A nomogram model for predicting MACE risk following primary percutaneous coronary intervention in STEMI patients: an exploratory study based on serum GSDMD

doi:10.12122/j.issn.1673-4254.2026.03.09

Abstract

Abstract:

Objective 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. Conclusion 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.

Key words: gasdermin D, pyroptosis, ST-segment elevation acute myocardial infarction, major adverse cardiovascular events, primary percutaneous coronary intervention

Xinyi HU, Weijian WANG, Hui LI, Zongzheng CHEN, Xin ZHOU, Junfei YUAN, Liang CHEN. A nomogram model for predicting MACE risk following primary percutaneous coronary intervention in STEMI patients: an exploratory study based on serum GSDMD[J]. Journal of Southern Medical University, 2026, 46(3): 550-558.

Figures/Tables 8

References 32

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Variable	Non-MACE (n=74)	MACE (n=26)	Overall (n=100)	P
Pre-PPCI GSDMD				0.036
Low	46 (82.1%)	10 (17.9%)	56 (100.0%)
High	28 (63.6%)	16 (36.4%)	44 (100.0%)
Post-PPCI GSDMD				0.010
Low	57 (81.4%)	13 (18.6%)	70 (100.0%)
High	17 (56.7%)	13 (43.3%)	30 (100.0%)
ΔGSDMD				0.141
Low	38 (80.9%)	9(19.1%)	47 (100.0%)
High	36 (67.9%)	17(32.1%)	53 (100.0%)

Variable	Non-MACE (n=74)	MACE (n=26)	Overall (n=100)	P
Pre-PPCI GSDMD				0.036
Low	46 (82.1%)	10 (17.9%)	56 (100.0%)
High	28 (63.6%)	16 (36.4%)	44 (100.0%)
Post-PPCI GSDMD				0.010
Low	57 (81.4%)	13 (18.6%)	70 (100.0%)
High	17 (56.7%)	13 (43.3%)	30 (100.0%)
ΔGSDMD				0.141
Low	38 (80.9%)	9(19.1%)	47 (100.0%)
High	36 (67.9%)	17(32.1%)	53 (100.0%)

