scholarly journals The Cadillac Risk Score Accurately Identifies Patients at Low Risk for In-Hospital Mortality and Adverse Cardiovascularevents Following St Elevation Myocardial Infarction.

2021 ◽  
Author(s):  
Ryan S. Wilson ◽  
Peter Malamas ◽  
Brent Dembo ◽  
Sumeet K Lall ◽  
Ninad Zaman DO ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Score ◽  
Odds Ratio ◽  
Risk Group ◽  
Low Risk ◽  
St Elevation Myocardial Infarction ◽  
Clinical Events ◽  
St Elevation ◽  
Event Rates

Abstract Background: The CADILLAC risk score was developed to identify patients at low risk for adverse cardiovascular events following ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI). Methods: We performed a single center retrospective review of STEMI hospitalizations treated with PPCI from 2014 to 2018. Patients were stratified using the CADILLAC risk score into low risk group versus intermediate to high risk group. Patients presenting with cardiac arrest or cardiogenic shock were excluded from the study. The primary outcome was adverse clinical events during initial hospitalization. Secondary outcomes were adverse clinical events at 30 days and 1 year following index hospitalization. Results: The study included 314 patients. It was found that patients with a low CADILLAC score had significantly lower adverse clinical events compared to the intermediate-high CADILLAC score group (10/213 (4.7%) vs. 15/128 (11.7%), odds ratio = 0.37, 95% CI 0.16-0.85, p= 0.028). Additionally, patients with a low CADILLAC score had significantly lower adverse clinical event rates at 30 day and 1 year follow up. The mortality rate was 0% for patients defined at low risk by CADILLAC score during hospitalization, as well up to 1 year follow up. ROC curve predicting in hospital event rate showed CADILLAC (C=0.66, odds ratio 1.18; 95% CI 1.04 - 1.33; p=0.0064). Conclusion: Patients defined as low risk by the CADILLAC score following a STEMI were associated with lower event rates when compared to those with an intermediate-high CADILLAC score.

scholarly journals The CADILLAC risk score accurately identifies patients at low risk for in-hospital mortality and adverse cardiovascular events following ST elevation myocardial infarction

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ryan S. Wilson ◽  
Peter Malamas ◽  
Brent Dembo ◽  
Sumeet K. Lall ◽  
Ninad Zaman ◽  
...  
Keyword(s):  
Risk Score ◽  
Risk Group ◽  
Event Rate ◽  
Low Risk ◽  
Clinical Event ◽  
Intermediate Risk ◽  
Clinical Events ◽  
Adverse Clinical Event ◽  
St Elevation

Abstract Background The CADILLAC risk score was developed to identify patients at low risk for adverse cardiovascular events following ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI). Methods We performed a single center retrospective review of STEMI hospitalizations treated with PPCI from 2014 to 2018. Patients were stratified using the CADILLAC risk score into low risk, intermediate risk and high risk groups. Patients presenting with cardiac arrest or cardiogenic shock were excluded from the study. The primary outcome was adverse clinical events during initial hospitalization. Secondary outcomes were adverse clinical events at 30 days and 1 year following index hospitalization. Results The study included 341 patients. Compared to patients with a low CADILLAC score, adverse clinical events were similar in the intermediate risk group during hospitalization (OR 1.23, CI 0.37–4.05, p 0.733) and at 30 days (OR 2.27, CI 0.93–5.56, p 0.0733) while adverse clinical events were significantly elevated in the high risk group during hospitalization (OR 4.75, CI 1.91–11.84, p 0.0008) and at 30 days (OR 8.73, CI 4.02–18.96, p < 0.0001). At 1 year follow-up, compared to the low risk CADILLAC group (9.4% adverse clinical event rate), cumulative adverse clinical events were significantly higher in the intermediate risk group (22.9% event rate, OR 2.86, CI 1.39–5.89, p 0.0044) and in the elevated risk group (58.6% event rate, OR 13.67, CI 6.81–27.43, p < 0.0001). The mortality rate was 0% for patients defined at low risk by CADILLAC score during hospitalization, as well up to 1 year follow up. On receiver operating curve analysis, discrimination of in-hospital adverse clinical events was fair using CADILLAC (C = 0.66, odds ratio 1.18; 95% CI 1.04–1.33; p = 0.0064) with somewhat better discrimination at 30-day follow-up (C = 0.719) and 1-year follow-up (C = 0.715). Conclusion Patients defined as low risk by the CADILLAC score following a STEMI were associated with lower mortality and adverse clinical event rates during hospitalization and up to 1 year following STEMI when compared to those with an intermediate or high CADILLAC score.

