Mortality prediction algorithms for patients undergoing primary percutaneous coronary intervention

Istvan Hizoh, Dominika Domokos, Gyongyver Banhegyi, David Becker, Bela Merkely, Zoltan Ruzsa, Istvan Hizoh, Dominika Domokos, Gyongyver Banhegyi, David Becker, Bela Merkely, Zoltan Ruzsa

Abstract

Mortality risk of ST-segment elevation myocardial infarction (STEMI) patients shows high variability. In order to assess individual risk, a number of scoring systems have been developed and validated. Yet, as treatment approaches evolve over time with improving outcomes, there is a need to build new risk prediction algorithms to maintain/increase prognostic accuracy. One of the most relevant improvements of therapy is primary percutaneous coronary intervention (PCI). We overview the characteristics and discriminative performance of the most studied and some recently constructed mortality risk models that were validated in patients with STEMI who underwent primary PCI.

Keywords: ST-elevation myocardial infarction (STEMI); decision support techniques; mortality; percutaneous coronary intervention (PCI); risk assessment.

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd.2019.12.83). The series “Interventional Cardiology” was commissioned by the editorial office without any funding or sponsorship. BM reports personal fees from Biotronik, Medtronic, Abbott, Astra Zeneca, Sanofi Aventis, Servier as well as grants from Boston Scientific, Medtronic, and Abbott, outside the submitted work. The other authors have no other of interest to declare.

2020 Journal of Thoracic Disease. All rights reserved.

Figures

Figure 1
Figure 1
Composition of mortality risk scores. Height of the bars shows the number of predictors needed for calculation of the score. Color of the predictor groups corresponds with the time needed for the availability of predictors: blue: variables that are available at or soon after admission (presentation characteristics and procedural data); orange: laboratory and imaging studies requiring some more time; green: in hospital events that can only be assessed at the time of discharge. True admission models are the TIMI and PAMI scores, whereas dynamic TIMI can only be calculated at the time of discharge. With the exception of the GRACE 2.0 and ALPHA models, there is a trend that newer algorithms became more complex with more predictors. TIMI, thrombolysis in myocardial infarction; PAMI, primary angioplasty in myocardial infarction.