Basic clinical characteristics	Non-MACE (n=74)	MACE (n=26)	Overall (n=100)	P
Male [n (%)]	57 (77.0)	25 (96.2)	82 (82.0)	0.029
Age [year, Median (Q₁, Q₃)]	59.5 (46.75, 74.0)	61.5 (49.0, 77.5)	60.0 (48.5, 74.0)	0.494
Days of hospitalization [day, Median (Q₁, Q₃)]	9.00 (8.00, 11.0)	10.5 (9.75, 15.0)	10.0 (8.00, 12.0)	0.005
Killip classes [n (%)]				0.000
I	55 (74.3)	15 (57.7)	70 (70.0)
II	15 (20.3)	4 (15.4)	19 (19.0)
III	4 (5.4)	1 (3.8)	5 (5.0)
IV	0 (0.0)	6 (23.1)	6 (6.0)
Body weight [kg, Median (Q₁, Q₃)]	70.0 (62.0, 77.6)	75.0 (65.0, 80.0)	71.5 (63.3, 79.5)	0.214
Number of stents [n (%)]				0.121
0	14 (18.9)	2 (7.7)	16 (16.0)
1	50 (67.6)	16 (61.5)	66 (66.0)
2	7 (9.5)	7 (26.9)	14 (14.0)
3	3 (4.1)	1 (3.8)	4 (4.0)
Diabetes [n (%)]	27 (36.5)	9(34.6)	36 (36.0)	0.864
Hypertension [n (%)]	40 (54.1)	13(50.0)	53 (53.0)	0.722
Hyperlipidemia [n (%)]	13 (17.6)	2 (7.7)	15 (15.0)	0.229
Gensini score [Median (Q₁, Q₃)]	52.0 (40.0, 80.0)	64.0 (44.5, 97.0)	53.5 (40, 82)	0.377
LVEF [%, Median (Q₁, Q₃)])	58.0 (48.0, 60.0)	56.5 (43.0, 59.0)	57.5 (45.5, 60.0)	0.241
RBC (×10¹²/L, Mean±SD)	4.56±0.705	4.48±0.743	4.54±0.712	0.654
N [×10⁹/L, Median (Q₁, Q₃)]	6.43 (4.95, 8.10)	7.05 (4.76, 8.75)	6.53 (4.94, 8.29)	0.755
hsCRP [mg/dL, Median (Q₁, Q₃)]	5.27 (2.60, 9.79)	19.9 (2.99, 52.39)	6.10 (2.75, 26.65)	0.021
ALB [g/L, Median (Q₁, Q₃)]	39.1 (36.10, 41.80)	35.2 (31.4, 36.8)	38.7 (35.5, 41.1)	0.000
UA [μmol/L, Median (Q₁, Q₃)]	359 (291, 432)	379 (348, 439)	368 (304, 435)	0.149
Cr [μmol/L, Median (Q₁, Q₃)]	69.0 (60.0, 79.0)	77.5 (63.0, 100.0)	71.0 (60.0, 82.0)	0.058
GGT [U/L, Median (Q₁, Q₃)]	25.5 (19.0, 39.0)	37.0 (24.0, 55.0)	27.0 (19.5, 48.5)	0.137
Glu [mmol/L, Median (Q₁, Q₃)]	5.96 (5.14, 6.89)	6.00 (5.01, 8.13)	5.96 (5.11, 7.65)	0.590
HbA1c [%, Median (Q₁, Q₃)]	5.85 (5.50, 7.20)	5.80 (5.50, 6.80)	5.80 (5.50, 7.15)	0.743
LDL-C [mmol/L, Median (Q₁, Q₃)]	2.64 (2.02, 3.14)	2.61 (2.00, 2.96)	2.64 (2.00, 3.12)	0.723
HDL-C [mmol/L, Median (Q₁, Q₃)]	0.945 (0.820, 1.112)	0.840 (0.800, 1.013)	0.935 (0.810, 1.070)	0.108
Apo(a) [mg/L, Median (Q₁, Q₃)]	130 (60, 270)	169 (63, 395)	141 (62, 320)	0.282
CKMB [U/L, Median (Q₁, Q₃)]	72.3 (14.7, 193.2)	33.1 (15.4, 117.2)	55.8 (15.3, 157.9)	0.207
NT-proBNP [pg/mL, Median (Q₁, Q₃)]	1905 (651, 2949)	1539 (848, 3313)	1864 (719, 3041)	0.782
cTnI [ng/mL, Median (Q₁, Q₃)]	33.8 (7.6, 50.0)	36.3 (8.4, 50.0)	33.8 (8.1, 50.0)	0.918
D-dimer [mg/L FEU, Median (Q₁, Q₃)]	0.335 (0.210, 0.540)	0.485 (0.270, 1.620)	0.405 (0.215, 0.680)	0.037
FIB [g/L, Median (Q₁, Q₃)]	2.80 (2.50, 3.65)	3.48 (2.54, 5.85)	2.94 (2.50, 3.96)	0.034

