Author + information
- Istvan Hizoh,
- Zalan Gulyas,
- Gabor Szabo,
- Zsuzsanna Majoros,
- Laszlo Major,
- Gabor Kerecsen and
- Robert Gabor Kiss
The benefit of transradial primary percutaneous coronary intervention (PPCI) on mortality of patients with ST-segment elevation myocardial infarction (STEMI) has been shown by several trials. Previous risk models have not considered access site as a variable and most of them were developed using relatively low risk populations of randomized trials excluding cardiogenic shock. We conducted a prospective cohort study to construct and validate a simple risk score for predicting 30-day mortality of STEMI patients undergoing PPCI.
The derivation dataset consisted of 588 patients including 51 cases with cardiogenic shock who were further studied for at least one year. We analyzed the role of access site and six other variables readily available at presentation by backward logistic regression. The model was externally validated using an independent cohort of 399 patients. Furthermore, we compared the prognostic capacity of the new score with existing risk models using the validation set.
Age (years, OR 1.07, p=0.0001), heart rate (1/min., OR 1.05, p<0.0001), systolic blood pressure (mmHg, OR 0.97, p<0.0001), access site (radial/femoral, OR 0.35, p=0.0036), and anterior localization of the infarction (OR 1.85, p=0.08) were predictive of 30-day mortality. The Hosmer-Lemeshow test revealed good model fit (p=0.43). ROC curve analysis showed high discriminatory power (c-statistic 0.85, p<0.0001) which was stable over time (c-statistic 0.83 at 1 year) and preserved in the validation set (c-statistic 0.83, p<0.0001). Compared to previous models, the discriminatory power of the new score was equivalent to that of the rather complicated CADILLAC score (c-statistic 0.83 vs. 0.83, p=0.98), the other models performed somewhat less well (c-statistic 0.81, 0.78, 0.76 for the TIMI, Zwolle, and PAMI scores, respectively). For the new risk model the acronym ALPHA (Age, Localization, Pressure, Heart rate, Access site) has been coined.
Using this simple tool, mortality risk of STEMI patients treated with PPCI may be assessed at presentation with the prognostic accuracy of the CADILLAC score without the need for performing ventriculography and blood tests.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: STEMI Topics
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1171-214
- 2013 American College of Cardiology Foundation