Short-term risk stratification using CADILLAC risk score in patients with ST elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Satou ◽  
H Kitahara ◽  
K Ishikawa ◽  
T Nakayama ◽  
Y Fujimoto ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Adverse Events ◽  
Risk Score ◽  
Risk Group ◽  
Risk Groups ◽  
Low Risk ◽  
Short Term ◽  
Recurrent Myocardial Infarction ◽  
St Elevation

Abstract Background The recent reperfusion therapy for ST-elevation myocardial infarction (STEMI) has made the length of hospital stay shorter without adverse events. CADILLAC risk score is reportedly one of the risk scores predicting the long-term prognosis in STEMI patients. Purpose To invenstigate the usefulness of CADILLAC risk score for predicting short-term outcomes in STEMI patients. Methods Consecutive patients admitted to our university hospital and our medical center with STEMI (excluding shock, arrest case) who underwent primary PCI between January 2012 and April 2018 (n=387) were enrolled in this study. The patients were classified into 3 groups according to the CADILLAC risk score: low risk (n=176), intermediate risk (n=87), and high risk (n=124). Data on adverse events within 30 days after hospitalization, including in-hospital death, sustained ventricular arrhythmia, recurrent myocardial infarction, heart failure requiring intravenous treatment, stroke, or clinical hemorrhage, were collected. Results In the low risk group, adverse events within 30 days were significantly less observed, compared to the intermediate and high risk groups (n=13, 7.4% vs. n=13, 14.9% vs. n=58, 46.8%, p&lt;0.001). In particular, all adverse events occurred within 3 days in the low risk group, although adverse events, such as heart failure (n=4), recurrent myocardial infarction (n=1), stroke (n=1), and gastrointestinal bleeding (n=1), were substantially observed after day 4 of hospitalization in the intermediate and high risk groups. Conclusions In STEMI patients with low CADILLAC risk score, better short-term prognosis was observed compared to the intermediate and high risk groups, and all adverse events occurred within 3 days of hospitalization, suggesting that discharge at day 4 might be safe in this study population. CADILLAC risk score may help stratify patient risk for short-term prognosis and adjust management of STEMI patients. Initial event occurrence timing Funding Acknowledgement Type of funding source: None

Clinical assessment and angiographic finding in patients with non ST-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Elbeyali
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
St Elevation Myocardial Infarction ◽  
Intermediate Risk ◽  
Coronary Syndrome ◽  
Clinical Risk ◽  
St Elevation

Abstract Background Non ST-elevation myocardial infarction is considered the intermediate form of acute coronary syndrome between unstable angina and ST-elevation myocardial infarction. Blockage either occurs in a minor coronary artery or causes partial obstruction of a major coronary artery. The rate of NSTEMI has increased to be 50% of all acute coronary syndrome. Purpose To compare some demographic, clinical risk assessments and angiographic data among high, intermediate and low risk NSTEMI patients. Methods We classified one hundred twenty (120) NSTEMI patients into 3groups by GRACE risk score (high risk group &gt;140, intermediate risk group from 109 to 140 and low risk group ≤108). The patients were evaluated by personal history taking, risk factors, clinical examination, ECG, laboratory investigations, echocardiography and percutaneous coronary intervention. Results We found that low risk group percentage was 47.5%, intermediate risk group percentage was 32.5% and high-risk group percentage was 20%. As regarding culprit lesion, LAD represent most affected artery (48.3% of patients).Recurrent ischemia and MI represent the highest percentage of major adverse cardiac event (MACE) among studied groups. All patients with LM disease have a MACE while 41.2% of MACE patients have significant LAD lesion. As time of intervention delayed the incidence of MACE increases among different groups. High risk group has significantly high percentage of type C lesion and TIMI 0/1 while type A lesion and TIMI III lesion highest among low risk patients. As regarding contour of the lesion, the irregularity increases as the clinical risk increases. Also as regarding occlusion of culprit artery, the incidence of total occlusion increases as the clinical risk increases. Conclusions We recommend selection of high-risk NSTEMI patient to direct them for early invasive therapy. Very high-risk directed for immediate revascularization like STEMI patient. NSTEMI considered precursors to STEMI and an early warning signal that aggressive medical intervention needed. Association between time to intervention Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): University budget

scholarly journals Complications Associated to High TIMI Score in Patients with Acute ST Elevation Myocardial Infarction

