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KAsH score – A clinical score to predict in-hospital mortality in Takotsubo syndrome
Session:
Comunicações Orais - Sessão 13 - Miocardiopatias
Speaker:
Isabel Maria Martins Moreira
Congress:
CPC 2024
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.3 Myocardial Disease – Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Isabel Martins Moreira; Catarina Ribeiro Carvalho; Marta Catarina Bernardo; Luís Sousa Azevedo; Pedro Rocha Carvalho; Catarina Ferreira; Pedro Magalhães; Inês Silveira; Ilídio Moreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Introduction: </span></strong><span style="font-size:12.0pt">Medical scoring systems are practical tools for decision making and prognostic assessment. Recent evidence suggests comparable in-hospital and long-term outcomes between takotsubo syndrome (TTS) and acute coronary syndrome. However, there is paucity of specific scoring systems for risk stratification in TTS patients. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Purpose:</span></strong><span style="font-size:12.0pt"> KAsH score is a simple score designed to predict in-hospital mortality in myocardial infarction pa</span><span style="font-size:12.0pt">ti</span><span style="font-size:12.0pt">ents at first medical contact, with easily obtainable parameters of daily clinical practice. The present study aimed to test the applicability of KAsH score in predicting in-hospital mortality in TTS.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Methods:</span></strong> <span style="font-size:12.0pt">We performed a retrospective analysis of patients admitted with TTS in our centre over the last 15 years. </span><span style="font-size:12.0pt">Patients’ baseline characteristics, clinical management and outcome data were collected. KAsH score at hospital admission was calculated using the following formula: KAsH = (Killip class × Age × Heart rate) / Systolic blood pressure (SBP). The score’s capacity to predict in-hospital mortality was analysed using ROC curves and their respective area under the curve (AUC). The optimal KAsH score cut-off for our population was determined through ROC curve analysis.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Results:</span></strong><span style="font-size:12.0pt"> A total of 121 patients were included, with a mean age of 71±12years, mostly female (86%). Mean heart rate at admission was 82±18/min and mean SBP was 130±27mmHg. Most patients were at Killip class I at admission (62%), followed by class II (37.2%). In-hospital mortality was 3.3%, with a median hospital stay of 5±4 days.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">In ROC curve analysis, KAsH score displayed excellent predictive power for in-hospital mortality in TTS population (AUC: 0.937, p=0.010 and 95% CI 0.889-0.986). The optimal KAsH score cut-off was 116.77 (100% sensitivity and 91% specificity). The adjusted probability of in-hospital mortality for patients with KAsH score ≥116.77 was 22.2%. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">At 3-year follow-up, using a Kaplan-Meyer survival analysis, mortality was significantly higher in patients with KAsH score ≥116.77 (log-rank p=0.002).<strong> </strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Conclusion: </span></strong><span style="font-size:12.0pt">KAsH score exhibited excellent predictive power for in-hospital mortality in TTS patients in our study. It is an easily applicable score that could serve as a valuable clinical tool to identify higher-risk patients. Nevertheless, external validation in a larger population is still needed.</span></span></span></p>
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