![]() However, the derivation and validation cohorts for these risk scores consisted predominantly of non-Asian patients treated by thrombolysis.Ībout 60% of the world population resides in the Asia-Pacific region 1 and Asians are known to have a different and higher cardiovascular risk profile than the western population 9. On the other hand, there is a specific TIMI risk score for STEMI 4 to predict 30-day mortality. The GRACE score can be used for all types of acute coronary syndromes (ACS), and can predict in-hospital and 6-month mortality. The most extensively investigated, and validated risk scores are the Global Registry of Acute Coronary Events (GRACE) 6, 7, and the Thrombolysis in Myocardial Infarction (TIMI) 4 risk scores, with the GRACE score performing better than the TIMI risk score in a recent meta-analysis 8. There are several risk scores available which can be used to risk-stratify STEMI patients at the time of hospitalization, and guide management 5. ![]() Therefore early risk-stratification of STEMI patients is important to guide in-patient management and follow-up in order to improve clinical outcomes. Those in the low-risk category have excellent prognosis 3, whereas those with high-risk features have significantly worse outcomes with the risk of all-cause mortality reaching up to 35% at 30-day in those in the highest risk category 4. However, not all STEMI patients have the same prognosis. These predictors could be incorporated into specific risk scores to stratify reperfused STEMI patients by their risk level for targeted intervention.ĭespite prompt reperfusion of ST-segment elevation myocardial infarction (STEMI) by primary percutaneous coronary intervention (PPCI), morbidity and mortality remain significant 1, 2. Applying these models to the validation cohort (30% of patients) showed good fit and discrimination (c-statistic 0.922, 0.913, 0.903 and 0.855 respectively misclassification rate 14.0%, 14.7%, 16.2% and 24.0% respectively). Age, previous IHD and diabetes, Killip class, creatinine, hemoglobin and troponin on admission, symptom-to-balloon-time and LVEF were predictors of 1-year HHF. Previous ischemic heart disease (IHD) was a predictor of in-hospital and 30-day cardiac mortality only, whereas diabetes was a predictor of 1-year cardiac mortality only. From the derivation cohort (70% of patients), age, Killip class and cardiac arrest, creatinine, hemoglobin and troponin on admission and left ventricular ejection fraction (LVEF) during hospitalization were predictors of in-hospital, 30-day and 1-year cardiac mortality. In-hospital, 30-day and 1-year cardiac mortality and 1-year HHF rates were 6.4%, 6.8%, 8.3% and 5.2%, respectively. 11,546 eligible STEMI patients between 20 were identified. We aimed to identify independent predictors of cardiac mortality and hospitalization for heart failure (HHF) from a real-world, multi-ethnic Asian registry of ST-segment elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention.
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