AJC: Risk scores may assist identification of high-risk STEMI patients

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Risk stratification of patients with STEMI undergoing primary PCI using three different risk scores provides important prognostic information and allows accurate identification of high-risk patients, according to a registry in the July issue of American Journal of Cardiology.

Even in patients with STEMI, for whom early therapeutic options are well defined, risk stratification has an impact on early and late therapeutic decision making in the management of acute coronary syndromes, according to the authors.

Eli I. Lev, MD, and colleagues from the Tel-Aviv University in Israel, compared the prognostic value of four risk scores used to evaluate patients with STEMI—TIMI (thrombolysis in MI), CADILLAC (controlled abciximab and device investigation to lower angioplasty complications), PAMI (primary angioplasty in MI) and GRACE (global registry for acute coronary events).

They conducted a prospective registry of all patients treated with primary PCI for STEMI from January 2001 to June 2006.

The researchers included a total of 855 consecutive patients in the analysis (average age 60.5, 19 percent women, 28 percent with diabetes and 48 percent with anterior wall MI). They assessed 30-day and one-year clinical outcomes.

Lev and colleagues evaluated the predictive accuracy of the four risk scores using the area under the curve or C-statistic method.

The researchers found that CADILLAC, TIMI and PAMI risk scores all had relatively high predictive accuracy for 30-day and one-year mortality (C statistic range 0.72 to 0.82), with slight superiority of the CADILLAC score. These three risk scores also performed well for prediction of reinfarction at 30 days (C statistic range 0.6 to 0.7), the authors wrote.

Lev and the colleagues found that the GRACE score did not perform as well and had low predictive accuracy for mortality (C statistic 0.47).

The authors wrote that all patients in the cohort were treated early using primary PCI, concluding that “risk stratification for such patients was mainly relevant for decision making during the latter course of their hospitalization. In addition, risk stratification has an important role in the design of future clinical trials, which may focus on certain risk groups.”