Risk score comparison of outcomes in patients presenting with ST-elevation myocardial infarction treated with
Elizabeth Ann Scruth1, Eugene Cheng, Linda Worrall-Carter
1St Vincent's/ACU Centre for Nursing Research, School of Nursing and Midwifery, Faculty of Health Sciences, Australian Catholic University National, Melbourne, Australia. Elizabeth.Scruth@kp.org
Insights
The CADILLAC risk score demonstrated superior prediction for major cardiac events in ST-elevation myocardial infarction (STEMI) patients undergoing primary PCI compared to TIMI and GRACE scores. All three scores effectively stratified risk, aiding acute coronary syndrome management.
Area of Science:
- Cardiology
- Clinical Risk Stratification
- Interventional Cardiology
Background:
- Accurate risk stratification is crucial for managing patients with acute coronary syndrome (ACS).
- Several risk scores exist for stratifying hospitalized ACS patients.
- This study focuses on ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI).
Purpose of the Study:
- To compare the prognostic value of three risk scores: Thrombolysis in Myocardial Infarction (TIMI), Controlled Abciximab and Device Investigation to Lower Late Angioplasty complications (CADILLAC), and Global Registry for Acute Coronary events (GRACE).
- To evaluate their effectiveness in predicting secondary events in STEMI patients undergoing primary PCI.
Main Methods:
- Retrospective analysis of 186 STEMI patients treated with PCI between January 2007 and January 2008.
- Calculation of TIMI, CADILLAC, and GRACE risk scores for each patient.
- Analysis of predictive ability using the area under the curve (C statistic).
Main Results:
- All three risk scores showed high predictive accuracy for in-hospital major cardiac events (C statistics 0.63-0.718), with CADILLAC being superior.
- Predictive accuracy for in-hospital non-major cardiac events was similar across the scores (C statistics 0.62-0.66).
Conclusions:
- TIMI, CADILLAC, and GRACE risk scores are all viable for stratifying STEMI patients undergoing primary PCI.
- CADILLAC and GRACE scores were more predictive for in-hospital major events.
- CADILLAC and TIMI scores were more predictive for major cardiac events at one year.
Background:
Accurate risk stratification is important in the management of acute coronary syndrome (ACS) patients. Several risk scores have been developed to stratify patients hospitalized with ACS.
Aim:
To compare the prognostic value of three risk scores used to determine the risk for secondary events in patients diagnosed with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).
Methods:
A retrospective analysis of patients with an ACS experiencing a STEMI treated with PCI presenting to a Kaiser Permanente Foundation Hospital in Northern California from January 2007 to January 2008 (n=186). For each patient, the Thrombolysis in Myocardial Infarction (TIMI), Controlled Abciximab and Device Investigation to Lower Late Angioplasty complications (CADILLAC), and Global Registry for Acute Coronary events (GRACE) risk scores were calculated and predictive ability was analysed using the area under the curve or C statistic method.
Results:
The CADILLAC, TIMI, and GRACE risk scores all had high predictive accuracy for a major cardiac event in hospital, with C statistics ranging from 0.63 to 0.718 with the CADILLAC risk score superior. For non-major cardiac events in hospital, the three risk scores were similar in accuracy for predictability, with C statistics ranging from 0.62 to 0.66.
Conclusions:
Risk stratification of patients with STEMI undergoing primary percutaneous coronary intervention can be done using all three risk scores. In our analysis, the CADILLAC and GRACE score was more predictive for major cardiac events in hospital and CADILLAC and TIMI for major cardiac events at 1 year.
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