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Prognostic Scale to Stratify Risk of Intrahospital Death in Patients with Acute Myocardial Infarction with ST-Segment
Insights
A new risk scale accurately predicts in-hospital death for ST-segment elevation myocardial infarction patients using accessible data. This tool aids resource-limited settings in assessing mortality risk effectively.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- Existing mortality prediction scales for acute coronary syndrome often rely on complex diagnostics unavailable in resource-limited settings.
- There is a need for accessible, sensitive, and specific instruments to evaluate risk in such environments.
- This study addresses the gap by focusing on readily available clinical and demographic data.
Purpose of the Study:
- To develop and validate a novel risk stratification scale for estimating intra-hospital mortality in patients diagnosed with ST-segment elevation myocardial infarction (STEMI).
- To provide a tool that utilizes accessible resources for risk assessment in healthcare facilities with limited capabilities.
- To improve the management of STEMI patients by enabling early identification of high-risk individuals.
Main Methods:
- An observational, analytical study was conducted on 667 STEMI patients admitted to a provincial hospital in Cuba.
- Data collected included demographic variables, cardiovascular risk factors, vital signs, blood glucose, ECG parameters (QT interval), left ventricular ejection fraction, and glomerular filtration rate.
- Patients were classified using the Killip-Kimball scale; a risk scale was constructed and its predictive ability assessed using receiver-operator curve analysis.
Main Results:
- The study identified 77 in-hospital deaths (11.5%) among STEMI patients.
- Deceased patients exhibited higher blood glucose levels and lower systolic blood pressure, diastolic blood pressure, left ventricular ejection fraction, and glomerular filtration rate compared to survivors.
- Key predictors for mortality included cardiorespiratory arrest, elevated blood glucose (>11.1 mmol/L), systolic blood pressure, Killip-Kimball class, glomerular filtration rate, corrected QT interval dispersion, and left ventricular ejection fraction. The scale achieved a detectability index of 0.92.
Conclusions:
- The developed numerical risk scale effectively estimates and stratifies the risk of in-hospital death for STEMI patients.
- The scale demonstrates robust metric properties, including predictive ability and calibration, making it suitable for clinical application.
- This tool offers a valuable, accessible method for risk assessment in resource-limited healthcare settings, aiding in timely interventions for STEMI patients.
Abstract:
INTRODUCTION The scales available to predict death and complica-tions after acute coronary syndrome include angiographic studies and serum biomarkers that are not within reach of services with limited resources. Such services need specifi c and sensitive instruments to evaluate risk using accessible resources and information. OBJECTIVE Develop a scale to estimate and stratify the risk of intra-hospital death in patients with acute ST-segment elevation myocardial infarction. METHODS An analytical observational study was conducted in a universe of 769 patients with acute ST-segment elevation myocardial infarction who were admitted consecutively to the Camilo Cienfuegos Provincial Hospital in Sancti Spíritus Province, Cuba, from January 2013 to March 2018. The fi nal study cohort included 667 patients, ex-cluding 102 due to branch blocks, atrial fi brillation, drugs that prolong the QT interval, low life expectancy or history of myocardial infarction. The demographic variables of age, sex, skin color, classic cardiovas-cular risk factors, blood pressure, heart rate, blood glucose level, in addition to duration and dispersion of the QT interval with and without correction, left ventricular ejection fraction, and glomerular fi ltration rate were included in the analysis. Patients were categorized according to the Killip-Kimball Classifi cation for degree of heart failure. A risk scale was constructed, the predictive ability of which was evaluated using the detectability index associated with an receiver-operator curve.RESULTS Seventy-seven patients died (11.5%). Mean blood glucose levels were higher among the deceased, while their systolic and dia-stolic blood pressure, left ventricular ejection fraction, and glomerular fi ltration rate were lower than those participants discharged alive. Rel-evant variables included in the scale were systolic blood pressure, Killip-Kimball class, cardiorespiratory arrest, glomerular fi ltration rate, corrected QT interval dispersion, left ventricular ejection fraction, and blood glucose levels. The variable with the best predictive ability was cardiorespiratory arrest, followed by a blood glucose level higher than 11.1 mmol/L. The scale demonstrated a great predictive ability with a detectability index of 0.92. CONCLUSIONS The numeric scale we designed estimates and strati-fi es risk of death during hospitalization for patients with ST-segment elevation myocardial infarction and has good metric properties for predictive ability and calibration. KEYWORDS ST-segment elevation myocardial infarction, mortality, risk assessment, Cuba.
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