Basic clinical characteristics	Non-MACE (n=74)	MACE (n=26)	Overall (n=100)	P
Male [n (%)]	57 (77.0)	25 (96.2)	82 (82.0)	0.029
Age [year, Median (Q₁, Q₃)]	59.5 (46.75, 74.0)	61.5 (49.0, 77.5)	60.0 (48.5, 74.0)	0.494
Days of hospitalization [day, Median (Q₁, Q₃)]	9.00 (8.00, 11.0)	10.5 (9.75, 15.0)	10.0 (8.00, 12.0)	0.005
Killip classes [n (%)]				0.000
I	55 (74.3)	15 (57.7)	70 (70.0)
II	15 (20.3)	4 (15.4)	19 (19.0)
III	4 (5.4)	1 (3.8)	5 (5.0)
IV	0 (0.0)	6 (23.1)	6 (6.0)
Body weight [kg, Median (Q₁, Q₃)]	70.0 (62.0, 77.6)	75.0 (65.0, 80.0)	71.5 (63.3, 79.5)	0.214
Number of stents [n (%)]				0.121
0	14 (18.9)	2 (7.7)	16 (16.0)
1	50 (67.6)	16 (61.5)	66 (66.0)
2	7 (9.5)	7 (26.9)	14 (14.0)
3	3 (4.1)	1 (3.8)	4 (4.0)
Diabetes [n (%)]	27 (36.5)	9(34.6)	36 (36.0)	0.864
Hypertension [n (%)]	40 (54.1)	13(50.0)	53 (53.0)	0.722
Hyperlipidemia [n (%)]	13 (17.6)	2 (7.7)	15 (15.0)	0.229
Gensini score [Median (Q₁, Q₃)]	52.0 (40.0, 80.0)	64.0 (44.5, 97.0)	53.5 (40, 82)	0.377
LVEF [%, Median (Q₁, Q₃)])	58.0 (48.0, 60.0)	56.5 (43.0, 59.0)	57.5 (45.5, 60.0)	0.241
RBC (×10¹²/L, Mean±SD)	4.56±0.705	4.48±0.743	4.54±0.712	0.654
N [×10⁹/L, Median (Q₁, Q₃)]	6.43 (4.95, 8.10)	7.05 (4.76, 8.75)	6.53 (4.94, 8.29)	0.755
hsCRP [mg/dL, Median (Q₁, Q₃)]	5.27 (2.60, 9.79)	19.9 (2.99, 52.39)	6.10 (2.75, 26.65)	0.021
ALB [g/L, Median (Q₁, Q₃)]	39.1 (36.10, 41.80)	35.2 (31.4, 36.8)	38.7 (35.5, 41.1)	0.000
UA [μmol/L, Median (Q₁, Q₃)]	359 (291, 432)	379 (348, 439)	368 (304, 435)	0.149
Cr [μmol/L, Median (Q₁, Q₃)]	69.0 (60.0, 79.0)	77.5 (63.0, 100.0)	71.0 (60.0, 82.0)	0.058
GGT [U/L, Median (Q₁, Q₃)]	25.5 (19.0, 39.0)	37.0 (24.0, 55.0)	27.0 (19.5, 48.5)	0.137
Glu [mmol/L, Median (Q₁, Q₃)]	5.96 (5.14, 6.89)	6.00 (5.01, 8.13)	5.96 (5.11, 7.65)	0.590
HbA1c [%, Median (Q₁, Q₃)]	5.85 (5.50, 7.20)	5.80 (5.50, 6.80)	5.80 (5.50, 7.15)	0.743
LDL-C [mmol/L, Median (Q₁, Q₃)]	2.64 (2.02, 3.14)	2.61 (2.00, 2.96)	2.64 (2.00, 3.12)	0.723
HDL-C [mmol/L, Median (Q₁, Q₃)]	0.945 (0.820, 1.112)	0.840 (0.800, 1.013)	0.935 (0.810, 1.070)	0.108
Apo(a) [mg/L, Median (Q₁, Q₃)]	130 (60, 270)	169 (63, 395)	141 (62, 320)	0.282
CKMB [U/L, Median (Q₁, Q₃)]	72.3 (14.7, 193.2)	33.1 (15.4, 117.2)	55.8 (15.3, 157.9)	0.207
NT-proBNP [pg/mL, Median (Q₁, Q₃)]	1905 (651, 2949)	1539 (848, 3313)	1864 (719, 3041)	0.782
cTnI [ng/mL, Median (Q₁, Q₃)]	33.8 (7.6, 50.0)	36.3 (8.4, 50.0)	33.8 (8.1, 50.0)	0.918
D-dimer [mg/L FEU, Median (Q₁, Q₃)]	0.335 (0.210, 0.540)	0.485 (0.270, 1.620)	0.405 (0.215, 0.680)	0.037
FIB [g/L, Median (Q₁, Q₃)]	2.80 (2.50, 3.65)	3.48 (2.54, 5.85)	2.94 (2.50, 3.96)	0.034