calibration curves and DCA showed the nomogram had acceptable calibration and clinical applicability.ConclusionsWe developed a simple and efficient nomogram for MACE after CTO‐PCI in IHF patients, which helps in early risk stratification and postoperative management optimization.