Key result
GRACE score best predicts in-hospital infection after STEMI PCI with an AUC of ~0.79.
Why the study?
Very few risk scores predicting infection in STEMI patients undergoing PCI have been validated, and reports comparing their differences are lacking.
Do the ACEF, AGEF, CACS, CHADS2, GRACE, and Mehran risk scores accurately predict infection in patients with STEMI undergoing PCI?
Cohort (n=2,260)
No
Do the ACEF, AGEF, CACS, CHADS2, GRACE, and Mehran risk scores accurately predict infection in patients with STEMI undergoing PCI?
Effect estimate: AUC 0.791 (95% CI 0.765-0.817)
The ACEF, AGEF, CACS, GRACE, and Mehran scores demonstrate good discrimination and calibration for predicting in-hospital infection and MACE in STEMI patients undergoing PCI.
May support GRACE for infection risk stratification in STEMI PCI; hypothesis-generating, requires prospective validation before practice change.
Aims: Very few of the risk scores to predict infection in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) have been validated, and reports on their differences. We aimed to validate and compare the discriminatory value of different risk scores for infection. Methods: A total of 2,260 eligible patients with STEMI undergoing PCI from January 2010 to May 2018 were enrolled. Six risk scores were investigated: age, serum creatinine, or glomerular filtration rate, and ejection fraction (ACEF or AGEF) score; Canada Acute Coronary Syndrome (CACS) risk score; CHADS2 score; Global Registry for Acute Coronary Events (GRACE) score; and Mehran score conceived for contrast induced nephropathy. The primary endpoint was infection during hospitalization. Results: Except CHADS2 score (AUC, 0.682; 95%CI, 0.652–0.712), the other risk scores showed good discrimination for predicting infection. All risk scores but CACS risk score (calibration slope, 0.77; 95%CI, 0.18–1.35) showed best calibration for infection. The risks scores also showed good discrimination for in-hospital major adverse clinical events (MACE) (AUC range, 0.700–0.786), except for CHADS2 score. All six risk scores showed best calibration for in-hospital MACE. Subgroup analysis demonstrated similar results. Conclusions: The ACEF, AGEF, CACS, GRACE, and Mehran scores showed a good discrimination and calibration for predicting infection and MACE.
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Wang et al. (2021) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) (n=2,260). Six risk scores (ACEF, AGEF, CACS, CHADS2, GRACE, Mehran) was evaluated on Infection during hospitalization (AUC 0.791, 95% CI 0.765-0.817). The GRACE risk score demonstrated the highest discrimination for predicting in-hospital infection in STEMI patients undergoing PCI (AUC 0.791), while ACEF, AGEF, CACS, and Mehran scores also showed good predictive value.
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