Simple risk score based on the China Acute Myocardial Infarction registry for predicting in-hospital mortality among patients with non-ST-segment elevation myocardial infarction: results of a prospective observational cohort study

Abstract

ObjectivesTo simplify our previous risk score for predicting the in-hospital mortality risk in patients with non-ST-segment elevation myocardial infarction (NSTEMI) by dropping laboratory data.DesignProspective cohort.SettingMulticentre, 108 hospitals across three levels in China.ParticipantsA total of 5775 patients with NSTEMI enrolled in the China Acute Myocardial Infarction (CAMI) registry.Primary outcome measuresIn-hospital mortality.ResultsThe simplified CAMI-NSTEMI (SCAMI-NSTEMI) score includes the following nine variables: age, body mass index, systolic blood pressure, Killip classification, cardiac arrest, ST-segment depression on ECG, smoking status, previous angina and previous percutaneous coronary intervention. Within both the derivation and validation cohorts, the SCAMI-NSTEMI score showed a good discrimination ability (C-statistics: 0.76 and 0.83, respectively); further, the SCAMI-NSTEMI score had a diagnostic performance superior to that of the Global Registry of Acute Coronary Events risk score (C-statistics: 0.78 and 0.73, respectively; p<0.0001 for comparison). The in-hospital mortality increased significantly across the different risk groups.ConclusionsThe SCAMI-NSTEMI score can serve as a useful tool facilitating rapid risk assessment among a broader spectrum of patients admitted owing to NSTEMI.Trial registration numberNCT01874691.

Comparison of the CAMI-NSTEMI and GRACE Risk Model for Predicting In-Hospital Mortality in Chinese Non-ST-Segment Elevation Myocardial Infarction Patients

“…To address the limitations mentioned above, the CRM was developed to predict in-hospital mortality, particularly for Chinese NSTEMI patients, and its diagnostic performance was superior to that of the GRM in two internal validation studies using data from CAMI registry [ 8 , 9 ]. Our effort further extended this conclusion in an external validation cohort by indicating a larger AUC, positive NRI, and less disagreement between the observed and predicted mortality for the CRM.…”

“…To diminish the impact of this paradox, the current guidelines consider the risk assessment by the Global Registry of Acute Coronary Events (GRACE) risk model as a fundamental component to select the most appropriate therapeutic strategy for NSTEMI patients [ 1 – 3 ]. However, several observations have suggested that the performance of the GRACE risk model (GRM) was unsatisfactory among Chinese NSTEMI patients [ 8 , 9 ]. Recently, a novel risk model has been developed for the risk evaluation of NSTEMI patients [ 8 ] based on multicenter data from the China Acute Myocardial Infarction (CAMI) registry [ 10 ].…”

“…However, several observations have suggested that the performance of the GRACE risk model (GRM) was unsatisfactory among Chinese NSTEMI patients [8,9]. Recently, a novel risk model has been developed for the risk evaluation of NSTEMI patients [8] based on multicenter data from the China Acute Myocardial Infarction (CAMI) registry [10].…”

Development of an optimized risk score to predict short‐term death among acute myocardial infarction patients in rural China

“…However, the impact of blood glucose in the context of MI is complex, involving both protective and deleterious effects on the myocardium 29 . This may explain why blood glucose was not included in the GRACE or CAMI risk scores 10,30 …”

“…29 This may explain why blood glucose was not included in the GRACE or CAMI risk scores. 10,30 Pulmonary hypertension is frequently observed following AMI, 31 and elevated PASP after AMI is often associated with poor prognosis. 32,33 Indeed, PASP was proved to be a strong independent predictor of short-term death in a previous study.…”