This study developed and validated a seven-predictor nomogram (smoking, ST depression ≥1 mm, regional wall motion abnormality, LVEF, admission cardiac troponin I, IL-6, hs-CRP) that showed acceptable performance for identifying acute coronary occlusion in NSTEMI patients before angiography, although reliance on IL-6, which is not routinely available in all centers, may limit generalizability.
About one-quarter of NSTEMI patients undergoing coronary angiography had acute coronary occlusion.
A temporal split was used to create training and validation cohorts for model development.
LASSO regression selected seven predictors for the ACO prediction model.
The model showed acceptable discrimination in both training and validation cohorts.
The model showed good calibration and favorable clinical utility.
The model may aid early identification of ACO before angiography, but its reliance on IL-6 may limit generalizability.
This study looked at patients having a type of heart attack called NSTEMI, in which the ECG does not show the classic ST-elevation pattern. In some of these patients, a coronary artery is completely blocked (acute coronary occlusion), which is linked to worse outcomes. Among 1,004 patients who had angiography at one center between 2016 and 2023, about 26% had this kind of blockage. The researchers built a scoring tool (a nomogram) to estimate each patient's chance of having a blocked artery before the angiogram. The tool uses seven pieces of information: smoking history, ST-segment depression on the ECG, abnormal wall motion of the heart on ultrasound, the heart's pumping strength (ejection fraction), troponin I on admission, and two inflammation markers (IL-6 and hs-CRP). It was built using patients from 2016-2020 and tested on later patients from 2021-2023. It performed moderately well in both groups (AUC about 0.73 and 0.72), and its predicted probabilities matched what was actually observed. This research suggests such a tool could help clinicians identify NSTEMI patients more likely to have a blocked artery earlier. However, performance was only moderate, and the model needs IL-6 measurements, which many hospitals do not routinely do. Since it was developed and tested at a single center over time, broader testing would be needed to know whether it works elsewhere.
Yu Q, Wang S, Zhao Y, Zhao Y, Xie S, Wang Y, et al.. (2026). Development and Validation of a Prediction Model for Acute Coronary Occlusion in Patients With Non-ST-Segment Elevation Myocardial Infarction.. Clinical cardiology. https://doi.org/10.1002/clc.70492