Prognostic utility of leukocyte parameters for prediction of in-hospital mortality among patients with acute myocardial infarction

2021 ◽  
Vol 42 (2) ◽  
pp. 22-27
Author(s):  
D. V. Zhehestovska ◽  
◽  
M. V. Hrebenyk ◽  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Risk Score ◽  
Prognostic Value ◽  
Risk Of Death ◽  
Grace Risk Score ◽  
Prognostic Utility ◽  
Strongly Connected ◽  
Long Term Prognosis

Among the tools presented today for predicting the risk of death from acute myocardial infarction (AMI) the most popular one is GRACE risk score. Along with it, due to the improvement of the prognostic value of the score, a number of parameters are displayed, the main features of which are the availability and ease of interpretation on early stages of hospitalization. The most promising among those are leukocyte parameters. While most studies evaluate the long-term prognosis of AMI, our work focused on potential precursors of in-hospital events. Among 228 patients diagnosed with AMI, 18 died at the hospital. They had a significantly higher GRACE and Gensini scores (p < 0.001). Also, patients of this group had s higher levels of leukocytes, granulocytes, lymphocytes and the neutrophil to lymphocyte ratio (NLR) (p < 0,05). According to the regression analysis, the NLR index along with GRACE was strongly connected to in-hospital mortality (OR = 1,364, 95 % CI 1,119-1,664, p = 0.002). To determine the prognostic value of these indicators, ROC analysis was performed. When evaluating the sensitivity (Se) and specificity (Sp) of parameters, the following results were obtained: GRACE score (Se = 80.0 %, Sp = 77.8 %, AUC 0.854), NLR (Se = 73.3 %, Sp = 73, 4 %, AUC 0.758), GRACE + NLR (Se = 80.0 %, Sp = 84.1 %, AUC 0.91). Thus, the combination of the GRACE risk score and NLR is more effective for predicting in-hospital mortality among patients with AMI.

scholarly journals SYNTAX score is associated with in-hospital mortality as assessed by GRACE risk score in patients with acute myocardial infarction

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P1207-P1207
Author(s):  
A. Gudjoncik ◽  
S. Richet ◽  
A. Derrou ◽  
J. Hamblin ◽  
L. Mock ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Risk Score ◽  
Syntax Score ◽  
Grace Risk Score

P845Comparison of the performance of the five validated risk scores in acute myocardial infarction patients undergoing primary PCI

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Z Mehmedbegovic ◽  
D Milasinovic ◽  
D Jelic ◽  
V Zobenica ◽  
V Dedovic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Risk Score ◽  
Prognostic Value ◽  
Goodness Of Fit ◽  
Risk Scores ◽  
Goodness Of Fit Test ◽  
Accurate Identification ◽  
One Year

Abstract Background Several risk scores have been developed to predict mortality of patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (pPCI), with limited data on the comparative prognostic value of these models. Purpose We aimed to compare the prognostic value of five validated risk scores for in-hospital and one-year mortality of patients with AMI undergoing pPCI. ume catheterization laboratory in a period from January 2009 to December 2017, a total of 3868 consecutive patients who underwent pPCI were available for analysis. For each patient, the Thrombolysis In Myocardial Infarction (TIMI), Controlled Abciximab and Device Investigation to Lower Late Angioplasty complications (CADILLAC), ACTION Registry-GWTG in-hospital mortality risk score (ACTION), Age, Creatinine, and Ejection Fraction (ACEF), and ZWOLLE risk scores were calculated using required clinical and angiographic characteristics. In-hospital and one-year mortality were assessed (follow-up available for 92% of pts). Calibration and discrimination of the three risk models were evaluated by the Hosmer-Lemeshow (H-L) goodness-of-fit test and C-statistic, respectively. Results Mortality rates for in-hospital and one-year mortality were 1.8% and 6.9% respectively. All five scores showed good model calibration as assessed by the H-L test and very good discriminative power for in-hospital and one-year mortality as assessed by C-statistics (Table 1 & Figure 1): Table 1 Risk score H-L H-L p AUC in-hospital 95% CI Significant p AUC one-year 95% CI Significant p ZWOLLE 1.3 0.7 0.90 0.89–0.91 vs. CADILLAC <0.05 0.75 0.74–0.77 vs. TIMI <0.005 ACTION 13.1 0.1 0.87 0.86–0.88 vs. TIMI <0.005 0.79 0.77–0.80 CADILLAC 5.5 0.2 0.85 0.84–0.86 vs. TIMI <0.01 0.81 0.80–0.83 vs. ZWOLLE <0.000 vs. TIMI <0.000 ACEF 9.9 0.3 0.814 0.83–0.85 0.80 0.78–0.81 vs. ZWOLLE <0.000 vs. TIMI <0.05 TIMI 7.1 0.3 0.79 0.78–0.80 0.76 0.75–0.78 Figure 1 Conclusion Risk stratification of patients with AMI undergoing pPCI using the ZWOLLE, ACTION, CADILLAC, ACEF or TIMI risk scores enables accurate identification of high-risk patients for in-hospital and one-year mortality in an all-comers population. Among evaluated scores, ZWOLLE model was better fitted for prediction of in-hospital mortality while CADILLAC and ACEF better predicted late events.

scholarly journals Serum lactic acid level predicts poor myocardial perfusion and in-hospital outcomes in patients undergoing primary percutaneous coronary intervention

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Y Liu ◽  
C F Dai ◽  
Z W Chen ◽  
J Y Qian ◽  
J B Ge
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Lactic Acid ◽  
Risk Score ◽  
Acid Level ◽  
Coronary Intervention ◽  
Hospital Death ◽  
Lactic Acid Level ◽  
Hospital Outcomes ◽  
Grace Risk Score

