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A new post-PCI scoring system for in-hospital mortality in STEMI patients

Chiostri, Marco; Valente, Serafina; Crudeli, Elena; Giglioli, Cristina; Gensini, Gian Franco

Journal of Cardiovascular Medicine: October 2010 - Volume 11 - Issue 10 - p 733–738
doi: 10.2459/JCM.0b013e328339d910
Original articles
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Objective To develop a scoring system for predicting in-hospital mortality among ST-elevation myocardial infarction (STEMI) patients submitted to percutaneous intervention (PCI) on intensive cardiac care unit admission by using early and readily available clinical, angiographic and laboratory data.

Design Prospective monocentric observational study in which we used discriminant analysis to develop a final scoring system, with prospective validation.

Setting Intensive cardiac care unit in Florence, a tertiary center.

Population Five hundred and fifty-eight unselected patients with STEMI (group A) consecutively admitted from 1 January 2004 to 31 December 2006. A control group (group B) comprising 183 STEMI patients admitted from 1 January 2007 to 30 September 2007.

Main outcomes and measures In-hospital death.

Results In group A the discriminant variables were admission Killip class, admission lactic acid, admission ejection fraction, admission troponin I (TnI), admission hemoglobin (Hb), ST-segment reduction post-PCI, systolic blood pressure on admission and chronic renal failure. We elaborated a scoring system, the Florence admission STEMI risk score, which shows an agreement of 95.7% between the observed and the estimated outcome on a statistical basis in the survival and death subgroups. We applied this score to group B (C statistics = 0.986).

Conclusion The Florence admission STEMI risk score incorporates anamnestic (chronic renal failure), laboratory (lactic acid, TnI and Hb), procedural and post-procedural data (ST-segment reduction post-PCI, Killip class) as well as data strictly related to infarct size (ejection fraction, TnI). This scoring system is likely to be a simple and practical tool at the bedside for risk evaluation in patients with STEMI submitted to primary PCI.

Intensive Cardiac Care Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

Received 31 October, 2009

Revised 29 January, 2010

Accepted 12 March, 2010

Correspondence to Serafina Valente, MD, Heart and Vessel Department, Viale Morgagni 85, 50134 Florence, Italy Tel: +39 55 7947518; fax: +39 55 7947518; e-mail: seravalente@hotmail.com

© 2010 Italian Federation of Cardiology. All rights reserved.