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Eur Heart J Acute Cardiovasc Care. 2015 Dec;4(6):509-17. doi: 10.1177/2048872614554198. Epub 2014 Oct 9.

Predictors of one-year mortality at hospital discharge after acute coronary syndromes: A new risk score from the EPICOR (long-tErm follow uP of antithrombotic management patterns In acute CORonary syndrome patients) study.

Author information

1
London School of Hygiene and Tropical Medicine, UK Stuart.Pocock@lshtm.ac.uk.
2
Hospital General Universitario Gregorio Marañón, Spain.
3
Medical Department, AstraZeneca France, France.
4
AstraZeneca Observational Research Center, Spain.
5
AstraZeneca Medical Evidence Center, USA.
6
Interuniversity Centre for Health Economics Research UGent, Vrije Universiteit Brussel, Belgium.
7
Hôpital Européen Georges Pompidou, René Descartes University, France.
8
Peking University First Hospital, China.
9
University Hospitals Leuven, Belgium.

Abstract

AIMS:

A reliable prediction tool is needed to identify acute coronary syndrome (ACS) patients with high mortality risk after their initial hospitalization.

METHODS:

EPICOR (long-tErm follow uP of antithrombotic management patterns In acute CORonary syndrome patients: NCT01171404) is a prospective cohort study of 10,568 consecutive hospital survivors after an ACS event (4943 ST-segment elevation myocardial infarction (STEMI) and 5625 non-ST-elevation ACS (NSTE-ACS)). Of these cases, 65.1% underwent percutaneous coronary intervention (PCI) and 2.5% coronary artery bypass graft (CABG). Post-discharge mortality was recorded for up to two years. From over 50 potential predictor variables a new risk score for one-year mortality was developed using forward stepwise Cox regression, and examined for goodness-of-fit, discriminatory power, and external validation.

RESULTS:

A total of 407 patients (3.9%) died within one year of discharge. We identified 12 highly significant independent predictors of mortality (in order of predictive strength): age, lower ejection fraction, poorer EQ-5D quality of life, elevated serum creatinine, in-hospital cardiac complications, chronic obstructive pulmonary disease, elevated blood glucose, male gender, no PCI/CABG after NSTE-ACS, low hemoglobin, peripheral artery disease, on diuretics at discharge. When combined into a new risk score excellent discrimination was achieved (c-statistic=0.81) and this was also validated on a large similar cohort (9907 patients) in Asia (c=0.78). For both STEMI and NSTE-ACS there was a steep gradient in one-year mortality ranging from 0.5% in the lowest quintile to 18.2% in the highest decile. NSTE-ACS contributes over twice as many high-risk patients as STEMI.

CONCLUSIONS:

Post-discharge mortality for ACS patients remains of concern. Our new user-friendly risk score available on www.acsrisk.org can readily identify who is at high risk.

KEYWORDS:

Acute coronary syndrome; hospital discharge; mortality; prognostic model; risk score

PMID:
25301783
PMCID:
PMC4657391
DOI:
10.1177/2048872614554198
[Indexed for MEDLINE]
Free PMC Article

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