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The Cardiac Infarction Injury Score as a predictor for long-term mortality in survivors of a myocardial infarction
R T van Domburg1, P Klootwijk, J W Deckers
1Thoraxcenter, Erasmus University, Rotterdam, The Netherlands.
Insights
The Cardiac Infarction Injury Score (CIIS) effectively predicts long-term cardiac mortality in post-myocardial infarction patients. This electrocardiographic scoring system is valuable for epidemiological studies and can be automated.
Area of Science:
- Cardiology
- Medical Diagnostics
- Public Health
Background:
- Acute myocardial infarction (MI) poses significant risks for long-term cardiac mortality.
- Electrocardiography (ECG) is a crucial tool for assessing cardiac injury.
- The Cardiac Infarction Injury Score (CIIS) was developed to quantify cardiac damage post-MI.
Purpose of the Study:
- To evaluate the prognostic value of the CIIS in patients following myocardial infarction.
- To determine if CIIS scores predict long-term total and cardiac mortality.
Main Methods:
- A large cohort of 3395 patients from the ASPECT trial were analyzed.
- Standard 12-lead ECGs were coded using the CIIS and Minnesota Code prior to hospital discharge.
- Statistical analysis adjusted for baseline characteristics to assess mortality risk.
Main Results:
- Higher CIIS scores were directly associated with increased risk of total and cardiac mortality.
- At 1-year follow-up, relative risks for CIIS > or = 40, 30-40, and 20-30 were significantly elevated compared to CIIS < 20.
- These associations remained significant even after excluding patients with major ECG abnormalities.
Conclusions:
- The CIIS is a significant predictor of long-term cardiac mortality in post-MI patients.
- The CIIS is efficient for classifying cardiac injury in epidemiological studies.
- The CIIS system is amenable to automation for widespread application.
Aims:
The Cardiac Infarction Injury Score (CIIS) is an electrocardiographic classification system that was developed as a diagnostic tool to assess the extent of cardiac injury in acute myocardial infarction. We investigated the prognostic value of the CIIS in post-myocardial infarction patients.
Methods And Results:
The prognostic values of the CIIS for total and cardiac mortality was assessed in a large series (n = 3395) of patients who were enrolled in the ASPECT trial. Standard 12-lead electrocardiograms, recorded prior to hospital discharge were coded according to the CIIS and the Minnesota Code. Mean CIIS was 26 (range--8 to 59). After adjustment for other baseline characteristics, the CIIS was directly related to the risk of total mortality and cardiac mortality. At one-year follow-up the relative risks of CIIS > or = 40, CIIS 30-40 and CIIS 20-30 were significantly higher than in those with a CIIS < 20. The relative risks were, respectively, 2.3 (1.2-4.4), 2.2 (1.3-3.9) and 1.6 (0.9-2.9). At 3 year follow-up, the relative risks were, respectively, 2.1 (1.4-3.2), 1.7 (1.2-2.4) and 1.5 (1.0-2.1). The relative risks for total mortality were similar. When patients with major ECG abnormalities, as defined by the Minnesota code, were excluded, the associations were still significant in the CIIS classes 30-40 and > 40.
Conclusion:
The CIIS ECG scoring system is an important predictor for long-term cardiac mortality in post myocardial infarction patients. It can easily be automated and is efficient for classifying cardiac injury in epidemiological studies.
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