P953Comparison of the original and updated ACTION risk scores for predicting in-hospital and one-year mortality in patients with acute myocardial infarction undergoing primary PCI

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Jelic ◽  
Z Mehmedbegovic ◽  
D Milasinovic ◽  
V Dedovic ◽  
V Zobenica ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Risk Score ◽  
Goodness Of Fit ◽  
External Validation ◽  
Risk Scores ◽  
P Value ◽  
Goodness Of Fit Test ◽  
Catheterization Laboratory ◽  
One Year

Abstract Background The Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry-Get With The Guidelines (GWTG) AMI mortality model and risk score (ACTION) were introduced in 2011 to predict in-hospital mortality. In 2016 score was updated to enable a more accurate assessment, but, up-to-date, external validation in direct comparison was not performed. Purpose We aimed to externally validate and compare the prognostic value of original and updated ACTION score for in-hospital and one-year mortality. Method From a prospective electronic registry of a high-volume catheterization laboratory in a period from January 2009 to December 2017, a total of 5615 consecutive patients who underwent pPCI were available for analysis. For each patient, original (O-) and updated (U-) ACTION scores were calculated using required clinical and angiographic characteristics. In-hospital and one-year mortality (follow-up available for 91%) were assessed. 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 4.2% and 9.6%, respectively. Both 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). Net reclassification index (NRI=1.06) showed that 48% of patients with in-hospital event and 58% without event, had their risk recalculated with U-ACTION with Integrated Discrimination Improvement slope 9.1% higher than in first model. Table 1 Risk score H-L H-L p value AUC 95% CI p value AUC 95% CI Significant p value O-ACTION 9.4 0.3 0.829 0.819 to 0.839 p<0.0001 0.781 0.769 to 0.792 p<0.0001 U-ACTION 10.9 0.2 0.918 0.911 to 0.925 0.838 0.827 to 0.848 Figure 1 Conclusion Updated ACTION score enables better prediction of in-hospital and one-year mortality in patients undergoing pPCI for acute myocardial infarction, thus it can be used preferentially over the original ACTION score for assessment of short and long-term mortality risks of this population.

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.

P4619Comparison of the CRUSADE, ACUITY-HORIZONS, and ACTION bleeding risk scores for predicting in-hospital bleeding in acute myocardial infarction patients undergoing primary PCI

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Z Mehmedbegovic ◽  
D Milasinovic ◽  
D Jelic ◽  
V Zobenica ◽  
D Matic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Goodness Of Fit ◽  
Academic Research ◽  
Bleeding Risk ◽  
Risk Scores ◽  
Bleeding Complications ◽  
Bleeding Events ◽  
Goodness Of Fit Test ◽  
Catheterization Laboratory

Abstract Background Considering clinical importance of bleeding complications in patients with acute myocardial infarction (AMI), bleeding risk stratification is a key part of the management of these patients. CRUSADE, ACTION and ACUITY-HORIZONS bleeding risk scores are available for predicting in-hospital major bleeding events in patients with acute myocardial infarction. Purpose We aimed to evaluate performance of the three above mentioned risk scores for predicting in-hospital bleeding events defined according to The Bleeding Academic Research Consortium (BARC) criteria. Methods From a prospective electronic registry of a high-volume catheterization laboratory in a period from January 2009 to December 2017, a total of 6505 consecutive patients with acute myocardial infarction who underwent pPCI were included in analysis. 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 Overall there were 372 (5.7%) bleeding events out of which 117 (1.8%) fulfilled stage BARC 3 or higher bleeding criteria. All three scores showed good model calibration as assessed by the H-Ls test and very good discriminative power for BARC 3 of higher bleeding events detection as assessed by C-statistics (Table 1 & Figure 1): Bleeding events stage BARC 3 or higher were statistically highly related with higher in-hospital mortality (13.7% vs. 3.5%; p<0.000). Table 1 Risk score H-L H-L p AUC 95% CI p CRUSADE 11.46 0.177 0.761 0.750–0.771 vs. ACUITY = ns vs. ACTION <0.000 ACUITY-HORIZONS 10.47 0.236 0735 0.724–0.745 vs. ACTION = ns ACTION 5.74 0.677 0.701 0.698–0.712 Figure 1 Conclusions All three evaluated scores showed very good discriminative capacity for predicting BARC 3 or higher bleeding events in patients undergoing pPCI for AMI.

scholarly journals “Get with the Guidelines Heart Failure Risk Score” for mortality prediction in patients undergoing MitraClip

2021 ◽  
Author(s):  
Christos Iliadis ◽  
Maximilian Spieker ◽  
Refik Kavsur ◽  
Clemens Metze ◽  
Martin Hellmich ◽  
...  
Keyword(s):  
Heart Failure ◽  
Risk Score ◽  
Goodness Of Fit ◽  
Left Ventricular ◽  
Risk Scores ◽  
Left Ventricular Ejection ◽  
Goodness Of Fit Test ◽  
Ventricular Ejection Fraction ◽  
Failure Risk ◽  
Get With The Guidelines