Abstract Background Elevated serum lactic acid level is associated with poor outcomes in patients with critical diseases like shock. However, the clinical implication of this biomarker in patients with acute myocardial infarction remains unclear. Purpose We aimed to explore the predictive power of serum lactic acid level on admission for in-hospital outcomes in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention (pPCI). Methods Consecutive patients undergoing pPCI with available data on serum lactid acid level were evaluated for eligbility in this retrospective cohort study. The primary outcome was all-cause death during hospitalization. Enzymatic infarct size and major adverse cardiovascular events (MACE, defined as a combination of all-cause death, recurrent myocardial infarction, and unplanned repeated revascularization) were considered secondary outcomes. Independent preditors of in-hospital death were determined by multiple logisic regression analysis. Odds ratio (OR) with 95% confidence interval (CI) was used to demonstrate the association. The predictive power of serum latictic acid level for in-hospital death was evaluated through receiver operator characteristic curve, which generated C-statictic. A combination model was further constructed by adding serum latictic acid level to the Global Registry of Acute Coronary Events (GRACE) risk score (LA-GRACE risk score). The linear dependence between serum lactic acids level and othe clinical variables was analysed using Spearman rank correlation. Results Of the 302 patients enrolled in the current analysis, 15 (5.0%) died during hospitalization. Serum lactic acid level (OR=1.657, 95% CI: 1.115 to 2.463, p=0.012)and left ventricular ejection fraction (OR=0.858, 95% CI: 0.767 to 0.959, p=0.007) were the only two independent predictors of in-hospital death. The C-statistic of serum lactic acid level for predicting in-hospital death was 0.886 (95% CI: 0.793 to 0.979). The LA-GRACE risk score improved the C-statistic of the GRACE score from 0.898 to 0.911 (p=0.294), with continuous net reclassification improvement of 0.567 (p=0.023) and integrated discrimination improvement of 0.206 (p=0.003). High serum lactic acid level was also asscoiated with larger enzymatic infarct size (p=0.002) and MACE (p=0.004). Further, it significantly correlated with white blood cell counts (r=0.264, p&lt;0.001), serum creatinine level (r=0.189, p=0.001), and systolic blood pressure (r=−0.122, p=0.034). Conclusion Serum lactic acid level on admission is asscoiated with poor myocardial perfusion and in-hospital outcomes in patients with acute myocardial infarction undergoing pPCI. It may contribute to better risk stratification in these populations. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study was supported by the National Program on Key Basic Research Project of China (Grant No: 2019YFC0840601 and 2014CBA02003), National Natural Science Foundation of China (Grant No: 81870267, 81970295, 81521001, 81670318 and 81570314), Grant of Shanghai Shenkang on Key Clinical Research Project (Grant No: SHDC2020CR2015A and SHDC12019104), Grant of Shanghai Science and Technology Committee (Grant No: 19MC1910300, 18411950200 and 20JC1410800), Key Medical and Health Projects of Xiamen Province (No: 3502Z20204004), Grant of Shanghai Municipal Commission of Health and Family Planning (Grant No: 2017YQ057), Grant of Zhongshan Hospital Affiliated to Fudan University (Grant No: 2018ZSLC01), VG Funding of Clinical Trials (2017-CCA-VG-036) and Merck Funding (Xinxin-merck-fund-051). ROC of lactic acid and GRACE score

Abstract 12197: China PEACE Risk Tool for Acute Myocardial Infarction: An Early Risk Classification Tree for Decisions About Fibrinolytic Therapy

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Xi Li ◽  
Jing Li ◽  
Frederick Masoudi ◽  
John Spertus ◽  
Zhenqiu Lin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Major Bleeding ◽  
Mortality Risk ◽  
Classification Tree ◽  
Fibrinolytic Therapy ◽  
Baseline Risk ◽  
Risk Of Death ◽  
The Absolute

Introduction: Timely fibrinolytic therapy is recommended to reduce short-term mortality for patients with ST-elevation myocardial infarction (STEMI). However, the absolute treatment benefit is related to baseline mortality risk, and may be offset by the risks of major bleeding for low-risk patients. We constructed a baseline risk-assessment tool in eligible but untreated patients, to estimate the absolute benefits from fibrinolytic treatment. Methods: The China PEACE study includes a nationally representative sample of patients admitted with acute myocardial infarction (AMI) in 162 Chinese hospitals. Comprehensive clinical information was centrally abstracted from medical records using standardized data definitions. We identified 3741 patients with STEMI who were fibrinolytic-eligible, but did not receive reperfusion therapy, and separated the cohort randomly into derivation and validation cohorts. We employed classification and regression tree methods to produce a simple algorithm to estimate the risk of in-hospital mortality. Results: The overall in-hospital mortality rate was 14.7%. In both derivation and validation cohorts, the combination of systolic blood pressure (≥ 100 mm Hg), age (< 60 years old), and male gender identified one fifth of the patients with an average mortality risk less than 3.0%; half of this group with a non-anterior AMI had an average in-hospital mortality risk of 1.5%. The classification tree performed consistently across study years, and in hospitals with or without PCI capability. Conclusions: Nearly one in five fibrinolytic-eligible patients with STEMI have an low estimated risk of death, with an absolute benefit of fibrinolytic therapy could be insufficient to justify the risks of major bleeding. The tool with three simple factors, easily available at hospital presentation, can identify these individuals and support decision-making about the use of fibrinolytic therapy.

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