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Identifying patients with refusal of percutaneous coronary intervention for acute myocardial infarction: a classification and regression tree analysis

  • Manyan Wu
  • Long Li
  • Sufang Li
  • Yuxia Cui
  • Dan Hu
  • Junxian Song
  • Chongyou Lee
  • Hong ChenEmail author
IM - ORIGINAL
  • 50 Downloads

Abstract

The purpose of the present study is to develop and validate a prediction tool to identify patients who refuse to receive percutaneous coronary intervention (PCI) rapidly. We developed a risk stratification model using the derivation cohort of 288 patients with ST segment elevation myocardial infarction (STEMI) in our hospital and validated it in a prospective cohort of 115 patients. There were 52 (18.1%) patients and 18 (15.7%) patients who refused PCI among derivation and validation cohort, respectively. A classification and regression tree (CART) analysis and multivariate logistic regression were used for statistical analysis. The decision-making factors for refusal of PCI were also investigated. The CART analysis and logistic regression both showed that self-rated mild symptom was the most significant predictor of not choosing PCI. The model generated three risk groups. The high-risk group included: self-rated mild symptoms; self-rated severe symptom, glomerular filtration rate < 60 ml/min/1.73m2. The intermediate-risk group included: self-rated severe symptom, glomerular filtration rate ≥ 60 ml/min/1.73m2 and age ≥ 75 years. The low-risk group included: self-rated severe symptom, glomerular filtration rate ≥ 60 ml/min/1.73m2 and age < 75 years. The prevalence for refusal of PCI of the three groups were 45%–44%, 18% and 4%, respectively. The sensitivity was 88% and the negative predictive value was 96%. And similar results were obtained when this prediction tool was applied prospectively to the validation cohort. Patients at low and high risk can be easily identified for refusal of PCI by the prediction tool using common clinical data. This practical model might provide useful information for rapid recognition and early response for this kind of crowd.

Keywords

Acute myocardial infarction Percutaneous coronary intervention Clinical prediction rule 

Notes

Acknowledgements

This study was supported by National Natural Science Foundation of China (81770356).

Conflict of interest

There were no potential conflicts of interest in this study, including related consultancies, shareholdings and grant funding.

Statement of human and animal rights

Our study has been approved by the institutional research ethics committee of our hospital (2014PHB125-01) and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki.

Informed consent

Informed consent was obtained from each patient.

Supplementary material

11739_2019_2079_MOESM1_ESM.pdf (295 kb)
Supplementary file1 (PDF 295 kb)

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Copyright information

© Società Italiana di Medicina Interna (SIMI) 2019

Authors and Affiliations

  1. 1.Department of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Center for Cardiovascular Translational ResearchPeking University People’s HospitalBeijingChina

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