Abstract Background Reliable risk scores in patients undergoing transcatheter edge-to-edge mitral valve repair (TMVR) are lacking. Heart failure is common in these patients, and risk scores derived from heart failure populations might help stratify TMVR patients. Methods Consecutive patients from three Heart Centers undergoing TMVR were enrolled to investigate the association of the “Get with the Guidelines Heart Failure Risk Score” (comprising the variables systolic blood pressure, urea nitrogen, blood sodium, age, heart rate, race, history of chronic obstructive lung disease) with all-cause mortality. Results Among 815 patients with available data 177 patients died during a median follow-up time of 365 days. Estimated 1-year mortality by quartiles of the score (0–37; 38–42, 43–46 and more than 46 points) was 6%, 10%, 23% and 30%, respectively (p < 0.001), with good concordance between observed and predicted mortality rates (goodness of fit test p = 0.46). Every increase of one score point was associated with a 9% increase in the hazard of mortality (95% CI 1.06–1.11%, p < 0.001). The score was associated with long-term mortality independently of left ventricular ejection fraction, NYHA class and NTproBNP, and was equally predictive in primary and secondary mitral regurgitation. Conclusion The “Get with the Guidelines Heart Failure Risk Score” showed a strong association with mortality in patients undergoing TMVR with additive information beyond traditional risk factors. Given the routinely available variables included in this score, application is easy and broadly possible. Graphic abstract

P4591Impact of extent of non-culprit lesions on one-year outcomes in patients with acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Tanaka ◽  
H Akahori ◽  
T Imanaka ◽  
K Miki ◽  
N Yoshihara ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Multivariable Analysis ◽  
P Value ◽  
Gensini Score ◽  
Culprit Lesion ◽  
Vessel Disease ◽  
Coronary Bypass Grafts ◽  
Multivariable Analyses ◽  
One Year

Abstract Background Presence of severe stenosis in non-infarct related arteries, i.e. multi-vessel disease (MVD), is associated with poor outcomes after acute myocardial infarction (AMI). However, impact of mild to moderate stenosis in non-culprit lesions remains unclear.Gensini score is an angiographic application grading the extent of coronary artery lesions including mild to moderate stenosis. Purpose To evaluate whether the extent of non-culprit lesion is related to one-year outcomes after AMI. Methods This study consisted of consecutive 168 patients who underwent primary percutaneous coronary intervention (PPCI) for AMI between 2015 and 2017. Patients with coronary bypass grafts were excluded from the analysis. To assess the extent of non-culprit lesions, we used “non-culprit Gensini score”, which is calculated by excluding score of the culprit lesion from the original Gensini score. Patients were divided into 2 groups by the median ofnon-culprit Gensini score: low score (0–14, n=84) and high score (>15, n=84). Major adverse cardiac events (MACE) included all cause of deaths, non-fatal MI, stroke and ischemia driven coronary revascularization during one-year follow-up period. Results MVDwas more frequent in patients with high score than those in those with low score (90% vs 25%, P<0.05). Kaplan-Mayer curves of patients with and without MVD are shown in left figure, and curves of patients with low score and those with high score are shown in right figure. Multivariable analysis showed that high score was an independent predictor of one-year MACE (HR 5.28, 95% CI 1.93–14.9, P<0.05), but MVD was not (HR 0.56, 95% CI 0.23–1.54, P=0.25) (Table). Multivariable analyses Univariable analyses Multivariable analyses HR (95% CI) P-value HR (95% CI) P-value Age 1.03 (1.01, 1.06) <0.05 1.15 (0.99, 1.05) 0.31 eGFR (<45ml/min/1.73m2) 2.95 (1.59, 5.38) <0.05 2.35 (1.26, 4.35) <0.05 Multi-vessel disease 1.84 (1.01, 3.55) <0.05 0.56 (0.23, 1.54) 0.25 Non-culprit-Gensini score (>15) 3.37 (1.79, 6.78) <0.05 5.28 (1.93, 14.9) <0.05 HR = hazard ratio; CI = confidence interval; eGFR = estimated glomerular filtration rate. Kaplan-Meier curves Conclusion These findings suggested that extent of mild to moderate stenosis in non-culprit lesions might affect the prognosis after AMI in patients undergoing PPCI. Non-culprit Gensini score may be useful to predict outcomes of patients with AMI. Acknowledgement/Funding None

P1551A genetic risk score predicts recurrent events after myocardial infarction in young adults

