Abstract
OBJECTIVES: To investigate the value of serum gasdermin D (GSDMD) level for predicting 30-day major adverse cardiovascular events (MACE) in patients following primary percutaneous coronary intervention (PPCI) for acute ST-segment elevation myocardial infarction (STEMI) and construct a predictive nomogram. METHODS: A total of 100 STEMI patients undergoing PPCI were prospectively enrolled. Serum GSDMD levels of the patients were measured by ELISA before and on the second morning after PPCI and compared using Wilcoxon signed-rank test. The patients were divided into high-GSDMD and low-GSDMD groups based on the optimal cut-off value of postoperative GSDMD levels determined by the Youden index. During the 30-day follow-up, the patients were categorized into MACE group (n=26) and non-MACE group (n=74). The key predictors were selected using univariable and LASSO regression, followed by multivariable logistic regression to identify the independent risk factors. A nomogram was constructed and evaluated by ROC curve analysis, Bootstrap internal validation, Hosmer-Lemeshow test, calibration plots and decision curve analysis (DCA). RESULTS: Post-PPCI serum GSDMD levels were significantly elevated relative to the pre-PPCI levels (Z=-4.848, P<0.001). The incidence of 30-day MACE was significantly higher in the high GSDMD group (P=0.01). Post-PPCI GSDMD level was identified as an independent risk factor for short-term MACE. The final nomogram incorporated Killip classification, number of stents, albumin, and post-PPCI GSDMD and demonstrated good predictive performance with an AUC of 0.847 (P<0.001, 95% CI: 0.759-0.936), a sensitivity of 84.6% and a specificity of 79.7%. All the validation analyses confirmed good predictive efficacy and clinical utility of the model. CONCLUSIONS: Elevated post-PPCI serum GSDMD level is an independent risk factor for 30-day MACE in STEMI patients. The nomogram model based on this biomarker provides a reliable tool for short-term risk stratification of these patients.