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Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: the CADILLAC risk score.

Publication ,  Journal Article
Halkin, A; Singh, M; Nikolsky, E; Grines, CL; Tcheng, JE; Garcia, E; Cox, DA; Turco, M; Stuckey, TD; Na, Y; Lansky, AJ; Gersh, BJ; Mehran, R ...
Published in: J Am Coll Cardiol
May 3, 2005

OBJECTIVES: We sought to develop a simple risk score for predicting mortality after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). BACKGROUND: Accurate risk stratification after primary PCI is important. Previous risk scores after reperfusion therapy have incorporated clinical +/- angiographic variables but have not considered baseline left ventricular function. Moreover, prior studies have not been validated against independent databases or studies. METHODS: The databases from the two largest multicenter, randomized AMI trials of primary PCI were utilized for score derivation (the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications [CADILLAC] trial, n = 2,082) and subsequent validation (the Stent-Primary Angioplasty in Myocardial Infarction [Stent-PAMI] trial, n = 900). Logistic regression and the jackknife procedure were used to select correlates of one-year mortality that were subsequently weighted and integrated into an integer scoring system. RESULTS: Seven variables selected from the initial multivariate model were weighted proportionally to their respective odds ratio for one-year mortality (age >65 years [2 points], Killip class 2/3 [3 points], baseline left ventricular ejection fraction <40% [4 points], anemia [2 points], renal insufficiency [3 points], triple-vessel disease [2 points], and post-procedural Thrombolysis In Myocardial Infarction flow grade [2 points]). Three strata of risk were defined (low risk, score 0 to 2; intermediate risk, score 3 to 5; and high risk, score >/=6) with excellent prognostic accuracy for survival in the derivation and validation sets (c statistics = 0.83 and 0.81 for 30-day mortality and 0.79 and 0.78 for 1-year mortality, respectively). CONCLUSIONS: In AMI patients treated with primary PCI, seven risk factors readily available at the time of intervention accurately predict short- and long-term mortality. Of note, measurement of baseline left ventricular function is the single most powerful predictor of survival and should be incorporated into risk score models.

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Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

May 3, 2005

Volume

45

Issue

9

Start / End Page

1397 / 1405

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Survival Analysis
  • Severity of Illness Index
  • Risk Factors
  • Randomized Controlled Trials as Topic
  • Predictive Value of Tests
  • Myocardial Infarction
  • Multicenter Studies as Topic
  • Male
  • Humans
 

Citation

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Halkin, A., Singh, M., Nikolsky, E., Grines, C. L., Tcheng, J. E., Garcia, E., … Stone, G. W. (2005). Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: the CADILLAC risk score. J Am Coll Cardiol, 45(9), 1397–1405. https://doi.org/10.1016/j.jacc.2005.01.041
Halkin, Amir, Mandeep Singh, Eugenia Nikolsky, Cindy L. Grines, James E. Tcheng, Eulogio Garcia, David A. Cox, et al. “Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: the CADILLAC risk score.J Am Coll Cardiol 45, no. 9 (May 3, 2005): 1397–1405. https://doi.org/10.1016/j.jacc.2005.01.041.
Halkin A, Singh M, Nikolsky E, Grines CL, Tcheng JE, Garcia E, et al. Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: the CADILLAC risk score. J Am Coll Cardiol. 2005 May 3;45(9):1397–405.
Halkin, Amir, et al. “Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: the CADILLAC risk score.J Am Coll Cardiol, vol. 45, no. 9, May 2005, pp. 1397–405. Pubmed, doi:10.1016/j.jacc.2005.01.041.
Halkin A, Singh M, Nikolsky E, Grines CL, Tcheng JE, Garcia E, Cox DA, Turco M, Stuckey TD, Na Y, Lansky AJ, Gersh BJ, O’Neill WW, Mehran R, Stone GW. Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: the CADILLAC risk score. J Am Coll Cardiol. 2005 May 3;45(9):1397–1405.
Journal cover image

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

May 3, 2005

Volume

45

Issue

9

Start / End Page

1397 / 1405

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Survival Analysis
  • Severity of Illness Index
  • Risk Factors
  • Randomized Controlled Trials as Topic
  • Predictive Value of Tests
  • Myocardial Infarction
  • Multicenter Studies as Topic
  • Male
  • Humans