TY - JOUR
T1 - Cardiovascular Mortality and Heart Failure Risk Score for Patients After ST-Segment Elevation Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention (Data from the Leiden MISSION! Infarct Registry)
AU - Antoni, ML
AU - Hoogslag, GE
AU - Boden, H
AU - Liem, SMS
AU - Boersma, Eric
AU - Fox, K
AU - Schalij, MJ
AU - Bax, JJ
AU - Delgado, V
PY - 2012
Y1 - 2012
N2 - The risk scores developed for the prediction of an adverse outcome in patients after ST-segment elevation myocardial infarction (STEMI) have mostly addressed patients treated with thrombolysis and evaluated solely all-cause mortality as the primary end point. Primary percutaneous coronary intervention in patients with STEMI has improved the outcome significantly and might have changed the relative contribution of different risk factors. Our patient population included 1,484 consecutive patients admitted with STEMI who had undergone primary percutaneous coronary intervention. The clinical, angiographic, and echocardiographic data obtained during hospitalization were used to derive a risk score for the prediction of short-term (30-day) and long-term (1- and 4-year) cardiovascular mortality and hospitalization for heart failure. During a median follow-up of 30 months, 87 patients (6%) died from cardiovascular mortality or were hospitalized for heart failure. Multivariate Cox regression analyses identified age >= 70 years, Killip class >= 2 diabetes, left anterior descending coronary artery as the culprit vessel, 3-vessel disease, peak cardiac troponin T level >= 3.5 mu g/L, left ventricular ejection fraction <= 40%, and heart rate at discharge >= 70 beats/min as relevant factors for the construction of the risk score. The discriminatory power of the model as assessed using the areas under the receiver operating characteristic curves was good (0.84, 0.83, and 0.81 at 30 days and 1 and 4 years, respectively), and the patients could be allocated to low-, intermediate-, or high-risk categories with an event rate of 1%, 6%, and 24%, respectively. In conclusion, the current risk model demonstrates for the first time that 8 parameters readily available during the hospitalization of patients with STEMI treated with primary percutaneous coronary intervention can accurately stratify patients at long-term follow-up (>= 4 years after the index infarction) into low-, intermediate-, and high-risk categories. (C) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;109:187-194)
AB - The risk scores developed for the prediction of an adverse outcome in patients after ST-segment elevation myocardial infarction (STEMI) have mostly addressed patients treated with thrombolysis and evaluated solely all-cause mortality as the primary end point. Primary percutaneous coronary intervention in patients with STEMI has improved the outcome significantly and might have changed the relative contribution of different risk factors. Our patient population included 1,484 consecutive patients admitted with STEMI who had undergone primary percutaneous coronary intervention. The clinical, angiographic, and echocardiographic data obtained during hospitalization were used to derive a risk score for the prediction of short-term (30-day) and long-term (1- and 4-year) cardiovascular mortality and hospitalization for heart failure. During a median follow-up of 30 months, 87 patients (6%) died from cardiovascular mortality or were hospitalized for heart failure. Multivariate Cox regression analyses identified age >= 70 years, Killip class >= 2 diabetes, left anterior descending coronary artery as the culprit vessel, 3-vessel disease, peak cardiac troponin T level >= 3.5 mu g/L, left ventricular ejection fraction <= 40%, and heart rate at discharge >= 70 beats/min as relevant factors for the construction of the risk score. The discriminatory power of the model as assessed using the areas under the receiver operating characteristic curves was good (0.84, 0.83, and 0.81 at 30 days and 1 and 4 years, respectively), and the patients could be allocated to low-, intermediate-, or high-risk categories with an event rate of 1%, 6%, and 24%, respectively. In conclusion, the current risk model demonstrates for the first time that 8 parameters readily available during the hospitalization of patients with STEMI treated with primary percutaneous coronary intervention can accurately stratify patients at long-term follow-up (>= 4 years after the index infarction) into low-, intermediate-, and high-risk categories. (C) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;109:187-194)
U2 - 10.1016/j.amjcard.2011.08.029
DO - 10.1016/j.amjcard.2011.08.029
M3 - Article
SN - 0002-9149
VL - 109
SP - 187
EP - 194
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 2
ER -