Simple risk score based on the China Acute Myocardial Infarction registry for predicting in-hospital mortality among patients with non-ST-segment elevation myocardial infarction: results of a prospective observational cohort study

Chenxi Song, Rui Fu, Sidong Li, Jingang Yang, Yan Wang, Haiyan Xu, Xiaojin Gao, Jia Liu, Qianqian Liu, Chunyue Wang, Kefei Dou, Yuejin Yang, Chenxi Song, Rui Fu, Sidong Li, Jingang Yang, Yan Wang, Haiyan Xu, Xiaojin Gao, Jia Liu, Qianqian Liu, Chunyue Wang, Kefei Dou, Yuejin Yang

Abstract

Objectives: To simplify our previous risk score for predicting the in-hospital mortality risk in patients with non-ST-segment elevation myocardial infarction (NSTEMI) by dropping laboratory data.

Design: Prospective cohort.

Setting: Multicentre, 108 hospitals across three levels in China.

Participants: A total of 5775 patients with NSTEMI enrolled in the China Acute Myocardial Infarction (CAMI) registry.

Primary outcome measures: In-hospital mortality.

Results: The simplified CAMI-NSTEMI (SCAMI-NSTEMI) score includes the following nine variables: age, body mass index, systolic blood pressure, Killip classification, cardiac arrest, ST-segment depression on ECG, smoking status, previous angina and previous percutaneous coronary intervention. Within both the derivation and validation cohorts, the SCAMI-NSTEMI score showed a good discrimination ability (C-statistics: 0.76 and 0.83, respectively); further, the SCAMI-NSTEMI score had a diagnostic performance superior to that of the Global Registry of Acute Coronary Events risk score (C-statistics: 0.78 and 0.73, respectively; p<0.0001 for comparison). The in-hospital mortality increased significantly across the different risk groups.

Conclusions: The SCAMI-NSTEMI score can serve as a useful tool facilitating rapid risk assessment among a broader spectrum of patients admitted owing to NSTEMI.

Trial registration number: NCT01874691.

Keywords: NSTEMI; in-hospital mortality; updated risk score.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
ROC curves of SCAMI risk model and SCAMI risk score. (A) Within the derivation cohort, the C-statistic was 0.7771 (95% CI: 0.7472 to 0.8071) for SCAMI risk model and 0.7643 (95% CI: 0.7343 to 0.7943) for the SCAMI risk score. (B) Within the validation cohort, the C-statistic was 0.8614 (95% CI: 0.8173 to 0.9055) for SCAMI risk model and 0.8286 (95% CI: 0.7825 to 0.8748) for the SCAMI risk score. (C) Within the entire cohort, the C-statistic was 0.7992 (95% CI: 0.7742 to 0.8243) for SCAMI risk model and 0.7992 (95% CI: 0.7742 to 0.8243) for the SCAMI risk score. ROC, receiver operating characteristic curve; SCAMI, simplified China Acute Myocardial Infarction registry.

References

    1. Reed GW, Rossi JE, Cannon CP. Acute myocardial infarction. Lancet 2017;389:197–210. 10.1016/S0140-6736(16)30677-8
    1. O'Gara PT, Kushner FG, Ascheim DD, et al. . 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of cardiology Foundation/American heart association task force on practice guidelines. Circulation 2013;127:e362–425. 10.1161/CIR.0b013e3182742cf6
    1. Granger CB, Goldberg RJ, Dabbous O, et al. . Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med 2003;163:2345–53. 10.1001/archinte.163.19.2345
    1. McNamara RL, Kennedy KF, Cohen DJ, et al. . predicting in-hospital mortality in patients with acute myocardial infarction. J Am Coll Cardiol 2016;68:626–35. 10.1016/j.jacc.2016.05.049
    1. Huynh T, Kouz S, Yan AT, et al. . Canada acute coronary syndrome risk score: a new risk score for early prognostication in acute coronary syndromes. Am Heart J 2013;166:58–63. 10.1016/j.ahj.2013.03.023
    1. Timóteo AT, Aguiar Rosa S, Afonso Nogueira M, et al. . ProACS risk score: an early and simple score for risk stratification of patients with acute coronary syndromes. Rev Port Cardiol 2017;36:77–83. 10.1016/j.repc.2016.05.010
    1. Fu R, Song C, Yang J, et al. . CAMI-NSTEMI score-China acute myocardial infarction registry-derived novel tool to predict in-hospital death in non-ST segment elevation myocardial infarction patients. Circ J 2018;82:1884–91. 10.1253/circj.CJ-17-1078
    1. Jobs A, Mehta SR, Montalescot G, et al. . Optimal timing of an invasive strategy in patients with non-ST-elevation acute coronary syndrome: a meta-analysis of randomised trials. Lancet 2017;390:737–46. 10.1016/S0140-6736(17)31490-3
    1. Deharo P, Ducrocq G, Bode C, et al. . Timing of angiography and outcomes in high-risk patients with Non-ST-Segment-Elevation myocardial infarction managed Invasively: insights from the TAO trial (treatment of acute coronary syndrome with Otamixaban). Circulation 2017;136:1895–907. 10.1161/CIRCULATIONAHA.117.029779
    1. Xu H, Li W, Yang J, et al. . The China acute myocardial infarction (CAMI) registry: a national long-term registry-research-education integrated platform for exploring acute myocardial infarction in China. Am Heart J 2016;175:193–201. 10.1016/j.ahj.2015.04.014
    1. Thygesen K, Alpert JS, Jaffe AS, et al. . Third universal definition of myocardial infarction. Circulation 2012;126:2020–35. 10.1161/CIR.0b013e31826e1058
    1. Steyerberg EW, Vickers AJ, Cook NR, et al. . Assessing the performance of prediction models: a framework for traditional and novel measures. Epidemiology 2010;21:128–38. 10.1097/EDE.0b013e3181c30fb2
    1. National Clinical Guideline C, National Institute for Health and Clinical Excellence: Guidance . Unstable angina and NSTEMI: the early management of unstable angina and non-ST-segment-elevation myocardial infarction. London: Royal College of Physicians (UK) National Clinical Guidelines Centre., 2010.
    1. D’Ascenzo F, Biondi-Zoccai G, Moretti C, et al. . Timi, grace and alternative risk scores in acute coronary syndromes: a meta-analysis of 40 derivation studies on 216,552 patients and of 42 validation studies on 31,625 patients. Contemp Clin Trials 2012;33:507–14. 10.1016/j.cct.2012.01.001
    1. Wu C, Gao XJ, Zhao YY, et al. . [Prognostic value of TIMI and GRACE risk scores for in-hospital mortality in Chinese patients with non-ST-segment elevation myocardial infarction]. Zhonghua Xin Xue Guan Bing Za Zhi 2019;47:297–304. 10.3760/cma.j.issn.0253-3758.2019.04.007
    1. Roffi M, Patrono C, Collet J-P, et al. . 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of cardiology (ESC). Eur Heart J 2016;37:267–315. 10.1093/eurheartj/ehv320
    1. Zhan L, Masoudi FA, Li X, et al. . Trends in cardiac biomarker testing in China for patients with acute myocardial infarction, 2001 to 2011: China PEACE-retrospective AMI study. PLoS One 2015;10:e0122237 10.1371/journal.pone.0122237
    1. Fox CS, Muntner P, Chen AY, et al. . Short-term outcomes of acute myocardial infarction in patients with acute kidney injury: a report from the National cardiovascular data registry. Circulation 2012;125:497–504. 10.1161/CIRCULATIONAHA.111.039909

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir