Key result
Updated ACTION risk score improves in-hospital mortality discrimination over the original score.
Why the study?
The original ACTION risk score was introduced in 2011 to predict in-hospital mortality after AMI treated with pPCI, and an updated score was developed in 2016 but lacked external validation and direct comparison.
Does the updated ACTION risk score improve prediction of in-hospital and one-year mortality compared to the original ACTION risk score in patients with acute myocardial infarction undergoing primary PCI?
Cohort (n=5,615)
No
Does the updated ACTION risk score improve prediction of in-hospital and one-year mortality compared to the original ACTION risk score in patients with acute myocardial infarction undergoing primary PCI?
The updated ACTION risk score provides superior discrimination for predicting in-hospital and one-year mortality compared to the original score in patients undergoing primary PCI for acute myocardial infarction.
Background The Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry-Get With The Guidelines (GWTG) AMI mortality model and risk score (ACTION) were introduced in 2011 to predict in-hospital mortality. In 2016 score was updated to enable a more accurate assessment, but, up-to-date, external validation in direct comparison was not performed. Purpose We aimed to externally validate and compare the prognostic value of original and updated ACTION score for in-hospital and one-year mortality. Method From a prospective electronic registry of a high-volume catheterization laboratory in a period from January 2009 to December 2017, a total of 5615 consecutive patients who underwent pPCI were available for analysis. For each patient, original (O-) and updated (U-) ACTION scores were calculated using required clinical and angiographic characteristics. In-hospital and one-year mortality (follow-up available for 91%) were assessed. Calibration and discrimination of the three risk models were evaluated by the Hosmer-Lemeshow (H-L) goodness-of-fit test and C-statistic, respectively. Results Mortality rates for in-hospital and one-year mortality were 4.2% and 9.6%, respectively. Both scores showed good model calibration as assessed by the H-L test and very good discriminative power for in-hospital and one-year mortality as assessed by C-statistics (Table 1 & Figure 1). Net reclassification index (NRI=1.06) showed that 48% of patients with in-hospital event and 58% without event, had their risk recalculated with U-ACTION with Integrated Discrimination Improvement slope 9.1% higher than in first model. Table 1 Risk score H-L H-L p value AUC 95% CI p value AUC 95% CI Significant p value O-ACTION 9.4 0.3 0.829 0.819 to 0.839 p<0.0001 0.781 0.769 to 0.792 p<0.0001 U-ACTION 10.9 0.2 0.918 0.911 to 0.925 0.838 0.827 to 0.848 Figure 1 Conclusion Updated ACTION score enables better prediction of in-hospital and one-year mortality in patients undergoing pPCI for acute myocardial infarction, thus it can be used preferentially over the original ACTION score for assessment of short and long-term mortality risks of this population.
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Jelic et al. (2019) conducted a cohort in acute myocardial infarction (n=5,615). Updated ACTION risk score vs. Original ACTION risk score was evaluated on In-hospital mortality prediction (discrimination) (AUC 0.918, 95% CI 0.911-0.925, p=<0.0001). The updated ACTION risk score provided better discrimination for in-hospital mortality compared to the original score (AUC 0.918 vs 0.829).
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