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Development and validation of clinical risk score to predict the cardiac rupture in patients with STEMI
Geng Qian1, Rong-Jie Jin1, Zhen-Hong Fu1
1Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
Insights
A new risk score identifies cardiac rupture (CR) in ST-elevation myocardial infarction (STEMI) patients. This tool helps predict CR risk, enabling timely interventions for better outcomes.
Area of Science:
- Cardiology
- Clinical Prediction Models
Background:
- Cardiac rupture (CR) is a critical and often fatal complication following ST-elevation myocardial infarction (STEMI).
- Existing prognostic tools for CR lack practicality, necessitating the development of accessible risk stratification methods.
Purpose of the Study:
- To develop and validate a practical risk score for predicting cardiac rupture in patients with STEMI.
- To identify key clinical predictors for early CR risk assessment.
Main Methods:
- A cohort of 11,234 STEMI patients from seven Chinese centers was analyzed.
- A risk model was developed using 7,455 patients and validated prospectively in 3,779 patients using ROC curves.
- The model incorporated seven independent baseline clinical predictors.
Main Results:
- The overall incidence of CR was 2.12%, with a 30-day mortality of 86% in CR patients.
- The developed risk score identified patients with CR incidence ranging from 0.2% to 13%, demonstrating good predictive value (AUC 0.78).
- Primary percutaneous coronary intervention reduced CR incidence in high and very high-risk groups.
Conclusions:
- A simple risk score utilizing seven baseline clinical variables effectively identifies STEMI patients at high risk of CR.
- This risk stratification tool facilitates the implementation of targeted treatment strategies for high-risk individuals.
Background:
Cardiac rupture (CR) is a fatal complication of ST-elevation myocardial infarction (STEMI) with poor prognosis. The aim of this study was to develop and validate practical risk score to predict the CR after STEMI.
Methods:
A total of 11,234 STEMI patients from 7 centers in China were enrolled in our study, we firstly developed a simplified fast-track CR risk model from 7455 STEMI patients, and then prospectively validated the CR risk model using receiver-operating characteristic (ROC) curves by the other 3779 consecutive STEMI patients. This trial is registered with ClinicalTrials.gov, number NCT02484326.
Results:
The incidence of CR was 2.12% (238/11,234), and the thirty-day mortality in CR patients was 86%. We developed a risk model which had 7 independent baseline clinical predictors (female sex, advanced age, anterior myocardial infarction, delayed admission, heart rate, elevated white blood cell count and anemia). The CR risk score system differentiated STEMI patients with incidence of CR ranging from 0.2% to 13%. The risk score system demonstrated good predictive value with area under the ROC of 0.78 (95% CI 0.73-0.84) in validation cohort. Primary percutaneous coronary intervention decreased the incidence of CR in high risk group (3.9% vs. 6.2%, p<0.05) and very high risk group (8.0% vs. 15.2%, p<0.05).
Conclusions:
A simple risk score system based on 7 baseline clinical variables could identify patients with high risk of CR, for whom appropriate treatment strategies can be implemented.
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