Key result
The CADILLAC risk score outperformed TIMI, GRACE, and PAMI scores in predicting 6-, 12-, and 24-month mortality in diabetic STEMI patients, with AUCs of 0.8207, 0.8210, and 0.8192 (p<0.0001).
Why the study?
ACS patients with diabetes have significantly worse cardiovascular outcomes, but the comparative performance of TIMI, GRACE, PAMI, and CADILLAC risk scores for predicting long-term outcomes in diabetic STEMI patients had not been evaluated.
Does the CADILLAC risk score better predict long-term mortality and complications compared to TIMI, GRACE, and PAMI scores in diabetic patients with STEMI?
Observational (n=455)
Yes
Does the CADILLAC risk score better predict long-term mortality and complications compared to TIMI, GRACE, and PAMI scores in diabetic patients with STEMI?
Effect estimate: AUC 0.8207, 0.8210, and 0.8192
p-value: p=<0.0001
The CADILLAC risk score outperforms TIMI, GRACE, and PAMI scores in predicting short- and long-term mortality, as well as in-hospital bleeding and acute renal failure, in diabetic patients with STEMI.
CADILLAC may aid stratification in diabetic STEMI; extends score comparisons yet leaves open prospective validation and impact.
Acute coronary syndrome (ACS) patients with diabetes have significantly worse cardiovascular outcomes than those without diabetes. This study aimed to compare the performance of The Thrombolysis In Myocardial Infarction (TIMI), Global Registry of Acute Coronary Events (GRACE), Primary Angioplasty in Myocardial Infarction (PAMI), and Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) risk scores in predicting long-term cardiovascular outcomes in diabetic patients with ST-segment elevation myocardial infarction (STEMI). From the Acute Coronary Syndrome-Diabetes Mellitus Registry of the Taiwan Society of Cardiology, patients with STEMI were included. The TIMI, GRACE, PAMI, and CADILLAC risk scores were calculated. The discriminative potential of risk scores was analyzed using the area under the receiver-operating characteristics curve (AUC). In the 455 patients included, all four risk score systems demonstrated predictive accuracy for 6-, 12- and 24-month mortality with AUC values of 0.67-0.82. The CADILLAC score had the best discriminative accuracy, with an AUC of 0.8207 (p<0.0001), 0.8210 (p<0.0001), and 0.8192 (p<0.0001) for 6-, 12-, and 24-month mortality, respectively. It also had the best predictive value for bleeding and acute renal failure, with an AUC of 0.7919 (p<0.05) and 0.9764 (p<0.0001), respectively. Patients with CADILLAC risk scores >8 had poorer 2-year survival than those with lower scores (log-rank p<0.0001). In conclusion, the CADILLAC risk score is more effective than other risk scores in predicting 6-month, 1-year, and 2-year all-cause mortality in diabetic patients with STEMI. It also had the best predictive value for in-hospital bleeding and acute renal failure.
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Kao et al. (2020) conducted an observational in Diabetic patients with ST-segment elevation myocardial infarction (STEMI) (n=455). CADILLAC risk score vs. TIMI, GRACE, and PAMI risk scores was evaluated on 6-, 12-, and 24-month mortality (AUC 0.8207, 0.8210, and 0.8192, p=<0.0001). The CADILLAC risk score outperformed TIMI, GRACE, and PAMI scores in predicting 6-, 12-, and 24-month mortality in diabetic STEMI patients, with AUCs of 0.8207, 0.8210, and 0.8192 (p<0.0001).
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