Prediction of Short-Term Outcome after Primary Percutaneous Coronary Intervention by CADILLAC Risk Score

Bangladesh Heart Journal Pub Date : 2023-07-08 DOI:10.3329/bhj.v38i1.67216

M. Kabir, M. Arefin, Md Shafiqul Islam, J. Jahan, B. Dutta, M Zahid Hasan, Md Imam Hosen, Tausif Amim Shadly, Md Nazmul Hoque Bhuiyan, M. Azam

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Abstract

Introduction: The CADILLAC risk score (CRS) has been developed and validated in the context of primary PCI as a reperfusion strategy for accurate risk stratification. Patients with low CRS have better outcome than those with intermediate to high CRS. However, further studies are needed to validate this score in our population. Aim of the study: The present study was conducted to predict the short-term outcome after primary percutaneous coronary intervention (pPCI) by CRS. Method: This prospective observational study was conducted at the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from March, 2019 to August, 2020, on 62 patients with two equally divided groups based on CRS: Group I with score 0-2 and Group II with e” 3. The score was calculated by summation of points gathered from each component of the score. Bleeding events, vascular access site complication, heart failure, cardiogenic shock, significant arrhythmia, major adverse cardiovascular and cerebrovascular events (MACCE), were observed during hospital stay and at 30- day follow up. Result: Mean CRS of the groups were 0.45±0.85 and 4.71±1.74 respectively. Overall adverse outcome, both in-hospital and 30-day, were significantly higher in group II (12.9%vs.35%, p=0.003 and 0vs.22.6%, p=0.001 respectively). Heart failure (22.6%vs.6.5%, p=0.04; 19.4%vs.0, p=0.01) and MACCE (19.3%vs.3.2%, P=0.04; 16.1vs.0%, p=0.02) were significant during hospital stay and at 30-day follow up. Bleeding events (12.9%vs.0, p=0.03) and significant arrhythmia (6.5%vs.0, p=0.04) were significant during hospital stay. Length of hospital stay was also significantly shorter in group I (d”3days: 74.2%vs.35.5%; p= 0.01). The components of CRS except post-PCI TIMI (Thrombolysis in myocardial infarction) flow, intermediate to high CRS, male gender, diabetes mellitus, hypertension, were significant in univariate regression analysis. Moderate to high CRS (in-hospital and 30-day), left ventricular ejection fraction< 40% (inhospital), triple vessel disease (30-day) were significant in multivariate analysis. ROC curve analysis showed, area under the curve for CRS was 0.745 (95% CI: 0.616- 0.874; p=0.001). CRSe”3 predicted in-hospital outcome after pPCI with sensitivity and specificity of 35.5% and 87%, respectively. Conclusion: In the setting of pPCI, low CRS is associated with better in-hospital outcome in comparison to intermediate to high CRS. Also, in comparison to intermediate to high CRS, low CRS is associated with better 30-day outcome after pPCI, However, for prediction of adverse short-term outcome after pPCI, CRS has got relatively low sensitivity and high specificity. Bangladesh Heart Journal 2023; 38(1): 32-37

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用CADILLAC风险评分预测初次经皮冠状动脉介入术后的短期预后

凯迪拉克风险评分(CRS)已经在初级PCI的背景下被开发和验证，作为一种精确的风险分层的再灌注策略。低CRS患者的预后优于中高CRS患者。然而，需要进一步的研究来验证这一评分在我们人群中的有效性。研究目的:本研究旨在预测经皮冠状动脉介入治疗(pPCI)后的短期预后。方法:本前瞻性观察研究于2019年3月至2020年8月在孟加拉国达卡国家心血管疾病研究所(NICVD)对62例患者进行了前瞻性观察研究，根据CRS分为两组:0-2分的I组和e“3”分的II组。分数是通过从分数的每个组成部分收集的分数的总和来计算的。住院期间及随访30天观察出血事件、血管通路并发症、心力衰竭、心源性休克、显著心律失常、主要心脑血管不良事件(MACCE)。结果:各组平均CRS分别为0.45±0.85和4.71±1.74。总体不良结局，包括住院和30天，II组明显更高(12.9%vs. 12.9%)。35%， p=0.003和0vs.22.6%， p=0.001)。心力衰竭(22.6%vs.6.5%， p=0.04;19.4% vs。0, p=0.01)和MACCE (19.3%vs.3.2%， p= 0.04;16.1 vs。0%， p=0.02)在住院期间和30天随访期间均有显著性差异。出血事件(12.9%vs。0, p=0.03)和明显的心律失常(6.5%vs. 0.03)。0, p=0.04)。I组住院时间也显著缩短(d“3”天:74.2%vs 35.5%;p = 0.01)。单因素回归分析显示，除pci术后TIMI (Thrombolysis in myocardial infarction，心肌梗死溶栓)血流、中高CRS、男性、糖尿病、高血压外，CRS各组成部分均有显著性差异。中高CRS(住院和30天)、左心室射血分数< 40%(住院)、三支血管疾病(30天)在多因素分析中具有显著性。ROC曲线分析显示，CRS曲线下面积为0.745 (95% CI: 0.616 ~ 0.874;p = 0.001)。CRSe“3预测pPCI术后住院预后的敏感性和特异性分别为35.5%和87%。结论:在pPCI环境下，与中高CRS相比，低CRS与更好的住院预后相关。此外，与中高CRS相比，低CRS与pPCI术后30天预后较好相关，但对于预测pPCI术后短期不良预后，CRS具有相对较低的敏感性和较高的特异性。孟加拉国心脏杂志2023;38 (1): 32-37

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Bangladesh Heart Journal

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