Usefulness of a Novel Risk Score to Predict In-Hospital Mortality in Patients ≥ 60 Years of Age with ST Elevation Myocardial Infarction

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Numerous algorithms are available to predict short-term mortality in ST elevation myocardial infarction (STEMI) but none are focused on elderly patients or include invasive hemodynamics. A simplified risk score (LASH score) including left ventricular end diastolic pressure > 20 mm Hg, age > 75 years, systolic blood pressure < 100 mm Hg and heart rate > 100 bpm was tested in a retrospective, single-center study of 346 patients ≥ 60 years old who underwent primary percutaneous coronary intervention (PPCI). The median age was 70 years [IQR: 64, 79], 60.1% were men, and 77.8% identified as White. In-hospital all-cause mortality was 10.1%. Patients with a LASH score ≥ 3 (n = 34) had an in-hospital mortality rate of 44.1% compared to 6.4% for LASH score ≤ 2 (p < 0.0001). The odds ratio for in-hospital mortality for patients with LASH score ≥ 3 was 13.2 (95% CI 5.3-33.1) compared to patients with a LASH score ≤ 2 when adjusted for sex, cardiac arrest, heart failure, and prior cerebrovascular event. The LASH score had an area under the ROC curve for predicting in-hospital mortality of 0.795 [CI 0.716-0.872], as compared to TIMI-STEMI (0.881, CI 0.829-0.931; p = 0.01), GRACE (0.849, CI 0.778-0.920; p = 0.19), shock index (0.769, CI 0.667-0.871; p = 0.51) and modified shock index (0.765, CI 0.716-0.873; p = 0.48). In summary, a simplified, easy to calculate risk score that incorporates age and invasive hemodynamics predicts in-hospital mortality in patients ≥ 60 years old undergoing PPCI for STEMI.

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Methods

This is a retrospective cohort study of 346 consecutive patients undergoing PPCI for STEMI at N.C. Memorial Hospital from 2007 to 2020 who had an LVEDP measured. STEMI was defined using American Heart Association and/or American College of Cardiology Foundation criteria.4 The University of North Carolina Institutional Review Board approved this study.

Patient medical history, demographics, angiographic characteristics, outcomes and laboratory values were abstracted from the electronic medical

Results

The median patient age of the 346 patients, 60 years or older, with STEMI included in this analysis was 70 years [IQR 64,79] and the majority of patients were male (60.1%) and identified as White (77.8%) (Figure 1 and Table 1). Hypertension (75.1%), hyperlipidemia (63.6%) and diabetes mellitus (31.2%) were common. Hemodynamic parameters measured at the start of the PPCI procedure included HR of 80 ± 19 bpm and aortic blood pressure of 124 ± 30/67 ± 15 mm Hg, and LVEDP measured after

Discussion

This study demonstrates that a simplified risk score consisting of only four variables (age > 75 years, HR > 100 bpm, SBP < 100 mm Hg, LVEDP > 20 mm Hg) and easily calculated in the cardiac catheterization laboratory can effectively risk stratify older STEMI patients undergoing PPCI. Patients with a LASH score ≥ 3 were found to have worse clinical outcomes than patients with LASH score ≤ 2, including a higher rate of in-hospital death (44.1% vs 6.4%), and increased requirement for hemodynamic

Disclosures

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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Lorena Millo reports financial support was provided by National Institute on Aging.

Funding: Lorena Millo received support from the National Institute on Aging grant, 5-T35-AG038047-09 - UNC-CH Summer Research in Aging for Medical Students.

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These authors made equal contributions to the manuscript

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