A novel risk score for predicting 6-months mortality at the time of hospital discharge in patients admitted with acute coronary syndrome

Abstract

Background: In patients with ACS, risk assessment at hospital discharge has not received much consideration in prior risk scoring systems. Hence, there is a need for a reliable and simple tool to identify patients with high mortality risk at discharge form the hospital. Methods: In a 1-year observational, prospective study, 1012 patients admitted with ACS were followed up for 6 months after discharge. From 26 potential variables, a new risk score to predict 6-month mortality was developed. Results: A multi-variant Cox regression analysis with forward stepwise variable selection was performed and 10 highly significant independent predictors of 6-month mortality were identified. These include previous history of ACS, higher Killip class at admission, NYHA class at discharge, recurrent ischemia during hospital stay, heart failure, requiring ionotropic supports, requiring hemodialysis, presence of arrhythmia, left ventricular dysfunction detected on echocardiography and elevated admission blood glucose levels. Points were given to each variable and a total score was calculated. A risk score of 0–4 (low risk) predicted a mortality of 3.7%,a risk score of 5–15 (Intermediate risk) predicted a mortality of 16.4% and a risk score of 11–15 predicted a mortality of 32.0% over a 6-month period. The new risk score was noninferior to GRACE risk score in its predictive accuracy of 6-month mortality in the same cohort of patients (p < 0.05). Conclusion: The risk score developed in our study can be easily calculated at the bedside and is aimed at identifying high risk patients who require more intense follow up after discharge.

Keywords

• Acute coronary syndrome
• Hospital discharge
• Risk score
• Mortality