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KAsH Score predicts long term mortality after acute myocardial infarction
Session:
CO - Prémio Jovem Investigador (Investigação Clínica)
Speaker:
Joel Monteiro
Congress:
CPC 2019
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:
Joel Ponte Monteiro; Joao Adriano Sousa; Flávio Mendonça; Micaela Rodrigues Neto; Ricardo C. Rodrigues; Gomes Serrão; Bruno Oliveira Silva; A. Paula Faria; Eva Henriques; A. Drumond de Freitas; Maria Isabel Mendonça
Abstract
<p><strong>INTRODUCTION:</strong> KAsH is a simple risk score, composed of 4 clinical variables drawn at the first medical contact, tailored to predict in-hospital mortality in patients with acute myocardial infarction (MI). Despite its simplicity, KAsH performed better than other more complex and well-established risk scores, like GRACE, at predicting hospital mortality. KAsH’s ability to predict long-term mortality is, however, unknown.</p> <p><strong>METHODS:</strong> Prospective registry evaluating 1241 consecutively admitted patients with MI, between October 2009 and September 2016. KAsH score was calculated at hospital admission using the following formula:</p> <p>KAsH = (Killip Kimbal x Age x Heart Rate) / Systolic Blood Pressure</p> <p>Patients with missing data on any of the variables composing the score were excluded (n=51). KAsH was categorized into 4 sub-groups using the recommended cut-offs (KAsH 1 – <40; KAsH 2 – 40-90; KAsH 3 – 90-190; KAsH 4 – >190). The score’s capacity to predict mortality at 1 year of follow up was analyzed using ROC curves and their respective area under the curve (AUC). KAsH was compared with GRACE and ProACS risk scores using the DeLong test.</p> <p><strong>RESULTS:</strong> KAsH predicts all-cause mortality at 1 year follow up after MI (OR 1.021, IC 1.018 – 1.025, p<0.001). Multivariate analysis displayed that KAsH retains its predictive power after adjusting for the following variables: age, diabetes, chronic kidney disease, previous stroke or MI, heart failure, cardiogenic shock or bleeding during admission and not submitted to invasive coronary angiography (OR 1.011, IC 1.007 – 1.014, p<0.001).</p> <p>KAsH displayed excellent predictive performance of mortality at 1 year follow up after MI (AUC: 0.832, IC 0.803 – 0.861). After categorization into 4 sub-groups, KAsH retains a very good predictive power (AUC: 0.800, IC 0.776 – 0.822).</p> <p>Compared with other scores, as a continuous score KAsH performed better than both the GRACE and ProACS scores (AUC: KAsH 0.832, GRACE 0.799, ProACS 0.796, p =0.03). After categorization, KAsH was non-inferior to both risk scores (AUC: KAsH_Cat 0.800, p=ns).</p> <p><strong>CONCLUSION</strong>: KAsH, a simple 4 variable risk score, is a robust predictor of all-cause mortality at 1 year follow up of patients with MI. Even after categorization into 4 sub-groups, KAsH displayed a similar predictive power as a more complex and well-established risk score.</p>
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