Specific and non-specific prognostic scores in patients with out-of-hospital cardiac arrest caused by ST-segment
Vincent Pham1, Tahar Ghannam2, Olivier Varenne3
1Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, AP-HP, 75014 Paris, France; Inserm U970, Paris Cardiovascular Research Centre (PARCC), Georges-Pompidou European Hospital, 75015 Paris, France; Université Paris-Cité, 75006 Paris, France.
Insights
Established and new prognostic scores show similar accuracy in predicting death for out-of-hospital cardiac arrest (OHCA) patients with ST-elevation myocardial infarction (STEMI). These scores offer moderate to good performance for in-hospital mortality prediction in STEMI-OHCA cases.
Area of Science:
- Cardiology
- Emergency Medicine
- Critical Care Medicine
Background:
- Out-of-hospital cardiac arrest (OHCA) survivors have a poor prognosis, necessitating accurate survival prediction.
- Acute coronary syndromes, particularly ST-segment elevation myocardial infarction (STEMI), are leading causes of OHCA.
- The Tran risk model was recently developed for STEMI-related OHCA, while other scores exist for general OHCA prognostication.
Purpose of the Study:
- To compare the predictive accuracy of existing non-STEMI-specific prognostic scores (OHCA, modified CAHP, NULL-PLEASE) against the Tran risk model.
- To evaluate these scores in predicting in-hospital mortality specifically in patients with STEMI-related OHCA.
Main Methods:
- An observational, single-center study included 315 consecutive patients with STEMI-related OHCA.
- Prognostic scores (OHCA, mCAHP, NULL-PLEASE, Tran risk model) were calculated for the majority of patients.
- C-statistic analysis was used to compare the performance of the different scoring systems.
Main Results:
- The Tran risk model had an Area Under the Curve (AUC) of 0.75.
- AUCs for OHCA, mCAHP, and NULL-PLEASE scores were 0.74, 0.74, and 0.76, respectively.
- No significant differences in AUCs were found between the Tran risk model and the other scores, nor among the non-STEMI-specific scores.
Conclusions:
- The OHCA, NULL-PLEASE, mCAHP scores, and the Tran risk model demonstrate moderate to good performance in predicting in-hospital death for STEMI-related OHCA patients.
- There were no significant differences in predictive accuracy between the non-STEMI-specific scores and the Tran risk model.
- Key predictors of mortality included no-flow duration, diabetes, blood lactate levels, femoral access, and age over 75 years.
Background:
Patients resuscitated after out-of-hospital cardiac arrest (OHCA) have a poor prognosis, with high death rates. Multiple scoring systems have been developed to predict survival in all-comers with OHCA. Acute coronary syndromes and ST-segment elevation myocardial infarction (STEMI) are the primary causes of OHCA. Recently, a specific prognostic score (Tran risk model) was developed for patients with STEMI-related OHCA.
Aim:
To compare the accuracy of established non-STEMI-specific prognostic scores (OHCA, modified CAHP and NULL-PLEASE) with the Tran risk model in predicting in-hospital death among patients with STEMI-related OHCA.
Methods:
This was an observational single-centre study including 315 consecutive patients treated for STEMI-related OHCA. The OHCA score was calculated for 310 patients (98.4%), the NULL-PLEASE and modified CAHP (mCAHP) scores were calculated for 308 patients (97.8%) and the Tran risk model score was calculated for 306 patients (97.1%). A C-statistic analysis was performed to determine score performance.
Results:
The area under the curve (AUC) for the Tran risk model was 0.75 (95% confidence interval [CI] 0.69-0.79). The AUCs for the OHCA, mCAHP and NULL-PLEASE scores were 0.74 (95% CI 0.69-0.80), 0.74 (95% CI 0.69-0.80) and 0.76 (95% CI 0.71-0.82), respectively. There was no significant difference in AUCs between the Tran risk model and the mCAHP score (P=0.95), the NULL-PLEASE score (P=0.42) or the OHCA score (P=0.93). Similarly, no significant difference was observed between the mCAHP, NULL-PLEASE and OHCA scores. Predictors of death were no-flow duration, diabetes, blood lactate, femoral access and age>75 years.
Conclusions:
The OHCA, NULL-PLEASE and mCAHP scores and the Tran risk model showed moderate to good performance in predicting in-hospital death in patients with STEMI-related OHCA. No differences in accuracy were found between non-STEMI-specific scores and the Tran risk model developed for patients with STEMI-related OHCA.
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