Key result
A novel prediction score strongly predicted pre-hospital sudden cardiac arrest in STEMI patients, with an event rate of 28.9% in those with a score ≥30 versus 1.6% in those with a score ≤9 (P<0.001).
Why the study?
Despite major investments in prevention and resuscitation, sudden cardiac death mortality remains high, highlighting the need for novel approaches such as anticipation and near-term prevention.
Can a clinical prediction score identify STEMI patients at high risk for pre-hospital sudden cardiac death?
Cohort (n=8,112)
Can a clinical prediction score identify STEMI patients at high risk for pre-hospital sudden cardiac death?
Effect estimate: 18-fold increase
Absolute Event Rate: 28.9% vs 1.6%
p-value: p=<0.001
A novel prediction score using simple clinical variables can identify STEMI patients at high risk of pre-hospital sudden cardiac death, potentially enabling near-term prevention strategies.
May stratify pre-hospital SCA risk in STEMI; hypothesis-generating for prevention strategies pending validation.
Background: Sudden cardiac death (SCD) is a major issue of public health with more than 350,000 deaths per year in the United States, accounting for almost half of cardiovascular mortality. Despite major investments in both prevention and resuscitation, SCD mortality remains high, highlighting the need for a novel approach. Purpose: To assess the feasibility of developing anticipation and near-term prevention as a novel approach for decreasing SCD burden. Methods: Using a prospective population-based study evaluating all STEMI patients managed by Emergency Medical Services (EMS) in the Greater Paris Area (11.7 million inhabitants) between 2006 and 2010, we identified characteristics associated with an increased risk of pre-hospital SCD and used these variables to build a SCD prediction score which we validated internally and externally. Results: In the overall STEMI population, (n=8112; median age 60 years, 78% males), SCD occurred in 452 patients (5.6%). By multivariate analysis, younger age, absence of obesity, absence of diabetes, shortness of breath, and a short delay between pain onset and call to EMS were the main predictors of SCA. A score built from these variables predicted SCA, with the risk increasing 2-fold in patients with a score between 10 and 19, 4-fold with a score between 20 and 29, and more than 18-fold with a score ≥30, compared to those with scores <10. The SCA rate was 28.9% in patients with a score ≥30 compared to 1.6% in patients with a score ≤9 (P for trend<0.001). Sensitivity and specificity varied between 96.9% and 10.5% for scores 10 and above, and 18.0% and 97.6% for scores 30 and above, with scores between 20 and 29 achieving the best sensitivity and specificity (65.4% and 62.6%, respectively).
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Karam et al. (2017) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=8,112). High sudden cardiac death (SCD) prediction score (≥30) vs. Low SCD prediction score (≤9) was evaluated on Pre-hospital sudden cardiac arrest (SCA) (18-fold increase, p=<0.001). A novel prediction score strongly predicted pre-hospital sudden cardiac arrest in STEMI patients, with an event rate of 28.9% in those with a score ≥30 versus 1.6% in those with a score ≤9 (P<0.001).
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