Korean Circ J.  2018 Jun;48(6):492-504. 10.4070/kcj.2017.0128.

Risk Scoring System to Assess Outcomes in Patients Treated with Contemporary Guideline-Adherent Optimal Therapies after Acute Myocardial Infarction

• Song PS
• Ryu DR
• Kim MJ
• Jeon KH
• Choi RK
• Park JS
• Song YB
• Hahn JY
• Gwon HC
• Ahn Y
• Jeong MH
• Choi SH
• Korea Acute Myocardial Infarction Registry Investigators

• KMID: 2412541
• DOI: http://doi.org/10.4070/kcj.2017.0128

Abstract

BACKGROUND AND OBJECTIVES
A risk prediction is needed even in the contemporary era of acute myocardial infarction (AMI). We sought to develop a risk scoring specific for patients with AMI being treated with guideline-adherent optimal therapies, including percutaneous coronary intervention and all 5 medications (aspirin, thienopyridine, β-blocker, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and statin).
METHODS
From registries, 12,174 AMI patients were evaluated. The primary outcome was 1-year all-cause death or AMI. The Korea Working Group in Myocardial Infarction (KorMI) system was compared with the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX AMI), Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC), and Global Registry of Acute Coronary Events scores (GRACE) models.
RESULTS
Ten predictors were identified: left ventricular dysfunction (hazard ratio [HR], 2.3), bare-metal stent (HR, 2.0), Killip class ≥II (HR, 1.9), renal insufficiency (HR, 1.8), previous stroke (HR, 1.6), regional wall-motion- score >20 on echocardiography (HR, 1.5), body mass index ≤24 kg/m2 (HR, 1.4), age ≥70 years (HR, 1.4), prior coronary heart disease (HR, 1.4), and diabetes (HR, 1.4). Compared with the previous models, the KorMI system had good discrimination (time-dependent C statistic, 0.759) and showed reasonable goodness-of-fit by Hosmer-Lemeshow test (p=0.84). Moreover, the continuous-net reclassification improvement varied from −27.3% to −19.1%, the integrated discrimination index varied from −2.1% to −0.9%, and the median improvement in risk score was from −1.0% to −0.4%.
CONCLUSIONS
The KorMI system would be a useful tool for predicting outcomes in survivors treated with guideline-adherent optimal therapies after AMI.

Keyword

Myocardial Infarction; Angioplasty; Drug Therapy; Risk Risk stratification

MeSH Terms

Angioplasty
Angiotensins
Body Mass Index
Coronary Disease
Discrimination (Psychology)
Drug Therapy
Echocardiography
Humans
Korea
Myocardial Infarction*
Percutaneous Coronary Intervention
Registries
Renal Insufficiency
Stents
Stroke
Survivors
Ventricular Dysfunction, Left
Angiotensins

Figure

• 

  Figure 1 Flow chart of patient enrollment.AMI = acute myocardial infarction; CABG = coronary artery bypass graft; KAMIR = Korea Acute Myocardial Infarction Registry; KorMI = Korea Working Group in Myocardial Infarction; MI = myocardial infarction; NSTEMI = non-ST-segment elevation myocardial infarction; PCI = percutaneous coronary intervention; STEMI = ST-segment elevation myocardial infarction.

• 

  Figure 2 Risk scoring system and corresponding 1-year all-cause death or MI rates.BMI = body mass index; BMS = bare-metal stent; CHD = coronary heart disease; LV = left ventricular; MI = myocardial infarction; RWMS = regional wall motion score.

• 

  Figure 3 Kaplan-Meier survival curves for 1-year all-cause death or MI in each tertile of the KorMI risk score.KorMI = Korea Working Group in Myocardial Infarction; MI = myocardial infarction.

• 

  Figure 4 ROC curves for the KorMI, APEX AMI, CADILLAC, and GRACE scores for 1-year all-cause death or MI in patients with AMI.AMI = acute myocardial infarction; APEX AMI = Assessment of Pexelizumab in Acute Myocardial Infarction; CADILLAC = Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications; GRACE = Global Registry of Acute Coronary Events; KorMI = Korea Working Group in Myocardial Infarction; MI = myocardial infarction; ROC = receiver operating characteristic.

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