Validation of the CREST score for predicting circulatory-aetiology death in out-of-hospital cardiac arrest without STEMI.

IF 1.3
American journal of cardiovascular disease Pub Date : 2021-12-15 eCollection Date: 2021-01-01
Timothy N Jones, Matthew Kelham, Krishnaraj S Rathod, Charles J Knight, Alastair Proudfoot, Ajay K Jain, Andrew Wragg, Muhiddin Ozkor, Paul Rees, Oliver Guttmann, Andreas Baumbach, Anthony Mathur, Daniel A Jones
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Abstract

Aims: The CREST tool was recently developed to stratify the risk of circulatory-aetiology death (CED) in out-of-hospital cardiac arrest (OHCA) patients without ST-elevation myocardial infarction (STEMI). We aimed to validate the CREST score using an external cohort and determine whether it could be improved by the addition of serum lactate on admission.

Methods: The study involved the retrospective analysis of consecutive patients admitted to a single tertiary centre with OHCA of presumed cardiac origin over a 51-month period. The CREST score was calculated by attributing points to the following variables: Coronary artery disease (CAD), non-shockable Rhythm, Ejection fraction <30%, cardiogenic Shock at presentation and ischaemic Time ≥25 minutes. The primary endpoint was CED vs neurological aetiology death (NED) or survival.

Results: Of 500 patients admitted with OHCA, 211 did not meet criteria for STEMI and were included. 115 patients died in hospital (71 NED, 44 CED). When analysed individually, CED was associated with all CREST variables other than a previous diagnosis of CAD. The CREST score accurately predicted CED with excellent discrimination (C-statistic 0.880, 95% CI 0.813-0.946) and calibration (Hosmer and Lemeshow P=0.948). Although an admission lactate ≥7 mmol/L also predicted CED, its addition to the CREST score (the C-AREST score) did not significantly improve the predictive ability (CS 0.885, 0.815-0.954, HS P=0.942, X2 difference in -2 log likelihood =0.326, P=0.850).

Conclusion: Our study is the first to independently validate the CREST score for predicting CED in patients presenting with OHCA without STEMI. Addition of lactate on admission did not improve its predictive ability.

Abstract Image

Abstract Image

CREST评分预测院外心脏骤停无STEMI时循环病因性死亡的验证
目的:CREST工具是最近开发的,用于对院外心脏骤停(OHCA)患者无st段抬高型心肌梗死(STEMI)的循环病因性死亡(CED)风险进行分层。我们的目的是通过外部队列验证CREST评分,并确定是否可以通过在入院时添加血清乳酸来改善CREST评分。方法:本研究回顾性分析了在单一三级中心连续收治的51个月推定心源性OHCA患者。CREST评分通过以下变量计算:冠状动脉疾病(CAD)、非休克性心律、射血分数结果:在500例OHCA患者中,211例不符合STEMI标准,并被纳入。115例患者在医院死亡,其中急诊71例,急症44例。当单独分析时,除了先前的CAD诊断外,CED与所有CREST变量相关。CREST评分准确预测CED具有良好的判别性(c -统计量0.880,95% CI 0.813-0.946)和校准(Hosmer和Lemeshow P=0.948)。入院时乳酸≥7 mmol/L对CED也有预测作用,但与CREST评分(C-AREST评分)加在一起对CED的预测能力无显著提高(CS = 0.885, 0.815-0.954, HS P=0.942, X2差值-2对数似然=0.326,P=0.850)。结论:我们的研究是第一个独立验证CREST评分预测无STEMI OHCA患者的CED的研究。入院时添加乳酸并没有提高其预测能力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
American journal of cardiovascular disease
American journal of cardiovascular disease CARDIAC & CARDIOVASCULAR SYSTEMS-
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