[Establishment and validation of echocardiographic index prediction model for mortality risk within 24 hours in patients with acute myocardial infarction complicated with cardiac rupture].

OBJECTIVE: To explore the risk factors of death within 24 hours in patients with acute myocardial infarction (AMI) complicated by cardiac rupture in echocardiographic indicators, build a risk prediction model and explore its prediction efficiency.

METHODS: A retrospective analysis was conducted. Echocardiographic data of patients diagnosed with AMI complicated by cardiac rupture admitted to Xiangya Third Hospital of Central South University from June 2020 to June 2025 were enrolled. Patients were divided into survival group and death group based on whether they died within 24 hours after diagnosis. Echocardiographic parameters were compared between the two groups. Multivariate Logistic regression analysis was performed to identify factors associated with death within 24 hours. Based on these findings, a risk prediction model was established and presented as a nomogram. The discriminative ability of the model was evaluated using the receiver operator characteristic curve (ROC curve). The Bootstrap method with 1 000 resampling iterations was used for internal validation. The predictive performance and clinical applicability of the model were comprehensively assessed by integrating the ROC curve, calibration curve, and decision curve analysis.

RESULTS: A total of 76 patients were included, comprising 54 males (71%) and 22 females (29%), with a median age of 64 (56, 68) years old. There were 50 patients in the death group and 26 patients in the survival group. The proportion of males was higher in the death group than in the survival group (80% vs. 54%, P<0.05), while there was no difference in age between the two groups (P>0.05). In the echocardiographic parameters, the death group showed larger left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), and a higher proportion of massive pericardial effusion compared with the survival group [LAD (mm): 39 (35, 43) vs. 33 (31, 37), LVEDD (mm): 59 (54, 64) vs. 48 (45, 54), massive pericardial effusion: 36% vs. 8%], left ventricular ejection fraction (LVEF) and stroke volume (SV) were lower in the death group than in the survival group [LVEF: 0.39 (0.31, 0.50) vs. 0.53 (0.45, 0.58), SV (mL): 40 (30, 52) vs. 55 (49, 67)], with all differences being statistically significant (all P<0.05). There were no significant differences in right atrial diameter, right ventricular diameter, severity of aortic regurgitation, mitral regurgitation, tricuspid regurgitation, and the proportions of ventricular aneurysm and anterior wall segmental wall motion abnormalities between the two groups (all P>0.05). Multivariate Logistic regression analysis showed that massive pericardial effusion [odds ratio (OR)=6.995, 95% confidence interval (95%CI) was 1.102-44.396, P=0.039] and elevated LVEDD (OR=1.188, 95%CI was 1.032-1.369, P=0.017) were risk factors for death within 24 hours in patients with AMI complicated by cardiac rupture, elevated SV was a protective factor against death within 24 hours in these patients (OR=0.926, 95%CI was 0.867-0.989, P=0.022). A prediction model was constructed using LVEDD, SV, and massive pericardial effusion. The area under the ROC curve (AUC) was 0.894 (95%CI was 0.817-0.955), and the sensitivity was 86.0% and specificity was 84.6% when the optimal cut-off value was 0.555. The internally validated model achieved an AUC of 0.899 (95%CI was 0.814-0.962), and the sensitivity was 83.7% and specificity was 90.7% when the optimal cut-off value was 0.638. Calibration curve and clinical decision curve analysis indicated good model consistency and net benefit.

CONCLUSIONS: The risk prediction model based on echocardiographic parameters has certain predictive value for the risk of death within 24 hours in patients with AMI complicated by cardiac rupture.