Factors associated with in-hospital heart failure after emergency percutaneous coronary intervention in patients with type 2 diabetes mellitus complicated by ST-segment elevation myocardial infarction: a retrospective study
TL;DR
Readily available admission variables were associated with in-hospital HF in T2DM-STEMI patients undergoing emergency PCI and the internally validated model showed good discrimination and calibration; however, external validation in an independent population is required before clinical implementation.
Abstract
Background Type 2 diabetes mellitus (T2DM) is associated with adverse outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Despite emergency percutaneous coronary intervention (PCI), in-hospital heart failure (HF) remains an important complication. This study aimed to identify factors independently associated with new-onset in-hospital HF and to develop an internally validated prediction model in patients with T2DM and STEMI undergoing emergency PCI. Methods This retrospective observational study included 306 adult patients with T2DM and STEMI who underwent emergency PCI at the People’s Hospital of Xinjiang Uygur Autonomous Region between January 2022 and February 2026. Patients were classified into HF (n=65) and non-HF (n=241) groups according to new-onset clinically documented HF during the index hospitalization; all patients classified as having HF had a maximum Killip class ≥ II. Natriuretic peptides and echocardiographic findings were used as supportive evidence and were not included as predictors. Clinical, laboratory, echocardiographic, and selected procedural variables were analyzed using univariate and multivariable binary logistic regression. Model performance was assessed using discrimination, calibration, 10-fold cross-validation, and bootstrap optimism correction. Results Independent positive associations with in-hospital HF were observed for prior myocardial infarction (OR = 6.205, 95% CI: 2.692–14.299, P<0.001), smoking (OR = 5.552, 95% CI: 2.517–12.247, P<0.001), regional wall motion abnormalities (OR = 2.415, 95% CI: 1.091–5.344, P = 0.030), higher white blood cell count (OR = 1.143 per 109/L, 95% CI: 1.072–1.219, P<0.001), higher systolic blood pressure (OR = 1.018 per mmHg, 95% CI: 1.001–1.034, P = 0.032), and age ≥75 years (OR = 4.792, 95% CI: 1.394–16.472, P = 0.013). Hemoglobin (OR = 0.971 per 1 g/L increase, 95% CI: 0.952–0.990, P = 0.003) and LVEF (OR = 0.953 per 1 percentage-point increase, 95% CI: 0.911–0.998, P = 0.040) were inversely associated with HF, indicating greater HF odds at lower values. The model showed an apparent AUC of 0.881 and an optimism-corrected AUC of 0.843, with Hosmer–Lemeshow P = 0.826. Conclusion Readily available admission variables were associated with in-hospital HF in T2DM-STEMI patients undergoing emergency PCI. The internally validated model showed good discrimination and calibration; however, given the retrospective single-center design and limited number of HF events, external validation in an independent population is required before clinical implementation.