Key result
CADILLAC and ZWOLLE scores outperform TIMI for predicting one-year post-PCI mortality, achieving ~0.92 AUC.
Why the study?
Several risk scores have been developed to predict prognosis in STEMI patients treated with pPCI, but their comparative predictive value for intrahospital, short-term, and long-term mortality was unclear.
Which risk score (CADILLAC, ZWOLLE, or TIMI) best predicts short- and long-term mortality in STEMI patients treated with primary PCI?
Cohort (n=311)
No
Which risk score (CADILLAC, ZWOLLE, or TIMI) best predicts short- and long-term mortality in STEMI patients treated with primary PCI?
Absolute Event Rate: 0.921% vs 0.786%
p-value: p=0.0087
CADILLAC and ZWOLLE scores provide superior long-term mortality prediction compared to the TIMI score in STEMI patients undergoing primary PCI.
May aid risk stratification in pPCI-treated STEMI; leaves open which score is superior without prospective validation.
Introduction: Primary percutaneous coronary intervention (pPCI) presents standard treatment in patients with acute myocardial infarction. In order to predict the prognosis of patients with ST segment elevation myocardial infarction (STEMI), several risk scores have been developed. Aim: Comparison of the predictive value of three validated risk scores, regarding intrahospital, short-term (30-days) and long-term (1-year) mortality among patients with a diagnosis of STEMI treated with pPCI in the Catheterization lab, Clinical Center of Serbia. Material and methods: The retrospective study included 311 consecutive patients with a diagnosis of STEMI treated with pPCI in 2017. Patients with cardiogenic shock at admission were excluded. Data were analyzed from the electronic database. For every patient the value of CADILLAC, ZWOLLE and TIMI score was calculated. The predictive ability of the risk scores was compared by area under (AUC) the ROC (Receiver Operating Characteristic) curves. The short-term and long-term outcome of the patient was assessed by telephone and clinical contact. Results: The study population was 311 patients, with an average age of 61±10 years, of which 237 (76.2%) were male. Rates of intrahospital, mortality at 30 days and at one year after pPCI were 1.9%, 3.2%, 6.1%. All three test scores showed very good predictive value in short-term mortality, both intrahospital (0.962; 0.986; 0.964, p=ns within scores) and after 30 days (0.920; 0.956; 0.861, p=ns within scores), while after 1 year accuracy of CADILLAC and ZWOLLE was better than TIMI score (0.921; 0.905; 0.786, p vs. TIMI 0,0087 and 0,0567). The age, three-vessel coronary disease and lower admission hemoglobin were identified as independent predictors for one-year mortality by logistic regression analysis. Conclusion: Both CADILLAC and ZWOLLE showed a very good predictive ability for intrahospital, short and long-term mortality, while for TIMI score, comparable accuracy was observed only for a period of up to 30 days following pPCI.
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Đurošev et al. (2020) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=311). CADILLAC and ZWOLLE risk scores vs. TIMI risk score was evaluated on Predictive accuracy (AUC) for 1-year mortality (95% CI 0.885-0.948, p=0.0087). The CADILLAC and ZWOLLE risk scores showed very good predictive ability for 1-year mortality after primary PCI (AUC 0.921 and 0.905), significantly outperforming the TIMI score (AUC 0.786).
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