References

    1. O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. J Am Coll Cardiol 2013;61:e78-140. 10.1016/j.jacc.2012.11.019
    1. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018;39:119-77. 10.1093/eurheartj/ehx393
    1. Neumann F-J, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2019;40:87-165. 10.1093/eurheartj/ehy394
    1. Sianos G, Morel M-A, Kappetein AP, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention 2005;1:219-27.
    1. Ong ATL, Serruys PW, Mohr FW, et al. The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) study: Design, rationale, and run-in phase. Am Heart J 2006;151:1194-204. 10.1016/j.ahj.2005.07.017
    1. Morrow DA, Antman EM, Charlesworth A, et al. TIMI risk score for ST-elevation myocardial infarction: A convenient, bedside, clinical score for risk assessment at presentation: An intravenous nPA for treatment of infarcting myocardium early II trial substudy. Circulation 2000;102:2031-7. 10.1161/01.CIR.102.17.2031
    1. Addala S, Grines CL, Dixon SR, et al. Predicting mortality in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention (PAMI risk score). Am J Cardiol 2004;93:629-32. 10.1016/j.amjcard.2003.11.036
    1. De Luca G, Suryapranata H, van ’t Hof AW, et al. Prognostic assessment of patients with acute myocardial infarction treated with primary angioplasty: implications for early discharge. Circulation 2004;109:2737-43. 10.1161/01.CIR.0000131765.73959.87
    1. Halkin A, Singh M, Nikolsky E, et al. Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: The CADILLAC risk score. J Am Coll Cardiol 2005;45:1397-405. 10.1016/j.jacc.2005.01.041
    1. Stebbins A, Mehta RH, Armstrong PW, et al. A Model for Predicting Mortality in Acute ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2010;3:414-22. 10.1161/CIRCINTERVENTIONS.109.925180
    1. de Mulder M, Gitt A, van Domburg R, et al. EuroHeart score for the evaluation of in-hospital mortality in patients undergoing percutaneous coronary intervention. Eur Heart J 2011;32:1398-408. 10.1093/eurheartj/ehr034
    1. Amin ST, Morrow DA, Braunwald E, et al. Dynamic TIMI risk score for STEMI. J Am Heart Assoc 2013;2:e003269. 10.1161/JAHA.112.003269
    1. Hizoh I, Gulyas Z, Domokos D, et al. A novel risk model including vascular access site for predicting 30-day mortality after primary PCI: The ALPHA score. Cardiovasc Revasc Med 2017;18:33-9. 10.1016/j.carrev.2016.10.002
    1. Chin CT, Chen AY, Wang TY, et al. Risk adjustment for in-hospital mortality of contemporary patients with acute myocardial infarction: the acute coronary treatment and intervention outcomes network (ACTION) registry-get with the guidelines (GWTG) acute myocardial infarction mortality mode. Am Heart J 2011;161:113-22.e2. 10.1016/j.ahj.2010.10.004
    1. Fox KAA, Fitzgerald G, Puymirat E, et al. Should patients with acute coronary disease be stratified for management according to their risk? Derivation, external validation and outcomes using the updated GRACE risk score. BMJ Open 2014;4:e004425. 10.1136/bmjopen-2013-004425
    1. Peterson ED, Dai D, DeLong ER, et al. Contemporary mortality risk prediction for percutaneous coronary intervention: results from 588,398 procedures in the National Cardiovascular Data Registry. J Am Coll Cardiol 2010;55:1923-32. 10.1016/j.jacc.2010.02.005
    1. Raposeiras-Roubín S, Abu-Assi E, Cabanas-Grandío P, et al. Walking Beyond the GRACE (Global Registry of Acute Coronary Events) Model in the Death Risk Stratification During Hospitalization in Patients With Acute Coronary Syndrome. JACC Cardiovasc Interv 2012;5:1117-25. 10.1016/j.jcin.2012.06.023
    1. Abelin AP, David RB, Gottschall CA, et al. Accuracy of Dedicated Risk Scores in Patients Undergoing Primary Percutaneous Coronary Intervention in Daily Clinical Practice. Can J Cardiol 2014;30:125-31. 10.1016/j.cjca.2013.07.673
    1. Littnerova S, Kala P, Jarkovsky J, et al. GRACE Score among Six Risk Scoring Systems (CADILLAC, PAMI, TIMI, Dynamic TIMI, Zwolle) Demonstrated the Best Predictive Value for Prediction of Long-Term Mortality in Patients with ST-Elevation Myocardial Infarction. PLoS One 2015;10:e0123215. 10.1371/journal.pone.0123215
    1. Parenica J, Kala P, Pavkova MG, et al. Natriuretic peptides, nitrite/nitrate and superoxide dismutase have additional value on top of the GRACE score in prediction of one-year mortality and rehospitalisation for heart failure in STEMI patients - Multiple biomarkers prospective cohort study. Int J Cardiol 2016;211:96-104. 10.1016/j.ijcard.2016.02.135