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L M Rincon ◽  
M Sanmartin ◽  
G L Alonso ◽  
J A Rodriguez ◽  
A Muriel ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Risk Score ◽  
Genetic Risk ◽  
Recurrent Events ◽  
Cardiac Ct ◽  
Ldl Cholesterol ◽  
Genetic Risk Score ◽  
P Value ◽  
Diabetic Patients

Abstract Background To evaluate whether a genetic risk score (GRS) improves the prediction of recurrent events in young non-diabetic patients presenting with an acute myocardial infarction and identifies a more aggressive form of atherosclerosis in this population. Methods and results We performed a prospective study including 81 consecutive non-diabetic patients aged below 55 y.o. presenting with an acute myocardial infarction (48±6 y.o., 89% male). A comprehensive study including serum biomarkers, genetic testing and cardiac CT was performed. We studied the association of a GRS composed of 11 genetic variants with a primary composite end-point (all-cause mortality, recurrent acute coronary syndrome, and cardiac re-hospitalisation). After a median follow-up of 4.1 (3.5 - 4.4) years 24 recurrent events were documented. A significantly higher prevalence of 9 out of 11 risk alleles was noted compared with general population. The GRS was significantly associated with recurrent events, especially when baseline LDL-cholesterol levels were elevated. Compared with the low-risk GRS category, the multivariate-adjusted hazard ratio for recurrent events for the intermediate-risk GRS category was 10.2 (95% CI 1.1–100.3, p=0.04) and for the high-risk GRS was 20.7 (2.4–181.0, p=0.006) when LDL-C ≥2.8 mmol/L. Inclusion of the GRS improved the C statistic (ΔC statistic =0.086), the continuous Net Reclassification Index (30%) and the Integrated Discrimination Improvement (0.05) compared with a multivariate clinical risk model. Cardiac CT detected coronary calcified atherosclerosis and numerous plaques but it had a limited value for prediction of recurrences. No association was observed between extracellular matrix metabolism biomarkers and GRS or recurrent events in this population. Cox regression analysis between GRS terciles and LDL-C Univariate analysis Multivariate analysis* HR (95% CI) p-value HR (95% CI) p-value* Low GRS 1 1 Intermediate GRS 2.0 (0.7–5.8) 0.21 LDL-C≤110 mg/dL (≤2.8 mmol/L) 1.0 (0.3–4.0) >110 mg/dL (>2.8 mmol/L) 10.2 (1.1–100.3) 0.04 High GRS 3.0 (1.0–9.2) 0.05 LDL-C≤110 mg/dL (≤2.8 mmol/L) 0.3 (0.1–1.9) >110 mg/dL (>2.8 mmol/L) 20.7 (2.4–181.0) 0.006 *Multivariate model adjusted for GRACE risk score and LDL-C and interaction. There was a strong interaction between GRS terciles and LDL-C (p<0.01). Recurrent events based on genetic risk Conclusions A multilocus genetic risk score identified non-diabetic young patients at increased risk for recurrent events after a myocardial infarction. The significance of LDL-cholesterol in relation to genetic predisposition for recurrences merits further evaluation. Acknowledgement/Funding Instituto de Salud Carlos III (PI12/0564, PI14/01152 and PI15/00667), the CIBERCV and the Spanish Society of Cardiology (2015/CC)

scholarly journals GRACE, SYNTAX I and SYNTAX II scores as predictors of one-year mace outcome in patients with myocardial infarction treated with percutaneous coronary intervention

2021 ◽  
pp. 55-55
Author(s):  
Aleksandar Davidovic ◽  
Dane Cvijanovic ◽  
Jelica Davidovic ◽  
Snezana Lazic ◽  
Bratislav Lazic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Predictive Power ◽  
Coronary Intervention ◽  
Cardiovascular Outcomes ◽  
Adverse Outcomes ◽  
Risk Scores ◽  
Percutaneous Coronary ◽  
One Year

Background/Aim. The fundamental objective of primary percutaneous coronary intervention (PKI) in myocardial infarction is to provide early, complete and sustained flow in the occluded artery that has led to myocardial ischemia or necrosis. The aim of this study was to determine the predictive power of a combination of GRACE, SYNTAX I, and SYNTAX II scores in predicting major cardiovascular adverse events and one-year mortality in patients with STEMI and NSTEMI myocardial infarction after primary PCI. Methods. Our study included 400 patients who had their first acute myocardial infarction and underwent percutaneous coronary intervention, treated and followed for one year at the Clinical Hospital Center Zvezdara at the Department of Interventional Cardiology. By monitoring the defined clinical parameters, a comparative analysis of risk scores was performed: GRACE, SYNTAX I and SYNTAX II, their sensitivity, specificity as well as predictive possibilities in predicting adverse outcomes were determined. Results. The incidence of major adverse cardiovascular outcomes in our sample was 12,8%. Patients with STEMI entity had significantly higher values of GRACE, SYNTAX I and SYNTAX II scores. The highest value for predicting the occurrence of major adverse cardiovascular outcomes was shown by the SYNTAX II score (score value 29,3) with a sensitivity of 88,2% and a specificity of 76,8%. The GRACE score is a significant predictor of SYNTAX I and SYNTAX II scores, a two-way correlation was observed between the high score values of all three scores. Conclusion. The presented scores for assessment of clinical and angiographic indicators, showed good predictive power in assessing the outcome of adverse cardiovascular events in both clinical entities of acute myocardial infarction during one year follow up. By using the proposed scores to assess adverse outcomes, we can single out high-risk patients in order to prevent outcomes and reduce mortality. This suggests its suitability for clinical use in this patient population.

