Development and validation of risk score for ACS in China:prognostic value in-hospital and interaction with revascularization

Objective:To develop a simple risk score of in-hospital major adverse cardiac events including all-cause mortality,new or recurrent MI(myocardial infarction),and evaluate the efficacy about revascularization on patients with different risk.Methods:The basic characteristics,diagnosis,therapy and in-hospital outcomes of 1512 ACS patients from GRACE study(global registry of acute coronary events)of China were collected to develop a risk score model by multivariable stepwise logistic regression.The goodness of fit and the discriminative power of the final model were assessed respectively.The best cut-off value for the risk score was used to assess the impact of revascularization for STEMI and NSTEACS on in-hospital outcomes.Results:(1)The following 6 independent risk factors accounted for about 92.5% of the prognostic information:age ≥80 years(4 points),SBP ≤90 mm Hg(6 points),DBP≥90 mm Hg(2 points),Killip Ⅱ(3 points),Killip Ⅲ or Ⅳ(9 points),cardiac arrest during presentation(4 points),ST-segment elevation(3 points)or depression(5 points)or combination of elevation and depression(4 points)on electrocardiogram at presentation.(2)CHIEF risk model was excellent with Hosmer-Lemeshow goodness-0f-fit test of 0.673 and c statistics of 0.776.(3)1301 ACS patients previously enrolled in GRACE study were divided into 2 groups with the best cut-off value of 5.5 points.Both STEMI(61.7% vs 78.3%,P=0.000)and NSTEACS(42.0% vs 62.3%,P=0.000)patients with the risk score more than 5.5 points have lower revascularization rate,However,the impact of revascularization on in-hospital MACE of higher risk subsets was stronger than lower risk subsets(P=0.02 and 0.04,respectively).Conclusion:The risk score provides excellent ability to predict in-hospital death or(re)MI quantitatively and accurately.Patients underwent revascularization with risk score greater than 5.5 have lower incidence rate of endpoint.