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A new predictive score for mortality and cardiogenic shock in patients with ST elevation myocardial infarction
Session:
CO9 - Doença Coronária
Speaker:
Bruno Piçarra
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:
Bruno Cordeiro Piçarra; Antonio; Ana Rita Santos; Mafalda Carrington; Diogo Brás; Kisa Hyde Congo; José Eduardo Aguiar; Em nome dos investigadores do Registo Nacional de Síndromes Coronárias Agudas
Abstract
<p>Introduction: Acute Myocardial Infarction with ST elevation (STEMI) presents a high rate of potentially fatal complications and in-hospital mortality.<br /> Objective: To test the predictive capacity for Cardiogenic Shock (CS) and In-hospital Mortality (MIH) of a new risk score in patients (Pts) with STEMI.<br /> Population and Methods: Evaluates 5765 Pts with STEMI without CS at admission. The new score, was derived by previous studies in this population, and was calculated according to the following criteria: age ≥65 years (1 point), heart rate ≥100bpm (2 points), systolic blood pressure <100mmHg (2 points), blood glucose at admission above 180 mg / dL (1 point) and creatinine on admission> 1.5mg / dL (2 points). The population was divided into three subgroups: group A low score (0-2 points), group B intermediate score (3-5 points) and group C score (6-8 points). The endpoints defined were CS during hospitalization, in-hospital mortality and combined end-point of MIH and CS. The relationship between each of the possible scores (from 0 to 8) and the various end-points was determined, and the sensitivity and specificity of the score as a predictor of MIH and CS was defined as the area under the ROC curve (ASC).<br /> RESULTS: After the application of the score, 3 subgroups were obtained: group A with 4819 Pts (83,6%), group B with 884 Pts (15,3%) and group C 62 Pts (1,1%). Patients of group C had a higher MIH (Group C: 45,2% vs B: 11,4% vs A: 2,0%, p<0,001), a higher CS (C: 29,5% vs B: 12,0% vs A: 2,3%, p<0,001) and a higher combined end-point of MIH and CC (C: 53,2% vs B: 17,8% vs A: 3,4%, p<0,001) during hospitalization. The proposed score revealed a high predictive capacity of MIH (ASC 0,802, 95% CI 0,775-0,830, p=0,001), CS (ASC 0,763, 95% CI 0,731-0,795, p=0,001) and for the combined endpoint (MIH and CC) ASC 0,781, 95% CI 0,756-0,806, p=0,001). The logistic regression models showed that Pts with a high score (group C) presented a 41-fold higher risk of MIH (OR 41,3; p <0,001) and 18-fold higher CS (OR 18,0; p <0.001) than patients with low score (group A). It was also found that the risk associated with an increase in one point score unit was 100% (OR 2,0 p <0.001) for MIH and 82% (OR 1,82, p<0,001) for CS.<br /> Conclusion: This new score, with the use of practical and friendly variables, demonstrated a high predictive capacity of MIH and CS.<br /> </p>
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