2021 ◽  
Vol 15 (5) ◽  
pp. 1526-1528
Author(s):  
M. U. Rehman ◽  
F. Faisal ◽  
A. Abrar ◽  
A. A. Shah ◽  
M. Shoaib ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Stay ◽  
Risk Score ◽  
St Elevation Myocardial Infarction ◽  
Cross Sectional ◽  
Timi Score ◽  
Detailed Medical History ◽  
St Elevation ◽  
Timi Risk Score

Objective: To determine the complications associated to High TIMI risk score among patients presented with acute ST elevation myocardial infarction. Study Design: Cross sectional Place & Duration: Study was conducted at Cardiac Centre of Pakistan Institute of Medical Sciences (PIMS), Islamabadfor duration of 6 months from January to June, 2020. Methods: Total 290 patients of both genders with ages 35 to 80 years presented with acute myocardial infarction were included in this study. Patients detailed medical history including age, sex and residence were recorded. Thrombolysis in Myocardial Infarction (TIMI) risk score was calculated for each patient. Follow up was taken during the hospital stay and after discharge. Complications were recorded on follow-up. Data was analyzed by SPSS 21.0. Results: From all the patients high TIMI score was found in 34.48% patients. Out of 100 patients 70% were male and 30% were females with mean age 54.25+12.65 years. According to the high TIMI score 100 (34.48%) patients had score above 8 and 190 (65.52%) had score less than 8. Complications were recorded ad Ventricular fibrillation, VT, AF, Heart block, cardiogenic shock and pulmonary edema in 17%, 13%, 2%, 7%, 24% and 24% patients respectively.15% patients were died during hospital stay. 28% patients had post infarct angina, 9% patients had stroke and 28% patients treated revascularization. Conclusion: We concluded from this study that frequency of high TIMI score is high in our setting and we patients with increase score had high risk of complications and mortality. Keywords: High Thrombolysis in Myocardial Infarction, Acute ST Elevation Myocardial Infarction, Frequency, Complications, Mortality.

scholarly journals Prognosis Between ST-Elevation and Non-ST-elevation Myocardial Infarction in Older Adult Patients

2022 ◽  
Vol 8 ◽  
Author(s):  
Shih-Sheng Chang ◽  
Chiung-Ray Lu ◽  
Ke-Wei Chen ◽  
Zhe-Wei Kuo ◽  
Shao-Hua Yu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Older Adult ◽  
Odds Ratio ◽  
Coronary Revascularization ◽  
Adult Patients ◽  
St Elevation Myocardial Infarction ◽  
Crude Odds Ratio ◽  
St Elevation ◽  
The Difference

Background: Whether there is a difference in prognosis between elderly patients with ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) remains mysterious.Methods: We conducted a retrospective cohort study by analyzing the data in the Longitudinal Health Insurance Database (LHID) in Taiwan to explore differences between STEMI and NSTEMI with respect to in-hospital and long-term (3-year) outcomes among older adult patients (aged ≥65 years). Patients were further stratified based on whether they received coronary revascularization.Results: In total, 5,902 patients aged ≥65 years with acute myocardial infarction (AMI) who underwent revascularization (2,254) or medical therapy alone (3,648) were included. In the revascularized group, no difference was observed in cardiovascular (CV) and all-cause mortality during hospitalization or at 3-year follow-up between the two AMIs. Conversely, in the non-revascularized group, patients with NSTEMI had higher crude odds ratio (cOR) for all-cause death during hospitalization [cOR: 1.33, 95% confidence interval (CI) = 1.07–1.65] and at 3-year follow-up (cOR: 1.47, 95% CI = 1.21–1.91) relative to patients with STEMI. However, after multivariable adjustments, only NSTEMI indicated fewer in-hospital CV death [adjusted odds ratio (aOR): 0.75, 95% CI = 0.58–0.98] than STEMI in non-revascularized group. Moreover, major bleeding was not different between patients with STEMI or NSTEMI aged ≥65 years old.Conclusion: Classification of AMI is not associated with the difference of in-hospital or 3-year CV and all-cause death in older adult patients received revascularization. In a 3-year follow-up period, STEMI was an independent predictor of a higher incidence of revascularization after the index event. Non-ST-elevation myocardial infarction had more incidence of MACE than patients with STEMI did in both treatment groups.

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