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External validation of a clinical score in predicting intrahospital death in myocardial infarction: the KAsH score
Session:
Posters (Sessão 1 - Écran 6) - Cuidados Intensivos em Síndromes Coronárias Agudas
Speaker:
Rafaela G. Lopes
Congress:
CPC 2023
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Rafaela G. Lopes; Isabel Cruz; Bruno Bragança; Inês Gomes Campos; Inês Oliveira; Mauro Moreira; Glória Abreu; Aurora Andrade; Joel Ponte Monteiro
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Introduction: Complex risk scores in myocardial infarction (MI) have limited applicability in the clinical practice. The KAsH score is a score design to predict in hospital mortality in MI patients, simple and easy to used at first medical contact. However there are no papers regarding its external validation. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Purpose: To test the applicability of KAsH score in predicting in-hospital all-cause mortality in a different cohort of MI patients. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Methods: We analysed a cohort of 132 patients admitted consecutively in our coronary care unit with a diagnosis of myocardial infarction during the first semester of 2019. Patients’ demographic, clinical management and clinical outcome data were collected. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">KAsH was calculated at hospital admission using the following formula: </span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">KAsH = Killip-Kimball x Age x Heart-Rate / Systolic Blood Pressure.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">KAsH was categorized into 4 sub-groups using the recommended cut-offs: <40 (KAsH 1); 40-90 (KAsH 2); 90-190; (KAsH 3); >190 KAsH 4. The score’s capacity to predict in-hospital mortality was analyzed using ROC curves and their respective area under the curve (AUC).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">RESULTS: The cohort had a mean age of 67,6 ±12,7 years, 75% were male and 39,4% had ST-elevation myocardial infarction (STEMI). In-hospital mortality was 3,8%. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The score displayed excellent discriminative power in the MI population (AUC = 0.905, SD 0,035, 95% CI 0.837-0.997, 83,3% sensitivity and 89,68% specificity), both in STEMI (AUC = 0.930, 95% CI 0.849-1.00) and non STEMI (AUC= 0.924, 95% CI 0.866-0.982) subgroups. KAsH categorization resulted in clear mortality group division (KAsH 1 – 0,0%; KAsH 2 – 2,6%; KAsH 3 – 22,2%; KAsH 4 – 33,3%). The score retained an excellent discriminative capacity (AUC = 0.905; 95%CI 0.820-0.990), corresponding to a significant increase in predictive power comparing to the Killip-Kimball classification (vs 0.741) in all MI subgroups.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Conclusion: This study shows that KAsH score, relying only in four clinical variables, has high predictive power and is consistent in different populations. Even after categorization, KAsH score remained highly discriminative capacity in prognostic prediction comparing to the widely used Killip-Kimball classification. Hence, this work validates KAsH score in a different population and steps should be taken towards the widespread clinical use of this score.</span></span></p>
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