Validation and Comparison of Six Risk Scores for Infection in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention.

Yuanhui Liu,Hualin Fan,Jiyan Chen,Ling Xue,Lihuan Zeng,Yining Dai,Wei Chen,Chongyang Duan,Ning Tan,Litao Wang,Pengcheng He

doi:10.3389/fcvm.2020.621002

Abstract

Aims: Very few of the risk scores to predict infection in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) have been validated, and reports on their differences. We aimed to validate and compare the discriminatory value of different risk scores for infection.Methods: A total of 2,260 eligible patients with STEMI undergoing PCI from January 2010 to May 2018 were enrolled. Six risk scores were investigated: age, serum creatinine, or glomerular filtration rate, and ejection fraction (ACEF or AGEF) score; Canada Acute Coronary Syndrome (CACS) risk score; CHADS2 score; Global Registry for Acute Coronary Events (GRACE) score; and Mehran score conceived for contrast induced nephropathy. The primary endpoint was infection during hospitalization.Results: Except CHADS2 score (AUC, 0.682; 95%CI, 0.652–0.712), the other risk scores showed good discrimination for predicting infection. All risk scores but CACS risk score (calibration slope, 0.77; 95%CI, 0.18–1.35) showed best calibration for infection. The risks scores also showed good discrimination for in-hospital major adverse clinical events (MACE) (AUC range, 0.700–0.786), except for CHADS2 score. All six risk scores showed best calibration for in-hospital MACE. Subgroup analysis demonstrated similar results.Conclusions: The ACEF, AGEF, CACS, GRACE, and Mehran scores showed a good discrimination and calibration for predicting infection and MACE.

Highlights

Six risk scores were investigated: age, serum creatinine, or glomerular filtration rate, and ejection fraction (ACEF or AGEF) score; Canada Acute Coronary Syndrome (CACS) risk score; CHADS2 score; Global Registry for Acute Coronary Events (GRACE) score; and Mehran score conceived for contrast induced nephropathy
Infection complicating the course of ST-segment elevation myocardial infarction (STEMI) is uncommon, with a reported incidence of 2.4%; it is associated with markedly worse 90-day clinical outcomes and longer hospital stay [1]
Our recent studies showed that the ACEF/AGEF, and CACS scores performed well in predicting infection in STEMI patients [8, 9]

Summary

Introduction

Infection complicating the course of ST-segment elevation myocardial infarction (STEMI) is uncommon, with a reported incidence of 2.4%; it is associated with markedly worse 90-day clinical outcomes and longer hospital stay [1]. Some commonly used risk scores in clinical practice, such as the age, serum Creatinine (sCr), or Glomerular filtration rate, and Ejection Fraction (ACEF or AGEF) score, Canada Acute Coronary Syndrome (CACS) score, CHADS2 score, Global Registry for Acute Coronary Events (GRACE) score and Mehran score (conceived for contrast induced nephropathy) have been reported to predict several clinical outcomes in patients with STEMI who have undergone PCI [2,3,4,5,6,7], and all scores include some risk factors of infection (age, heart failure, diabetes mellitus and so on). Our recent studies showed that the ACEF/AGEF, and CACS scores performed well in predicting infection in STEMI patients [8, 9].

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Results

Conclusion