The risk score for in-hospital mortality in patients with ST-segment elevation myocardial infarction
I S Bessonov1, V A Kuznetsov1, S S Sapozhnikov1
1Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia.
Insights
A new scoring system accurately predicts in-hospital death risk for patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). This tool helps identify high-risk STEMI patients for improved clinical management.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Risk Prediction
Background:
- ST-segment elevation acute myocardial infarction (STEMI) remains a leading cause of mortality.
- Accurate prediction of in-hospital death is crucial for timely intervention and resource allocation.
- Existing risk stratification tools may not fully incorporate outcomes of percutaneous coronary intervention (PCI).
Purpose of the Study:
- To develop and validate a novel scoring scale for predicting individual in-hospital mortality risk in STEMI patients.
- To integrate percutaneous coronary intervention (PCI) results into the risk prediction model.
- To identify key independent predictors of in-hospital death in this patient cohort.
Main Methods:
- Retrospective analysis of 1,649 STEMI patients undergoing PCI from a hospital registry (2006-2017).
- Data split into a training set (n=1150) for score development and a test set (n=499) for validation.
- Multivariate logistic regression and linear transformation used to compute the risk score based on identified predictors.
Main Results:
- Seven independent predictors of in-hospital death identified: advanced age, Killip class III-IV heart failure, prolonged ischemia time (>180 min), anterior MI, PCI failure, high SYNTAX score (≥16), and elevated admission glycemia.
- A total score of ≥10 indicated a high probability of in-hospital death (18.2% in training set).
- The scale demonstrated high predictive accuracy with an Area Under the Curve (AUC) of 0.902 (training) and 0.924 (test) and good sensitivity and specificity in both sets.
Conclusions:
- The developed scoring scale provides a reliable and accurate method for identifying STEMI patients at high risk of in-hospital mortality.
- This tool can aid clinicians in risk stratification and optimizing management strategies for STEMI patients undergoing PCI.
- The scale's validation in an independent test set supports its clinical utility.
Abstract:
Aim To develop a scale (score system) for predicting the individual risk of in-hospital death in patients with ST segment elevation acute myocardial infarction (STEMI) with an account of results of percutaneous coronary intervention (PCI).Material and methods The analysis used data of 1 649 sequential patients with STEMI included into the hospital registry of PCI from 2006 through 2017. To test the model predictability, the original sample was divided into two groups: a training group consisting of 1150 (70 %) patients and a test group consisting of 499 (30 %) patients. The training sample was used for computing an individual score. To this purpose, β-coefficients of each variable obtained at the last stage of the multivariate logistic regression model were subjected to linear transformation. The scale was verified using the test sample.Results Seven independent predictors of in-hospital death were determined: age ≥65 years, acute heart failure (Killip class III-IV), total myocardial ischemia time ≥180 min, anterior localization of myocardial infarction, failure of PCI, SYNTAX scale score ≥16, glycemia on admission ≥7.78 mmol/l for patients without a history of diabetes mellitus and ≥14.35 mmol/l for patients with a history of diabetes mellitus. The contribution of each value to the risk of in-hospital death was ranked from 0 to 7. A threshold total score of 10 was determined; a score ≥10 corresponded to a high probability of in-hospital death (18.2 %). In the training sample, the sensitivity was 81 %, the specificity was 80.6 %, and the area under the curve (AUC) was 0.902. In the test sample, the sensitivity was 96.2 %, the specificity was 83.3 %, and the AUC was 0.924.Conclusion The developed scale has a good predictive accuracy in identifying patients with acute STEMI who have a high risk of fatal outcome at the hospital stage.
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