A Novel Risk Score to Predict In-Hospital Mortality in Patients With Acute Myocardial Infarction: Results From a Prospective Observational Cohort

Frontiers in Cardiovascular Medicine

article

Lulu Li¹  Xiling Zhang²  Yini Wang²  Xi Yu²  Haibo Jia²  Jingbo Hou²  Chunjie Li³  Wenjuan Zhang⁴  Wei Yang⁵  Bin Liu⁶  Lixin Lu⁷  Ning Tan⁸  Bo Yu²  Kang Li¹ 

[1] Department of Biostatistics, School of Public Health, Harbin Medical University;Department of Cardiology, Second Affiliated Hospital of Harbin Medical University;Department of Emergency, Tianjin Chest Hospital;Department of Cardiology, Tianjin Medical University General Hospital;Department of Cardiology, Fourth Affiliated Hospital of Harbin Medical University;Department of Cardiology, The Second Hospital of Jilin University;Department of Cardiology, Daqing Long Nan Hospital;Department of Cardiology, Guangdong General Hospital

关键词: acute myocardial infarction;    in-hospital mortality;    risk score;    logistic regression model;    net reclassification improvement;    integrated discrimination index;   

DOI  :  10.3389/fcvm.2022.840485

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Objectives The aim of this study was to develop and validate a novel risk score to predict in-hospital mortality in patients with acute myocardial infarction (AMI) using the Heart Failure after Acute Myocardial Infarction with Optimal Treatment (HAMIOT) cohort in China. Methods The HAMIOT cohort was a multicenter, prospective, observational cohort of consecutive patients with AMI in China. All participants were enrolled between December 2017 and December 2019. The cohort was randomly assigned (at a proportion of 7:3) to the training and validation cohorts. Logistic regression model was used to develop and validate a predictive model of in-hospital mortality. The performance of discrimination and calibration was evaluated using the Harrell’s c-statistic and the Hosmer-Lemeshow goodness-of-fit test, respectively. The new simplified risk score was validated in an external cohort that included independent patients with AMI between October 2019 and March 2021. Results A total of 12,179 patients with AMI participated in the HAMIOT cohort, and 136 patients were excluded. In-hospital mortality was 166 (1.38%). Ten predictors were found to be independently associated with in-hospital mortality: age, sex, history of percutaneous coronary intervention (PCI), history of stroke, presentation with ST-segment elevation, heart rate, systolic blood pressure, initial serum creatinine level, initial N-terminal pro-B-type natriuretic peptide level, and PCI treatment. The c-statistic of the novel simplified HAMIOT risk score was 0.88, with good calibration (Hosmer–Lemeshow test: P = 0.35). Compared with the Global Registry of Acute Coronary Events risk score, the HAMIOT score had better discrimination ability in the training (0.88 vs. 0.81) and validation (0.82 vs. 0.72) cohorts. The total simplified HAMIOT risk score ranged from 0 to 121. The observed mortality in the HAMIOT cohort increased across different risk groups, with 0.35% in the low risk group (score ≤ 50), 3.09% in the intermediate risk group (50 74). Conclusion The novel HAMIOT risk score could predict in-hospital mortality and be a valid tool for prospective risk stratification of patients with AMI.

【 授权许可】

CC BY