Abstract
Risk stratification of patients with acute myocardial infarction (AMI) is of clinical significance. Although there are many existing risk scores, periodic update is required to reflect contemporary patient profile and management. The present study aims to develop a risk model to predict in-hospital death among contemporary AMI patients as soon as possible after admission. We included 23417 AMI patients from China Acute Myocardial Infarction (CAMI) registry from January 2013 to September 2014 and extracted relevant data. Patients were divided chronologically into a derivation cohort (n = 17563) to establish the multivariable logistic regression model and a validation cohort (n = 5854) to validate the risk score. Sixteen variables were identified as independent predictors of in-hospital death and were used to establish CAMI risk model and score: age, gender, body mass index, systolic blood pressure, heart rate, creatinine level, white blood cell count, serum potassium, serum sodium, ST-segment elevation on ECG, anterior wall involvement, cardiac arrest, Killip classification, medical history of hypertension, medical history of hyperlipidemia and smoking status. Area under curve value of CAMI risk model was 0.83 within the derivation cohort and 0.84 within the validation cohort. We developed and validated a risk score to predict in-hospital death risk among contemporary AMI patients.
Highlights
Considerable variability exists among patients with acute myocardial infarction (AMI) and many factors have an impact on an individual’s prognosis
We demonstrated that China Acute Myocardial Infarction (CAMI) risk score was non-inferior to Global Registry in Acute Coronary Events (GRACE) and was superior to TIMI risk score in terms of c-statistics
We focused our comparison with GRACE risk score because CAMI score shared similar study design with GRACE score (GRACE score was designed from registry data while TIMI score was derived from clinical trial data)
Summary
Considerable variability exists among patients with AMI and many factors have an impact on an individual’s prognosis. Careful risk stratification is of clinical significance, as it informs decisions regarding treatment strategies as well as triage among alternative levels of care and provides an opportunity to estimate patient’s prognosis Guidelines from both the American College of Cardiology/American Heart Association[2,5] and the European Society of Cardiology[6] recommended that the most appropriate pharmacological and interventional management should be determined after comprehensive risk assessment. Many risk models of in-hospital mortality have been developed among patients with acute coronary syndrome[7,8,9,10,11] Among these scores, The Thrombolysis in Myocardial Infarction(TIMI) score and the Global Registry in Acute Coronary Events (GRACE) score are the most commonly used and are recommended in the guideline[6].
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