Evaluation of a risk index for predicting short-term and long-term outcomes in patients with ST-elevation myocardial
Chunli Shao1, Jingjia Wang1, Ping Li1
1The State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
The admission Risk Index (RI) effectively predicts short-term and long-term mortality in ST-elevation myocardial infarction (STEMI) patients. This simple tool, using routine variables, aids clinicians in initial patient risk assessment.
Area of Science:
- Cardiology
- Clinical Risk Prediction
- Public Health
Background:
- The Risk Index (RI) is a simple tool for predicting death risk in ST-elevation myocardial infarction (STEMI) patients.
- Its predictive performance for short- and long-term mortality in Chinese STEMI patients undergoing percutaneous coronary intervention or conservative treatment is not well-established.
Purpose of the Study:
- To evaluate the utility of the admission Risk Index (RI) for predicting short-term and long-term outcomes in a diverse population of STEMI patients.
- To assess the RI's effectiveness in the Chinese population using data from the Chinese Acute Myocardial Infarction Registry.
Main Methods:
- The RI was calculated using age, heart rate (HR), and systolic blood pressure (SBP) with the formula (HR×[age/10]²)/SBP.
- The study predicted mortality over 12 months using the RI and compared its performance to the Global Registry in Acute Coronary Events (GRACE) score.
Main Results:
- The admission RI demonstrated strong predictive ability for in-hospital, 1-, 6-, and 12-month mortality (C-indices ranging from 0.77 to 0.78), outperforming the GRACE score (C-index 0.75).
- Categorizing RI into quintiles revealed a significant mortality gradient, with RI >34 indicating the highest mortality risk.
- The RI effectively differentiated short- and long-term mortality across different treatment groups.
Conclusions:
- The admission Risk Index (RI) is a valuable tool for predicting in-hospital and long-term mortality in STEMI patients.
- Its ease of calculation using routine variables makes it highly practical for clinicians during initial patient consultations.
Objective:
This study aimed to evaluate the usefulness of the admission risk index (RI) to predict short-term and long-term outcomes in a broad population with ST-elevation myocardial infarction (STEMI) using data from the Chinese Acute Myocardial Infarction Registry.
Background:
The RI was developed as a simple tool to predict risk of death in STEMI patients. The performance in predicting short-term and long-term risk of death in Chinese patients receiving percutaneous coronary intervention and conservative treatment for STEMI remains unclear.
Methods:
Age, heart rate (HR), and systolic blood pressure (SBP) were used to calculate RI using (HR×[age/10]2 )/SBP. We used the prediction tool to predict mortality over 12 months.
Results:
The C-index of the admission RI for predicting in-hospital, 1-, 6-, and 12-months mortality were 0.78, 0.78, 0.78, and 0.77, respectively, compared with 0.75 of the Global Registry in Acute Coronary Events score. Based on the receiver operating characteristic curve analysis, the RI was categorized into quintiles for convenient clinical use, and it revealed a nearly 15-fold gradient of increasing mortality from 2.29 to 32.5% (p < .0001) while RI >34 had the highest mortality. By categorizing into five different risk groups, the short-term and long-term mortality of patients receiving different treatments could be distinguished.
Conclusions:
RI based on three routine variables and easily calculated by any medical practitioner is useful for predicting in-hospital and long-term mortality in patients with STEMI at the initial consultation with clinicians.
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