Prognostic value of Charlson comorbidity index in patients admitted with acute myocardial infarction

Abstract

Relevance. To investigate the prognostic value of the Charlson Comorbidity Index (CCI) and its components in assessing outcomes related to in-hospital and 18‑month mortality and to determine additional prognostic value when incorporating them into the GRACE score among patients with acute myocardial infarction (MI). Material and methods. A prospective study enrolled 712 patients diagnosed with acute MI who underwent coronary angiography within 24 hours of hospitalization. Results and Discussion. Of the patients, 61 % were male, median age 65 (interquartile range [IQR] 56–74years). In-hospital and 18‑month mortality rates were 5.1 % (n = 36) and 12.1 % (n = 86), respectively. Median GRACE, CCI scores were 117 (IQR: 98–141), and 4 (IQR: 3–6) respectively. Common comorbidities within the CCI components included previous MI (21.8 %), diabetes mellitus (21.1 %), chronic pulmonary disease (16.2 %), dementia (9.2 %), peptic ulcer disease (9.1 %), renal failure (8.6 %). Factors associated with in-hospital and 18‑month mortality included chronic lung disease (odds ratio [OR] = 4.21 and 2.04, respectively) and renal failure (OR = 3.51 and 1.99, respectively) after adjusting for GRACE score. Dementia (OR 2.10; 95 % confidence interval [CI] 1.11–3.97) was a significant risk factor for 18‑month mortality. CCI was associated with in-hospital and 18‑month mortality (GRACE-adjusted OR 1.29, 95 % CI:1.07–1.57, p = 0.001 and 1.37, 95 % CI (1.20–1.57, p = 0.001, respectively). CCI demonstrated good predictive ability for in-hospital mortality (area under the ROC Curve [AUC]: 0.826) and modest performance for 18‑month mortality (AUC: 0.797). Adding chronic lung disease, renal failure in the GRACE score significantly improved the predictive efficacy for in-hospital mortality, with an AUC of 0.932 (95 % CI: 0.905–0.959, p = 0.001). Including CCI in the GRACE score enhanced the prediction efficiency for 18‑month mortality (AUC 0.819, 95 % CI: 0.768–0.871, p = 0.001). Conclusion. The CCI demonstrated moderate prognostic value in assessing in-hospital mortality among patients with acute MI and good predictive ability for long-term mortality. The CCI and its components (chronic lung disease, renal failure) added prognostic significance in addition to the GRACE score for predicting both short-term and long-term adverse outcomes.

Keywords

• charlson comorbidity index
• comorbidity
• mortality
• myocardial infarction
• grace score