Affordable Access

deepdyve-link
Publisher Website

Predicting two-year mortality from discharge after acute coronary syndrome: An internationally-based risk score.

Authors
  • Pocock, Stuart J1
  • Huo, Yong2
  • Van de Werf, Frans3
  • Newsome, Simon1
  • Chin, Chee Tang4
  • Vega, Ana Maria5
  • Medina, Jesús5
  • Bueno, Héctor6, 7
  • 1 London School of Hygiene and Tropical Medicine, London, UK.
  • 2 Peking University First Hospital, Beijing, China. , (China)
  • 3 Department of Cardiovascular Sciences, University of Leuven, Belgium. , (Belgium)
  • 4 National Heart Centre Singapore, Singapore. , (Singapore)
  • 5 Medical Evidence and Observational Research, Global Medical Affairs, AstraZeneca, Madrid, Spain. , (Spain)
  • 6 Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain. , (Spain)
  • 7 Instituto de investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain. , (Spain)
Type
Published Article
Journal
European Heart Journal Acute Cardiovascular Care
Publisher
SAGE Publications
Publication Date
Dec 01, 2019
Volume
8
Issue
8
Pages
727–737
Identifiers
DOI: 10.1177/2048872617719638
PMID: 28777005
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Long-term risk of post-discharge mortality associated with acute coronary syndrome remains a concern. The development of a model to reliably estimate two-year mortality risk from hospital discharge post-acute coronary syndrome will help guide treatment strategies. EPICOR (long-tErm follow uP of antithrombotic management patterns In acute CORonary syndrome patients, NCT01171404) and EPICOR Asia (EPICOR Asia, NCT01361386) are prospective observational studies of 23,489 patients hospitalized for an acute coronary syndrome event, who survived to discharge and were then followed up for two years. Patients were enrolled from 28 countries across Europe, Latin America and Asia. Risk scoring for two-year all-cause mortality risk was developed using identified predictive variables and forward stepwise Cox regression. Goodness-of-fit and discriminatory power was estimated. Within two years of discharge 5.5% of patients died. We identified 17 independent mortality predictors: age, low ejection fraction, no coronary revascularization/thrombolysis, elevated serum creatinine, poor EQ-5D score, low haemoglobin, previous cardiac or chronic obstructive pulmonary disease, elevated blood glucose, on diuretics or an aldosterone inhibitor at discharge, male sex, low educational level, in-hospital cardiac complications, low body mass index, ST-segment elevation myocardial infarction diagnosis, and Killip class. Geographic variation in mortality risk was seen following adjustment for other predictive variables. The developed risk-scoring system provided excellent discrimination (c-statistic=0.80, 95% confidence interval=0.79-0.82) with a steep gradient in two-year mortality risk: >25% (top decile) vs. ~1% (bottom quintile). A simplified risk model with 11 predictors gave only slightly weaker discrimination (c-statistic=0.79, 95% confidence interval =0.78-0.81). This risk score for two-year post-discharge mortality in acute coronary syndrome patients ( www.acsrisk.org ) can facilitate identification of high-risk patients and help guide tailored secondary prevention measures.

Report this publication

Statistics

Seen <100 times