Tags

Type your tag names separated by a space and hit enter

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.
Eur Heart J Acute Cardiovasc Care. 2015 Dec; 4(6):509-17.EH

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.

Authors+Show Affiliations

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

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25301783

Citation

Pocock, Stuart, et al. "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." European Heart Journal. Acute Cardiovascular Care, vol. 4, no. 6, 2015, pp. 509-17.
Pocock S, Bueno H, Licour M, et al. 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. Eur Heart J Acute Cardiovasc Care. 2015;4(6):509-17.
Pocock, S., Bueno, H., Licour, M., Medina, J., Zhang, L., Annemans, L., Danchin, N., Huo, Y., & Van de Werf, F. (2015). 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. European Heart Journal. Acute Cardiovascular Care, 4(6), 509-17. https://doi.org/10.1177/2048872614554198
Pocock S, et al. 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. Eur Heart J Acute Cardiovasc Care. 2015;4(6):509-17. PubMed PMID: 25301783.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Pocock,Stuart, AU - Bueno,Héctor, AU - Licour,Muriel, AU - Medina,Jesús, AU - Zhang,Lin, AU - Annemans,Lieven, AU - Danchin,Nicholas, AU - Huo,Yong, AU - Van de Werf,Frans, Y1 - 2014/10/09/ PY - 2014/10/11/entrez PY - 2014/10/11/pubmed PY - 2016/9/17/medline KW - Acute coronary syndrome KW - hospital discharge KW - mortality KW - prognostic model KW - risk score SP - 509 EP - 17 JF - European heart journal. Acute cardiovascular care JO - Eur Heart J Acute Cardiovasc Care VL - 4 IS - 6 N2 - 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. SN - 2048-8734 UR - https://www.unboundmedicine.com/medline/citation/25301783/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_ L2 - https://journals.sagepub.com/doi/10.1177/2048872614554198?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -