Risk Estimation for Infection in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous
Yuanhui Liu1,2, Litao Wang1,3, Pengyuan Chen4
1Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Insights
A new risk score helps predict hospital infection risk in acute myocardial infarction (AMI) patients after percutaneous coronary intervention (PCI). This simple bedside tool aids clinicians in assessing infection risk and making informed treatment decisions.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Informatics
Background:
- Hospital-acquired infections are a significant risk for acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI).
- Current methods for assessing infection risk in these patients are inadequate.
- There is a need for a simple, accurate tool to predict post-PCI infection.
Purpose of the Study:
- To develop and validate a straightforward scoring system for predicting post-AMI infection risk in patients undergoing PCI.
- To create a bedside tool for clinicians to estimate infection risk and guide patient management.
Main Methods:
- A derivation cohort of ST-segment elevation myocardial infarction (STEMI) patients undergoing PCI (Jan 2010-May 2016) and a validation cohort (June 2016-May 2018) were analyzed.
- Logistic regression was used to develop a simplified risk model.
- The primary endpoint was post-AMI infection; secondary endpoints included all-cause death and major adverse cardiovascular events (MACE).
- Model performance was assessed using the area under the receiver operating curve (C-statistic) and calibration analysis.
Main Results:
- A 24-point risk score was developed, incorporating age, Killip classification, insulin use, white blood cell count, serum albumin, diuretic use, and transfemoral approach.
- The risk score demonstrated high discrimination in both development (C-statistic: 0.851) and validation cohorts.
- Infection risk increased progressively with higher scores in both cohorts (P < 0.001).
- The score also showed good performance for predicting in-hospital death and MACE.
Conclusions:
- A simple bedside risk score effectively estimates the risk of infection and other adverse outcomes in STEMI patients undergoing PCI.
- This tool empowers clinicians to proactively manage infection risk and improve patient care decisions.
- The validated scoring system offers a practical approach to risk stratification in this vulnerable patient population.
Background:
Infection during hospitalization is a serious complication among patients who suffered from acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI); however, there are no suitable and accurate means to assess risk. This study aimed to develop and validate a simple scoring system to predict post-AMI infection in such patients.
Methods:
All patients with ST-segment elevation myocardial infarction (STEMI) undergoing PCI consecutively enrolled from January 2010 to May 2016 were served as derivation cohort, and those from June 2016 to May 2018 as validation cohort, respectively. The primary endpoint was post-AMI infection during hospitalization, and all-cause death and major adverse cardiovascular events (MACE) were considered as secondary endpoints. The simplified risk model was established using logistic regression. The area under the receiver operating curve and calibration of predicted and observed infection risk were calculated.
Results:
A 24-point risk score was developed, with infection risk ranging from 0.7 to 99.6% for patients with the lowest and highest score. Seven variables including age, Killip classification, insulin use, white blood cell count, serum albumin, diuretic use, and transfemoral approach were included. This model achieved the same high discrimination in the development and validation cohort (C-statistic:0.851) and revealed adequate calibration in both datasets. The incidences of post-AMI infection increased steadily across risk score groups in both development (1.3, 5.1, 26.3, and 69.1%; P < 0.001) and validation (1.8, 5.9, 27.2, and 79.2%; P < 0.001) cohort. Moreover, the risk score demonstrated good performance for infection, in-hospital all-cause death, and MACE among these patients, as well as in patients with the non-ST-elevation acute coronary syndrome.
Conclusion:
This present risk score established a simple bedside tool to estimate the risk of developing infection and other in-hospital outcomes in patients with STEMI undergoing PCI. Clinicians can use this risk score to evaluate the infection risk and subsequently make evidence-based decisions.
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