scholarly journals Clinical Prediction Scores for Type 1 Cardiorenal Syndrome Derived and Validated in Chinese Cohorts

2014 ◽  
Vol 5 (1) ◽  
pp. 12-19 ◽  
Author(s):  
Hong Cheng ◽  
Yi-pu Chen
Keyword(s):  
Coronary Angiography ◽  
Risk Score ◽  
Roc Curve ◽  
Goodness Of Fit ◽  
External Validation ◽  
Multivariate Logistic Regression Analysis ◽  
Cardiorenal Syndrome ◽  
Chinese Patients ◽  
Risk Scores

Type 1 cardiorenal syndrome is one of the major diseases threatening human life in China. The incidence of acute kidney injury (AKI) associated with acute heart failure (AHF), acute myocardial infarction (AMI), cardiac surgery, and coronary angiography has been reported to be 32.2, 14.7, 40.2, and 4.5%, respectively. In the past 2 years, we derived and validated 4 risk scores for the prediction of AKI associated with the above acute heart diseases as well as for examination and treatment in Chinese cohorts. A univariable comparison and a subsequent multivariate logistic regression analysis of the potential predictive variables of AKI in the derivation set were conducted and used to establish the prediction scores, which were then verified in the validation set. The area under the receiver operating characteristic (ROC) curve and the Hosmer-Lemeshow goodness-of-fit statistic test were performed to assess the discrimination and calibration of the prediction scores, respectively. These 4 prediction scores all showed adequate discrimination (area under the ROC curve, ≥0.70) and good calibration (p > 0.05). Both Forman's risk score (for AKI associated with AHF) and Mehran's risk score (for AKI associated with coronary angiography) are widely applied around the world. The external validation of these 2 risk scores was performed in our patients, but their discriminative power was quite low (area under the ROC curve, 0.65 and 0.57, respectively). Therefore, these prediction scores derived from Chinese cohorts might be more accurate than those derived from different races when they are applied in Chinese patients. © 2014 S. Karger AG, Basel

External validation of PRECISE-DAPT score and PARIS bleeding risk score in a real-world cohort of patients with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D.R.P.P Chan Pin Yin ◽  
D.M.F Claassens ◽  
F.P Van Baal ◽  
G.J Vos ◽  
J Peper ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Risk Score ◽  
External Validation ◽  
Bleeding Risk ◽  
Risk Scores ◽  
Severe Bleeding ◽  
Coronary Syndrome ◽  
Kaplan Meier ◽  
One Year

Abstract Background In patients with acute coronary syndrome (ACS) shortened duration of dual antiplatelet therapy (DAPT) should be considered in those at high risk of bleeding. Risk scores may be used to assess the bleeding risk, but their predictive value remains unclear. Purpose To externally validate and compare the PRECISE-DAPT and the PARIS bleeding risk scores in patients with ACS. Methods From January 2015 to June 2018, all patients admitted with ACS were consecutively included in a single center, observational, prospective registry with follow-up of at least one year. In all patients, the PRECISE-DAPT and the PARIS risk-score were retrospectively assessed. Primary endpoint was moderate or severe bleeding defined as Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding within one year after ACS. Kaplan-Meier curves showed the probabilty of bleeding during follow-up as assessed by both scores. Score discrimination using c-statistic were calculated and calibration curves were visually assessed. Results 2,729 patients were included for analysis. 93.6% were discharged with ≥2 antithrombotic drugs. At one year follow-up, the event rate of moderate or severe bleeding was 5.5%. High bleeding risk as stratified by both risk scores was associated with higher bleeding rates. Discriminative values for BARC 3 or 5 bleeding at one year were 0.67 [95% CI 0.61–0.72] for the PRECISE-DAPT score and 0.62 [95% CI 0.57–0.68] for the PARIS bleeding score (p=0.31). Conclusion The PRECISE-DAPT and the PARIS bleeding scores both showed adequate discriminative performances in predicting moderate or severe bleeding in this study. Kaplan-meier and ROC-curves Funding Acknowledgement Type of funding source: None

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