Key result
GRACE score best predicts long-term mortality after primary PCI for STEMI yielding 0.77 AUC.
Why the study?
The prognostic accuracy of six risk scoring models for long-term mortality and hospitalization due to acute decompensated heart failure in STEMI patients treated with primary PCI was unclear.
Which risk scoring system provides the best prognostic accuracy for long-term mortality and ADHF hospitalization in STEMI patients treated with primary PCI?
Cohort (n=593)
No
Which risk scoring system provides the best prognostic accuracy for long-term mortality and ADHF hospitalization in STEMI patients treated with primary PCI?
Effect estimate: AUC 0.77 (95% CI 0.70-0.83)
p-value: p=<0.001
The GRACE score is the most suitable model for predicting long-term mortality in STEMI patients treated with primary PCI, whereas the Zwolle score is best for predicting subsequent heart failure hospitalizations.
AIM: To compare the prognostic accuracy of six scoring models for up to three-year mortality and rates of hospitalisation due to acute decompensated heart failure (ADHF) in STEMI patients. METHODS AND RESULTS: A total of 593 patients treated with primary PCI were evaluated. Prospective follow-up of patients was ≥3 years. Thirty-day, one-year, two-year, and three-year mortality rates were 4.0%, 7.3%, 8.9%, and 10.6%, respectively. Six risk scores--the TIMI score and derived dynamic TIMI, CADILLAC, PAMI, Zwolle, and GRACE--showed a high predictive accuracy for six- and 12-month mortality with area under the receiver operating characteristic curve (AUC) values of 0.73-0.85. The best predictive values for long-term mortality were obtained by GRACE. The next best-performing scores were CADILLAC, Zwolle, and Dynamic TIMI. All risk scores had a lower prediction accuracy for repeat hospitalisation due to ADHF, except Zwolle with the discriminatory capacity for hospitalisation up to two years (AUC, 0.80-0.83). CONCLUSIONS: All tested models showed a high predictive value for the estimation of one-year mortality, but GRACE appears to be the most suitable for the prediction for a longer follow-up period. The tested models exhibited an ability to predict the risk of ADHF, especially the Zwolle model.
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Littnerová et al. (2015) conducted a cohort in ST-Elevation Myocardial Infarction (STEMI) (n=593). GRACE risk score vs. CADILLAC, PAMI, TIMI, Dynamic TIMI, and Zwolle risk scores was evaluated on 3-year all-cause mortality (AUC 0.77, 95% CI 0.70-0.83, p=<0.001). The GRACE risk score demonstrated the best predictive value for long-term all-cause mortality in STEMI patients treated with primary PCI, with an AUC of 0.77 at three years.
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