Risk of complications after a non-ST segment elevation acute myocardial infarction in a Latin-American cohort: An
Juan Felipe Vasquez-Rodriguez1, Carolina Idrovo-Turbay2, Oscar M Perez-Fernandez3
1Department of Cardiology, Fundación Cardioinfantil, LaCardio, Bogota, Colombia.; Universidad del Rosario, School of Medicine and Health Sciences, Bogota, Colombia..
Insights
The ACTION ICU score shows promise for identifying high-risk non-ST-elevation myocardial infarction (NSTEMI) patients in Latin America who may need Intensive Care Unit (ICU) care. This score can help guide selective ICU admissions for NSTEMI management.
Area of Science:
- Cardiology
- Critical Care Medicine
Background:
- European Society of Cardiology (ESC) guidelines recommend Intensive Care Unit (ICU) surveillance for acute coronary syndromes without persistent ST-segment elevation (NSTEMI) patients.
- Decreasing in-hospital mortality for NSTEMI patients suggests potential for management in general hospital wards.
- The ACTION ICU score was developed to identify high-risk NSTEMI patients needing selective ICU care.
Purpose of the Study:
- To evaluate the utility of the ACTION ICU score in predicting complications requiring ICU admission in a Latin American NSTEMI cohort.
- To assess the risk stratification capabilities of the ACTION ICU score for NSTEMI patients in a real-world setting.
Main Methods:
- A retrospective cohort study applied the ACTION ICU score to NSTEMI patients.
- A composite primary outcome included cardiorespiratory arrest, shock, high-grade atrio-ventricular block, respiratory failure, stroke, or death.
- Predictive performance was analyzed using conditional multivariable logistic regression.
Main Results:
- Of 1,062 NSTEMI patients, 7.1% experienced the primary outcome; 96% were admitted to the ICU.
- Respiratory failure (4.0%), cardiogenic shock (3.7%), and cardiac arrest (1.7%) were the most frequent complications.
- Heart failure signs/symptoms showed the highest association with the primary outcome (OR: 2.16). A score of 3 was the optimal cut-off (Sensitivity: 96%, Specificity: 15.4%).
Conclusions:
- The ACTION ICU score demonstrates potential as a tool for identifying the need for ICU care in Latin American NSTEMI patients.
- Further research is warranted to explore the cost-effectiveness of utilizing the ACTION ICU score for selective ICU admission strategies.
Background:
European Society of Cardiology (ESC) guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation (NSTEMI) recommend Intensive Care Unit (ICU) surveillance during the first 24-48 h. Interestingly, the in-hospital mortality of NSTEMI patients has consistently decreased, giving some patients the option to be managed in general hospital wards. The ACTION ICU score has been proposed to identify high-risk patients with NSTEMI and guide the selective risk-based need for ICU care.
Objective:
To evaluate the usefulness of the ACTION ICU score to predict patients' risk of developing complications requiring ICU care in a Latin-American cohort with NSTEMI.
Methods:
We applied the ACTION ICU score in a retrospective cohort. A composite primary outcome included: cardiorespiratory arrest, shock, high-grade atrio-ventricular block, respiratory failure, stroke, or death. The predictive performance of this model was estimated with a conditional multivariable logistic regression analysis.
Results:
Of 1,062 patients with NSTEMI, the primary outcome was present in 75 patients (7.1%), and 1,019 (96%) were admitted to ICU. The most common event was respiratory failure (4.0%), followed by cardiogenic shock (3.7%), and cardiac arrest (1.7%). The presence of heart failure signs or symptoms had the highest association with the primary outcome (OR:2.16; 95%CI:1.61-2.92). The best cut-off point for this population was 3 (complications risk: 4.0%, SEN:96%, SP:15.4%, NPV:98.1%, PPV:7.9%).
Conclusion:
The ACTION ICU score may be a promising tool to identify the need for ICU care in Latin-American patients with NSTEMI. Furthermore, additional research is needed to evaluate the cost-effectiveness of this strategy.
More Related Videos
05:26Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Acute Coronary Syndrome V: Nursing Management
01:28Cardiac Catheterization I: Pre-Procedure Overview