    1. Huang W, FitzGerald G, Goldberg RJ, et al. Performance of the GRACE Risk Score 2.0 Simplified Algorithm for Predicting 1-Year Death After Hospitalization for an Acute Coronary Syndrome in a Contemporary Multiracial Cohort. Am J Cardiol 2016;118:1105-10. 10.1016/j.amjcard.2016.07.029
    1. Timóteo AT, Monteiro AV, Portugal G, et al. Validation of two US risk scores for percutaneous coronary intervention in a single-center Portuguese population of patients with acute coronary syndrome. Rev Port Cardiol 2016;35:73-8. 10.1016/j.repc.2015.09.018
    1. Yu T, Tian C, Song J, et al. ACTION (acute coronary treatment and intervention outcomes network) registry-GWTG (get with the guidelines) risk score predicts long-term mortality in acute myocardial infarction. Oncotarget 2017;8:102559-72. 10.18632/oncotarget.21741
    1. Hizoh I, Banhegyi G, Domokos D, et al. Comparative Validation of the ALPHA Score, a Novel Risk Model Including Vascular Access Site for Predicting 30-Day Mortality in Patients Treated With Primary PCI. J Am Coll Cardiol 2018;72:B320-1. 10.1016/j.jacc.2018.08.2039
    1. Lev EI, Kornowski R, Vaknin-Assa H, et al. 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. Am J Cardiol 2008;102:6-11. 10.1016/j.amjcard.2008.02.088
    1. Elbarouni B, Goodman SG, Yan RT, et al. Validation of the Global Registry of Acute Coronary Event (GRACE) risk score for in-hospital mortality in patients with acute coronary syndrome in Canada. Am Heart J 2009;158:392-9. 10.1016/j.ahj.2009.06.010
    1. Abu-Assi E, Ferreira-González I, Ribera A, et al. Do GRACE (Global Registry of Acute Coronary events) risk scores still maintain their performance for predicting mortality in the era of contemporary management of acute coronary syndromes? Am Heart J 2010;160:826-834.e1-3.
    1. Yusufali A, Zubaid M, Al-Zakwani I, et al. Validation of the GRACE risk score for hospital mortality in patients with acute coronary syndrome in the Arab Middle East. Angiology 2011;62:390-6. 10.1177/0003319710387921
    1. Méndez-Eirín E, Flores-Ríos X, García-López F, et al. Comparison of the prognostic predictive value of the TIMI, PAMI, CADILLAC, and GRACE risk scores in STEACS undergoing primary or rescue PCI. Rev Esp Cardiol 2012;65:227-33. 10.1016/j.recesp.2011.10.019
    1. Timóteo AT, Papoila AL, Lopes JP, et al. Is it possible to simplify risk stratification scores for patients with ST-segment elevation myocardial infarction undergoing primary angioplasty? Rev Port Cardiol 2013;32:967-73. 10.1016/j.repc.2013.06.006
    1. Fujii T, Suzuki T, Torii S, et al. Diagnostic Accuracy of Global Registry of Acute Coronary Events (GRACE) Risk Score in ST-Elevation Myocardial Infarction for In-Hospital and 360-Day Mortality in Japanese Patients. Circ J 2014;78:2950-4. 10.1253/circj.CJ-14-0808
    1. Morrow DA, Antman EM, Parsons L, et al. Application of the TIMI risk score for ST-elevation MI in the National Registry of Myocardial Infarction 3. JAMA 2001;286:1356-9. 10.1001/jama.286.11.1356
    1. Selvarajah S, Fong AYY, Selvaraj G, et al. An Asian validation of the TIMI risk score for ST-segment elevation myocardial infarction. PLoS One 2012;7:e40249. 10.1371/journal.pone.0040249
    1. Mehta SR, Jolly SS, Cairns J, et al. Effects of radial versus femoral artery access in patients with acute coronary syndromes with or without ST-segment elevation. J Am Coll Cardiol 2012;60:2490-9. 10.1016/j.jacc.2012.07.050
    1. Romagnoli E, Biondi-Zoccai G, Sciahbasi A, et al. Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome. J Am Coll Cardiol 2012;60:2481-9. 10.1016/j.jacc.2012.06.017
    1. Karrowni W, Vyas A, Giacomino B, et al. Radial Versus Femoral Access for Primary Percutaneous Interventions in ST-Segment Elevation Myocardial Infarction Patients. JACC Cardiovasc Interv 2013;6:814-23. 10.1016/j.jcin.2013.04.010
    1. Valgimigli M, Gagnor A, Calabró P, et al. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. Lancet 2015;385:2465-76. 10.1016/S0140-6736(15)60292-6
    1. Grines CL, Cox DA, Stone GW, et al. Coronary angioplasty with or without stent implantation for acute myocardial infarction. Stent Primary Angioplasty in Myocardial Infarction Study Group. N Engl J Med 1999;341:1949-56. 10.1056/NEJM199912233412601
    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. Steyerberg EW, Vergouwe Y. Towards better clinical prediction models: Seven steps for development and an ABCD for validation. Eur Heart J 2014;35:1925-31. 10.1093/eurheartj/ehu207
    1. Davis J, Goadrich M. The relationship between Precision-Recall and ROC curves. In: Proceedings of the 23rd international conference on Machine learning - ICML ’06.Vol 73. New York, New York, USA: ACM Press, 2006:233-40.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi