A novel echo-score for the prediction of cardiovascular outcomes in patients with STEMI

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Echocardiography is a tool extensively studied for predicting adverse outcomes in heart failure and after MI. However, most studies are focused on predicting long-term events, and tools to predict in-hospital outcomes are needed. Objectives to identify echocardiographic parameters associated with the occurrence of in-hospital major adverse cardiovascular events and to develop an echocardiographic score to predict outcomes in patients with STEMI. Methods Single-center, observational, descriptive, longitudinal study, including consecutive STEMI patients undergoing reperfusion therapy within 12 hours since symptom onset. An echocardiogram was performed early (<48h) during hospitalization. An echocardiographic score (Echo Score) including LVEF (0 = LVEF <45%, 1 = LVEF between 44% and 35%, 2 <35% ), left ventricular wall motion score index (LVWMSi) (1 = LVWMSi>1.5, 0 = LVWMSi≤1.5) E/e’ ratio (1 = E/e’> 15, 0 = E/e’≤ 15)and RV fractional shortening (RVFS) (1 = RVFS <30%, 0 = RVFS ≥ 30%) was derived. The study's primary objective was to evaluate the primary endpoint (a composite of cardiovascular death, congestive heart failure, cardiogenic shock, and recurrent MI) and its relation with echo score during 30 days follow-up. Results A total of 270 consecutive patients participate in this study. The mean echo score was 2 (1-3). Patients with a mean echo score > 2 exhibited an increased risk for the primary endpoint during 30-day follow-up (HR 2.18. 95%CI 0.99-4.86, p= 0.06). Individual components of the primary endpoint exhibited an increased risk of mainly heart failure 5.9 vs. 14.1% (p=0.03). AUC-ROC was analyzed for echo score, and GRACE / TIMI scores on admission; no significant differences were found between these scores (Echo score: 0.65, GRACE 0.66 & TIMI 0.68, p = 0.06). Conclusion in patients with STEMI receiving reperfusion, an echocardiographic score including LVEF, LVWMSi, E/e´ratio, and RVFS performed similarly to GRACE and TIMI scores in the prediction of major cardiovascular events in the short term.