A Practical Nomogram for Predicting the Bleeding Risk in Patients with a History of Myocardial Infarction Treating with Aspirin.

IF 2.3 4区 医学 Q2 HEMATOLOGY
Jin Jing, Lei Wanling, Wang Maofeng
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Abstract

Background: Aspirin is a widely used antiplatelet medication to prevent blood clots, reducing the risk of cardiovascular event. Healthcare providers need to be mindful of the risk of aspirin-induced bleeding and carefully balancing its benefits against potential risks. The objective of this study was to create a practical nomogram for predicting bleeding risk in patients with a history of myocardial infarction treating with aspirin.

Methods: A total of 2099 myocardial infarction patients with aspirin were enrolled. The patients were randomly divided into two groups, with a 7:3 ratio, for model development and internal validation. Boruta analysis was utilized to identify clinically significant features associated with bleeding. Logistic regression model based on independent bleeding risk factors was constructed and presented as a nomogram. Model performance was assessed from three aspects: identification, calibration, and clinical utility.

Results: Boruta analysis identified eight clinical features from 25, and further multivariate logistic regression analysis selected four independent risk factors: hemoglobin, platelet count, previous bleeding, and sex. A visual nomogram was created based on these variables. The model achieved an area under the curve of 0.888 (95% CI: 0.845-0.931) in the training dataset and 0.888 (95% CI: 0.808-0.968) in the test dataset. Calibration curve analysis showed close approximation to the ideal curve. Decision curve analysis demonstrated favorable clinical net benefit for the model.

Conclusions: Our study focused on creating and validating a model to evaluate bleeding risk in patients with a history of myocardial infarction treated with aspirin, which demonstrated outstanding performance in discrimination, calibration, and net clinical benefit.

预测有心肌梗死病史患者使用阿司匹林治疗时出血风险的实用提名图。
背景:阿司匹林是一种广泛使用的抗血小板药物,可预防血栓形成,降低心血管事件的风险。医疗服务提供者需要注意阿司匹林诱发出血的风险,并谨慎权衡其益处与潜在风险。本研究的目的是建立一个实用的提名图,用于预测接受阿司匹林治疗的有心肌梗死病史患者的出血风险:方法:共招募了 2099 名服用阿司匹林的心肌梗死患者。这些患者按 7:3 的比例随机分为两组,用于模型开发和内部验证。利用 Boruta 分析确定与出血相关的临床重要特征。建立了基于独立出血风险因素的逻辑回归模型,并以提名图的形式呈现。从识别、校准和临床实用性三个方面评估了模型的性能:Boruta分析从25个临床特征中找出了8个,进一步的多变量逻辑回归分析选出了4个独立的风险因素:血红蛋白、血小板计数、既往出血和性别。根据这些变量创建了一个可视化提名图。该模型在训练数据集中的曲线下面积为 0.888(95% CI:0.845-0.931),在测试数据集中的曲线下面积为 0.888(95% CI:0.808-0.968)。校准曲线分析显示与理想曲线接近。决策曲线分析表明该模型具有良好的临床净效益:我们的研究重点是创建和验证一个模型,用于评估接受阿司匹林治疗的心肌梗死患者的出血风险,该模型在辨别、校准和临床净获益方面表现出色。
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来源期刊
CiteScore
4.40
自引率
3.40%
发文量
150
审稿时长
2 months
期刊介绍: CATH is a peer-reviewed bi-monthly journal that addresses the practical clinical and laboratory issues involved in managing bleeding and clotting disorders, especially those related to thrombosis, hemostasis, and vascular disorders. CATH covers clinical trials, studies on etiology, pathophysiology, diagnosis and treatment of thrombohemorrhagic disorders.
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