Analysis of prognostic factors and construction of a risk model for patients with acute cerebral infarction treated with dual antiplatelet therapy after optimal hyper thrombolytic time window.

The objective was to identify potential risk factors for the progno-sis of dual antiplatelet therapy in patients with acute cerebral infarction (ACI) treated beyond the optimal time window to prevent thrombolysis, and to con-struct a nomogram to evaluate such risk. The clinical data of 300 ACI patients treated outside the optimal hyperthrombolytic time window and admitted to our hospital from January 2020 to May 2024 were analyzed retrospectively. The association between potential risk factors for poor prognosis after dual anti-platelet therapy was tested by logistic regression. A nomogram was constructed to evaluate the risk of poor prognosis based on the results. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the ability of the model to differentiate types of prognoses. A calibration curve evaluated the consistency of the model, and the fitting of the model was evalu-ated by the Hosmer-Lemeshow (HL) test. Of the 300 patients, 52 (17.3%) had a poor prognosis. Old age, hypertension history, elevated homocysteine, elevated fibrinogen level and carotid artery stenosis were risk factors associated with poor prognosis in patients with ACI. A nomogram was built based on these risk factors. The AUC, calibration curve, and HL test demonstrated that the selected model was statistically capable of discriminating between good and poor prognosis. In conclusion, advanced age, a history of hypertension, elevated homocysteine, elevated fibrinogen, and carotid artery stenosis are risk factors associated with a poor prognosis for patients with ACI treated beyond the op-timal time window. If validated, the nomogram based on these five risk factors could be used to distinguish between cases with poor prognosis and those with good prognosis among these patients.