scholarly journals Incremental predictive value of adding the CHA2DS2-VASc score to the GRACE score for in-hospital mortality in patients with ST-segment elevation myocardial infarction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Lyu ◽  
L Yu ◽  
J Zhu ◽  
Y Yang
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Predictive Value ◽  
Operating Characteristic ◽  
Independent Predictor ◽  
Predictive Performance ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Grace Score

Abstract Objective The Global Registry of Acute Coronary Events (GRACE) score is recommended for risk stratification for patients with ST-segment elevation myocardial infarction (STEMI) by clinical guidelines. Data about comorbidities were not incorporated in the GRACE score. This study aimed to evaluate the incremental predictive value of adding the CHA2DS2-VASc score to the GRACE score for in-hospital mortality in patients with STEMI. Methods 7476 patients with STEMI were recruited and divided into five groups according to the CHA2DS2-VASc score (1, 2, 3, 4 and ≥5 points) at admission. The primary outcome was defined as in-hospital mortality, while the secondary outcomes were recurrent MI, stroke and major adverse cardiovascular events (MACE) during hospitalization. Univariate and multivariate logistic regression were performed to evaluate the association between the CHA2DS2-VASc score and outcomes. Incremental predictive performance of adding the CHA2DS2-VASc score to the GRACE score were evaluated through analysis of the receiver operating characteristic (ROC) curves, net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results With the increase of CHA2DS2-VASc score, patients with STEMI tended to have more comorbidities, receive less evidence-based treatments and carry worse in-hospital outcomes. Multivariate logistic regressions demonstrated that the CHA2DS2-VASc score was an independent predictor for in-hospital mortality [OR (95% CI): 1.320 (1.238–1.407), p<0.001], recurrent myocardial infarction [OR (95% CI): 1.233 (1.086–1.401), p=0.001], stroke [OR (95% CI): 1.433 (1.207–1.702), p<0.001] and MACE [OR (95% CI): 1.146 (1.088–1.207), p<0.001]. The c statistic value of combining the GRACE score with the CHA2DS2-VASc score was significantly higher than that of the GRACE score alone in predicting in-hospital mortality (0.784, 95% CI: 0.774–0.793 vs. 0.769, 95% CI: 0.760–0.779, z=4.180, p<0.001). The addition of the CHA2DS2-VASc score to the GRACE score resulted in significantly improved predictive performance for in-hospital mortality, with a NRI of 0.356 (95% CI: 0.280–0.432, p<0.001) and a IDI of 0.013 (95% CI: 0.009–0.018, p<0.001). Conclusion The CHA2DS2-VASc score was an independent predictor of in-hospital outcomes in patients with STEMI. Compared to the GRACE score alone, the addition of the CHA2DS2-VASc score to the GRACE score improved the predictive performance for in-hospital mortality in patients STEMI. FUNDunding Acknowledgement Type of funding sources: None. Receiver operating characteristic curve

scholarly journals Admission Bedside Lung Ultrasound Reclassifies Mortality Prediction in Patients With ST-Segment–Elevation Myocardial Infarction

2020 ◽  
Vol 13 (6) ◽  
Author(s):  
Gustavo N. Araujo ◽  
Anderson D. Silveira ◽  
Fernando L. Scolari ◽  
Julia L. Custodio ◽  
Felipe P. Marques ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Receiver Operating Characteristic ◽  
Operating Characteristic ◽  
Pulmonary Congestion ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Net Reclassification Improvement ◽  
St Segment ◽  
Receiver Operating

Background: Early risk stratification is essential for in-hospital management of ST-segment–elevation myocardial infarction. Acute heart failure confers a worse prognosis, and although lung ultrasound (LUS) is recommended as a first-line test to assess pulmonary congestion, it has never been tested in this setting. Our aim was to evaluate the prognostic ability of admission LUS in patients with ST-segment–elevation myocardial infarction. Methods: LUS protocol consisted of 8 scanning zones and was performed before primary percutaneous coronary intervention by an operator blinded to Killip classification. A LUS combined with Killip (LUCK) classification was developed. Receiver operating characteristic and net reclassification improvement analyses were performed to compare LUCK and Killip classifications. Results: We prospectively investigated 215 patients admitted with ST-segment–elevation myocardial infarction between April 2018 and June 2019. Absence of pulmonary congestion detected by LUS implied a negative predictive value for in-hospital mortality of 98.1% (93.1–99.5%). The area under the receiver operating characteristic curve of the LUCK classification for in-hospital mortality was 0.89 ( P =0.001), and of the Killip classification was 0.86 ( P <0.001; P =0.05 for the difference between curves). LUCK classification improved Killip ability to predict in-hospital mortality with a net reclassification improvement of 0.18. Conclusions: In a cohort of patients with ST-segment–elevation myocardial infarction undergoing primary percutaneous coronary intervention, admission LUS added to Killip classification was more sensitive than physical examination to identify patients at risk for in-hospital mortality. LUCK classification had a greater area under the receiver operating characteristic curve and reclassified Killip classification in 18% of cases. Moreover, absence of pulmonary congestion on LUS provided an excellent negative predictive value for in-hospital mortality.

Abstract P188: Impact of Metabolic Crisis on Fatal Outcome in Patients with Cardiogenic Shock Complicating ST-segment Elevation Myocardial Infarction

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Makoto Suzuki ◽  
Hideaki Shimizu ◽  
Shinpei Fujita ◽  
Yasuhiro Sasaki ◽  
Akihito Miyoshi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Fatal Outcome ◽  
Gas Analysis ◽  
St Segment Elevation ◽  
Microvascular Injury ◽  
Segment Elevation Myocardial Infarction ◽  
Metabolic Crisis ◽  
St Segment

We investigated the relation of initial metabolic acidemia to in-hospital mortality in patients treated with emergency coronary angioplasty for shock complicating first anterior ST-segment elevation myocardial infarction (STEMI). Methods A total of 23 consecutive patients (17 men, 73±12 years) with Killip class IV class due to anterior STEMI were studied. Using median levels of arterial base excess (BE, −5.8 mmol/L), the patients were divided into high and low BE groups, and both groups were compared regarding microvascular revascularization and clinical outcomes. To evaluate myocardial tissue-level reperfusion, severe microvascular injury was defined by the presence of both angiographic myocardial blush grade 0/1 and less than 30 % resolution of ST-elevation after angioplasty. Results In-hospital mortality was 92 % in the high BE group (−12.0±4.9 mmol/L) as compared with 9 % in the low BE group (−0.9±2.4mmol/L, p=0.0001 vs. high BE group). Baseline clinical and angiographic characteristics were not different between the two groups. Arterial gas analysis showed lower pH and higher levels of lactate in the high BE group than in the low BE group (7.22±0.16 vs. 7.42±0.06, p=0.006, 8.52±4.43 vs. 2.42±1.33, p=0.016). Despite successfully culprit angioplasty in all cases, the incidence of severe microvascular injury was significantly high in the high BE group as compared with the low BE group (83 vs. 36 %, p=0.018). Initial levels of BE showed a significant negative relation to ST-segment resolution (r=0.61, p=0.002). A multivariate regression analysis demonstrated a potent association of initial levels of BE with severe microvascular injury (r 2 =0.341, p=0.015). Conclusions We identified the pivotal association of initial metabolic crisis with severe microvascular reperfusion injury leading to high in-hospital mortality in patients with cardiogenic shock complicating STEMI.

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