Key result
Modified SMIR score performs similarly to GRACE 2.0 in predicting 1-year mortality after AMI PCI.
Why the study?
Existing AMI risk scores like GRACE were derived predominantly from Caucasian populations, and a previous Singapore registry score was limited to STEMI patients.
Does the modified SMIR risk score predict 1-year all-cause mortality as well as the GRACE 2.0 score in a multi-ethnic Asian AMI population undergoing PCI?
Observational (n=5,658)
Yes
Does the modified SMIR risk score predict 1-year all-cause mortality as well as the GRACE 2.0 score in a multi-ethnic Asian AMI population undergoing PCI?
In a multi-ethnic Asian population with acute myocardial infarction undergoing PCI, the modified SMIR risk score performed similarly to the widely used GRACE 2.0 score in predicting 1-year all-cause mortality.
Answers are grounded in this paper and cite their sources.
Similar performance supports modified SMIR in Asian AMI-PCI cohorts; leaves open prospective validation before clinical adoption.
Risk stratification plays a key role in identifying acute myocardial infarction (AMI) patients at higher risk of mortality. However, current AMI risk scores such as the Global Registry of Acute Coronary Events (GRACE) score were derived from predominantly Caucasian populations and may not be applicable to Asian populations. We previously developed an AMI risk score from the national-level Singapore Myocardial Infarction Registry (SMIR) confined to ST-segment elevation myocardial infarction (STEMI) patients and did not include non-STEMI (NSTEMI) patients. Here, we derived a modified SMIR risk score for both STEMI and NSTEMI patients and compared its performance to the GRACE 2.0 score for predicting 1-year all-cause mortality in our multi-ethnic population. The most significant predictor of 1-year all-cause mortality in our population using the GRACE 2.0 score was cardiopulmonary resuscitation on admission (adjusted hazards ratio [HR] 6.50), while the most significant predictor using the SMIR score was age 80-89 years (adjusted HR 7.78). Although the variables used in the GRACE 2.0 score and SMIR score were not exactly the same, the c-statistics for 1-year all-cause mortality were similar between the two scores (GRACE 2.0 0.841 and SMIR 0.865). In conclusion, we have shown that in a multi-ethnic Asian AMI population undergoing PCI, the SMIR score performed as well as the GRACE 2.0 score.
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Sia et al. (2022) conducted an observational in Acute myocardial infarction (STEMI and NSTEMI) (n=5,658). Modified SMIR risk score vs. GRACE 2.0 risk score was evaluated on 1-year all-cause mortality prediction (Area under the ROC curve) (p=0.075). The modified SMIR score performed similarly to the GRACE 2.0 score in predicting 1-year all-cause mortality in a multi-ethnic Asian acute myocardial infarction population undergoing PCI (AUC 0.865 vs 0.841).
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