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A single end-organ lesion marker outperforms GRACE and Zwolle scores combined: the value of delta creatinine
Session:
CO 05 - Isquemia/SCA
Speaker:
Catarina Brízido
Congress:
CPC 2018
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Catarina Brízido; António Tralhão; Francisco Fernandes Gama; JOANA LIMA; Mariana Gonçalves; Gustavo Sá Mendes; Carlos Aguiar; Jorge Santos Ferreira; Miguel Mendes
Abstract
<p><strong>Background and aim: </strong>prognosis refinement is a never-ending quest in acute coronary syndromes. Beyond cardiac troponin, no currently existing score incorporates specific ongoing end-organ lesion markers in risk estratification. We sought to evaluate the prognostic impact of adding absolute creatinine changes to known risk scores.</p> <p><strong>Methods: </strong>retrospective single-center analysis of all patients admitted for STEMI and undergoing primary PCI in a two-year period (January 2009 to December 2010). Modified Zwolle (age, time to reperfusion, anterior infarct, multivessel disease, post-reperfusion TIMI) and GRACE (age, systolic blood pressure, heart rate, admission creatinine, Killip class, cardiac arrest, troponin, ST-segment changes) were included in a multivariate Cox regression model to account for known prognostic variables. Delta creatinine was defined as the difference between admission and peak creatinine during index hospitalization. Primary endpoint was 5-year all-cause mortality.</p> <p><strong>Results: </strong>276 patients were included (mean age 62 ± 14 years, 75% male), with 49% (n = 134) being admitted for anterior STEMIs. Median GRACE score was 147 (IQR 130-170) and median modified Zwolle was 1 (IQR 1-2). Median delta creatinine was 0.19 (IQR 0.04-0.40) mg/dL. 30-day, 1-year and 5-year all-cause mortality were 4.8%, 8.7% and 23%, respectively. In the follow-up period, delta creatinine stratified primary endpoint by tertiles of increasing severity (log-rank p < 0.001). After Cox regression multivariate analysis, delta creatinine was the strongest independent predictor of 5-year all-cause mortality [HR 1.239 (CI 95% 1.001-1.534)] and was not influenced by total contrast volume administered during PCI [HR 1.001 (CI 95% 0.998-1.003)]. Adding delta creatinine to a model including GRACE and modified Zwolle provided incremental prognostic value to assess the primary endpoint [AUC 0.847 (CI 95% 0.779-0.914) vs. AUC 0.763 (CI 95% 0.681-0.845), p = 0.058)</p> <p><strong>Conclusion: </strong>delta creatinine is a powerful prognostic end-organ lesion marker that improves 5-year prognosis stratification in STEMI patients beyond static renal function and currently used risk scores. External validation is warranted to confirm and broaden its future applicability.</p> <p> </p>
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