Abstract 15329: The CADILLAC Risk Score Outperforms the TIMI Risk Score in Accurately Identifying Patients at Low Risk for In-hospital Mortality and Adverse Cardiovascular Events Following ST-Elevation Myocardial Infarction

Abstract

The CADILLAC and TIMI risk scores have been used to predict events following revascularization following STEMI. Utilizing these scores may help to identify patients at low risk for mortality and major adverse cardiac events (MACE) following STEMI. We aimed to compare the prognostic accuracy of CADILLAC and TIMI risk scores for identifying patients with low risk for mortality and MACE. Retrospective review at a tertiary medical center of patients presenting with STEMI from 2014-2018, excluding those who presented with cardiogenic shock, cardiac arrest, or need for mechanical circulatory support. MACE was defined as sustained ventricular arrhythmias, ACS, CHF, and stroke. Low risk patient (CADILLAC 0-2, TIMI 0-1) outcomes were compared to high risk (CADILLAC>2, TIMI>1) using chi square, ROC, and logistic regression analyses. The study includes 341 patients. In hospital CADILLAC score for low risk patients had significantly lower event rate compared to high risk (4.7% vs. 11.7%, odds ratio = 0.37, 95% CI 0.16-0.85, p= 0.028). In hospital TIMI score comparing low vs. high risk patients showed no difference (8.3% vs. 7.2%, odds ratio= 1.18, 95% CI 0.39 - 3.59, p= 0.48). ROC curve predicting event rate showed CADILLAC (C=0.66, odds ratio 1.18; 95% CI 1.04 - 1.33; p=0.0064) vs. TIMI (C= 0.57, odds ratio 1.20; 95% CI 0.98 - 1.46; p=0.071). Evaluating 30 day and 1 year follow up, CADILLAC better predicted event rates vs. TIMI (Figure 1). Logistic regression for CADILLAC at 1 year shows significant association with event rates independent of parameters comprising either risk score (odds ratio 1.29; 95% CI 1.07 - 1.57; p=0.011) while TIMI does not (odds ratio 1.21; 95% CI 0.93 - 1.56; p=0.16). In conclusion, patients defined as low risk by CADILLAC following STEMI have significantly reduced in-hospital event rates. Utilizing this scoring system may help to guide feasibility of early hospital discharge. CADILLAC outperforms TIMI in its prognostic ability both in-hospital and follow ups.