Purpose: Acute Coronary Syndromes (ACS), and especially STEMI (ST segment elevation myocardial infarction), are one of the main causes of death in the western countries. Many scoring systems were developed to help physicians to correctly manage risk stratification of patients' invasive procedures, ranging from those based on clinical features like ACEF and EuroSCORE, to those derived from angiographic characteristics, like SYNTAX Score. The aim of this study was to evaluate the predictive role of ACEF, EuroSCORE and SYNTAX Score and to compare their accuracy for patients with STEMI undergoing primary angioplasty (PCI). Methods: All consecutive patients with diagnosis of STEMI undergoing primary PCI at our Institution between July 2002 and December 2005 were enrolled. ACEF and EuroSCORE have been calculated for all of them, and SYNTAX SCORE for consecutive 100 patients. The primary end-point was the predictive accuracy of the different scoring systems compared with AUC (Areas Under Curves) for MACE (defined as composite of death for cardiac and non-cardiac causes, non-fatal myocardial re-infarction, repeated angioplasty or bypass grafting, and global mortality), death and stent thrombosis. Results: 414 patients with diagnosis of STEMI were enrolled; after a median follow-up of 61±19,5 months 38% of MACE, 10,7% of death and 1,7% of stent thrombosis occurred. ACEF and EuroSCORE showed low accuracy for MACE (AUC 0.549, 95% CI 0,496-0,602 and 0.579, 95% CI 0,526-0,631), while both of them have a good predictive power for death (AUC 0.737, 95% CI 0,687-0,782 and 0.758, 95% CI 0,710-0,802) and stent thrombosis (AUC 0.766, 95% CI 0,711-0,814 and 0.601, 95% CI 0,541-0,659), without a significant difference; moreover EuroSCORE demonstrated to have a better ability than ACEF for stroke (AUC 0.848, 95% CI 0,805-0,885 and 0.588, 95% CI 0,533-0,641, p=0.015). In a subgroup analysis on 100 patients, SYNTAX Score results most accurate to predict MACE (AUC 0.891, 95% CI 0,531-0,728), while ACEF performed best for global mortality (AUC 0.802, 95% CI 0,710-0,875). Conclusions: ACEF and EuroSCORE demonstrate high accuracy to predict the risk of death in patients with STEMI undergoing primary PCI, while performed worse for MACE, for which SYNTAX SCORE showed a good performance; ACEF in particular resulted an easy and accurate tool.
Risk prediction in patients with STEMI undergoing primary PCI: an observational study
BALLOCCA, Flavia;D'ASCENZO, FABRIZIO;DI CUIA, Marco;GAITA, Fiorenzo
2013-01-01
Abstract
Purpose: Acute Coronary Syndromes (ACS), and especially STEMI (ST segment elevation myocardial infarction), are one of the main causes of death in the western countries. Many scoring systems were developed to help physicians to correctly manage risk stratification of patients' invasive procedures, ranging from those based on clinical features like ACEF and EuroSCORE, to those derived from angiographic characteristics, like SYNTAX Score. The aim of this study was to evaluate the predictive role of ACEF, EuroSCORE and SYNTAX Score and to compare their accuracy for patients with STEMI undergoing primary angioplasty (PCI). Methods: All consecutive patients with diagnosis of STEMI undergoing primary PCI at our Institution between July 2002 and December 2005 were enrolled. ACEF and EuroSCORE have been calculated for all of them, and SYNTAX SCORE for consecutive 100 patients. The primary end-point was the predictive accuracy of the different scoring systems compared with AUC (Areas Under Curves) for MACE (defined as composite of death for cardiac and non-cardiac causes, non-fatal myocardial re-infarction, repeated angioplasty or bypass grafting, and global mortality), death and stent thrombosis. Results: 414 patients with diagnosis of STEMI were enrolled; after a median follow-up of 61±19,5 months 38% of MACE, 10,7% of death and 1,7% of stent thrombosis occurred. ACEF and EuroSCORE showed low accuracy for MACE (AUC 0.549, 95% CI 0,496-0,602 and 0.579, 95% CI 0,526-0,631), while both of them have a good predictive power for death (AUC 0.737, 95% CI 0,687-0,782 and 0.758, 95% CI 0,710-0,802) and stent thrombosis (AUC 0.766, 95% CI 0,711-0,814 and 0.601, 95% CI 0,541-0,659), without a significant difference; moreover EuroSCORE demonstrated to have a better ability than ACEF for stroke (AUC 0.848, 95% CI 0,805-0,885 and 0.588, 95% CI 0,533-0,641, p=0.015). In a subgroup analysis on 100 patients, SYNTAX Score results most accurate to predict MACE (AUC 0.891, 95% CI 0,531-0,728), while ACEF performed best for global mortality (AUC 0.802, 95% CI 0,710-0,875). Conclusions: ACEF and EuroSCORE demonstrate high accuracy to predict the risk of death in patients with STEMI undergoing primary PCI, while performed worse for MACE, for which SYNTAX SCORE showed a good performance; ACEF in particular resulted an easy and accurate tool.
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