Bedside prediction of 9-year mortality after ST‑segment elevation myocardial infarction treated with primary percutaneous coronary intervention

Abstract

Background: Despite similar underlying pathogenesis, clinical features, and management of ST‑segment elevation myocardial infarction (STEMI), the long‑term prognosis of patients is highly variable. The ability to stratify an individual’s long‑term mortality risk could facilitate development of focused interventions aimed at reducing poor long‑term outcomes.

Aims: This study aimed to develop and validate a simple risk score based on routinely collected data for all‑cause and cardiovascular 9-year mortality in a homogeneous group of patients with STEMI undergoing primary percutaneous coronary intervention (pPCI).

Methods: All consecutive patients with STEMI treated with pPCI were randomly divided into 2 groups. The first group was called the building group and was used to develop logistic regression models that were converted into a simple risk scores that estimated all‑cause and cardiovascular long‑term mortality risk (ANIN risk score I and II, respectively) and subsequently validated in the second group, called the validating group.

Results: The 9-year follow‑up data were available in 1059 out of 1064 patients with STEMI. We developed 4 independent risk scores with the highest predictive accuracy of ANIN risk score I. Validation cohorts identified 4 most important risk factors: age, renal dysfunction, Killip class, and thrombolysis in myocardial infarction flow. Low, intermediate, and high‑risk subgroups were identified based on those factors with different long‑term mortalities: 10%, 37%, and 71%, respectively.

Conclusions: Long‑term mortality after STEMI treated with pPCI can be accurately predicted using 4-variable bedside risk score, which is ready to calculate right after pPCI. Patients in the low‑risk group have an excellent prognosis despite having experienced potentially lethal disease.