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Sequential KAsH score evaluation results in near perfect mortality risk prediction in acute myocardial infarction
Session:
Comunicações Orais - Sessão 11 - 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:
13.7 Acute Coronary Syndromes - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Rafaela G. Lopes; Débora Sá; Isabel Cruz; Bruno Bragança; Inês Gomes Campos; Mauro Moreira; Glória Abreu; António Drumond; Aurora Andrade; Joel Ponte Monteiro
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">INTRODUCTION: </span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">KAsH is the first continuous multiplicative score able to predict in-hospital mortality in patients with myocardial infarction (MI). It has been validated in the context of first medical contact to predict mortality during hospitalization. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">PURPOSE: </span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">To test the predictive value of systematic KAsH evaluation during the first 48h of hospitalization.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">METHODS: </span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Multicentric study of consecutive patients admitted with myocardial infarction in two tertiary centers. Patients’ medical history, clinical management and outcome data were collected. KAsH was calculated at hospital admission, 24 hours and 48 hours of hospitalization using the following formula: KAsH = Killip-Kimbal x Age x Heart-Rate / Systolic Blood Pressure. KAsH was categorized into 4 sub-groups using the recommended cut-offs: <40 (</span></span>KAsH 1)<span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">; 40-90 (</span></span>KAsH 2)<span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">; 90-190 (</span></span>KAsH 3)<span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">; >190 (</span></span>KAsH 4)<span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">. A cumulative continuous and categorized score at 48 hours was analyzed. The score’s capacity to predict in-hospital mortality was analyzed using ROC curves, their respective area under the curve (AUC) and 95% confidence intervals.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">RESULTS: </span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">196 patients were included, with mean age of 66.8±12.6 years, 74% were male, 43% had ST-elevation myocardial infarction (STEMI) and in-hospital mortality of 6%. </span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Daily KAsH evaluation led to significant improvements in mortality risk prediction: admission - AUC 0.905 (0.853-0.958); 24h - AUC 0.950 (0.917-0.984); 48h - AUC 0.946 (0.908-0.984). Categorization did not significantly impact the score’s risk prediction: Admission – AUC 0.892 (0.827-0.958); 24h - AUC 0.923 (0.857-0.990); 48h - AUC 0.912 (0.848-0.976). </span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Subgroup analysis at 48 hours excellent predictive capacity in both the STEMI (AUC = 0.891, 95% CI 0.820-0.961) and NSTEMI groups (AUC= 0.991, 95% CI 0.974 – 1.00). There were no differences between centers. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">CONCLUSION: </span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">This work shows that systematically recalculating KAsH score since admission results in near perfect hospital mortality prediction, regardless of categorization or center, showing a significant improvement of risk prediction comparing to KAsH at admission alone. This work supports the use of this score in routine clinical practice.</span></span></p>
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