Development and Validation of NICVD-NQ Score for Predicting Short-Term Outcomes After Primary PCI.

Area of Science:

• Cardiology
• Clinical Risk Prediction
• Interventional Cardiology

Background:

• Despite advances in primary percutaneous coronary intervention (PCI), ST-elevation myocardial infarction (STEMI) patients face significant risks of major adverse cardiovascular events (MACE).
• Existing risk scores (TIMI, GRACE, PAMI, CADILLAC) are outdated, mortality-focused, and limited in global applicability, necessitating new predictive tools.

Purpose of the Study:

• To develop and validate a novel predictive model for short-term MACE (approximately 8 months) in STEMI patients undergoing primary PCI.
• To compare the performance of the new model against established risk scores.

Main Methods:

• Prospective enrollment of STEMI patients at a major cardiac center in Pakistan.
• Development of a new additive risk model and validation in a 20% testing cohort.
• Comparative analysis of the new model's predictive performance against TIMI, GRACE, PAMI, and CADILLAC scores using AUC and NRI.

Main Results:

• The study included 2839 STEMI patients; 20.4% were in the testing cohort.
• MACE occurred in 18.4% of patients at a median follow-up of 244 days.
• The novel model achieved an AUC of 0.772, outperforming TIMI and PAMI scores and showing comparable accuracy to GRACE and CADILLAC scores.

Conclusions:

• The developed NICVD predictive instrument demonstrates superior accuracy in predicting short-term MACE post-primary PCI compared to TIMI and PAMI.
• The model's performance is comparable to GRACE and CADILLAC, offering a valuable tool for enhanced risk stratification of STEMI patients.
• This new model can assist clinicians in optimizing patient management and improving outcomes after primary PCI.