Document Detail


Comparison of the predictive value of four different risk scores for outcomes of patients with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention.
MedLine Citation:
PMID:  18572028     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Accurate risk stratification has an important role in the management of patients with acute coronary syndromes. Even in patients with ST-elevation acute myocardial infarction (STEMI), for whom early therapeutic options are well defined, risk stratification has an impact on early and late therapeutic decision making. We aimed to compare the prognostic value of 4 risk scores used to evaluate patients with STEMI. We conducted a prospective registry of all patients treated with primary percutaneous coronary intervention for STEMI from January 2001 to June 2006. Excluded were patients with cardiogenic shock. A total of 855 consecutive patients were included in the analysis (age 60.5 +/- 13 years, 19% women, 28% with diabetes, and 48% with anterior wall myocardial infarction). For each patient, the Thrombolysis In Myocardial Infarction (TIMI), Controlled Abciximab and Device Investigation to Lower Late Angioplasty complications (CADILLAC), Primary Angioplasty in Myocardial Infarction (PAMI), and Global Registry for Acute Coronary Events (GRACE) risk scores were calculated using specific clinical variables and angiographic characteristics. Thirty-day and 1-year clinical outcomes were assessed. The predictive accuracy of the 4 risk scores was evaluated using the area under the curve or C statistic method. The CADILLAC, TIMI, and PAMI risk scores all had relatively high predictive accuracy for 30-day and 1-year mortality (C statistic range 0.72 to 0.82), with slight superiority of the CADILLAC score. These 3 risk scores also performed well for prediction of reinfarction at 30 days (C statistic range 0.6 to 0.7). The GRACE score did not perform as well and had low predictive accuracy for mortality (C statistic 0.47). In conclusion, risk stratification of patients with STEMI undergoing primary percutaneous coronary intervention using the CADILLAC, TIMI, or PAMI risk scores provide important prognostic information and enables accurate identification of high-risk patients.
Authors:
Eli I Lev; Ran Kornowski; Hana Vaknin-Assa; Avital Porter; Igal Teplitsky; Itsik Ben-Dor; David Brosh; Shmuel Fuchs; Alexander Battler; Abid Assali
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2008-05-28
Journal Detail:
Title:  The American journal of cardiology     Volume:  102     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-06-23     Completed Date:  2008-08-12     Revised Date:  2008-11-06    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  6-11     Citation Subset:  AIM; IM    
Affiliation:
Cardiology Department, Rabin Medical Center, Petah-Tikva, and the Sackler Faculty of Medicine, Tel-Aviv University, Israel. elil@clalit.org.il <elil@clalit.org.il>
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary*
Electrocardiography
Female
Fibrinolytic Agents / therapeutic use*
Humans
Male
Middle Aged
Myocardial Infarction / diagnosis,  mortality*,  therapy*
Predictive Value of Tests
Risk Assessment
Risk Factors
Severity of Illness Index
Thrombolytic Therapy*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents
Comments/Corrections
Comment In:
Am J Cardiol. 2008 Oct 15;102(8):1114   [PMID:  18929720 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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