Risk Factors and Predictive Value of Risk Scoring Systems for Long-term Major Adverse Cardiovascular Events in Patients with ST-segment Elevation Myocardial Infarction Following Percutaneous Coronary Intervention

Abstract

Background Patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) face a significant risk of long-term major adverse cardiovascular events (MACEs). Accurate early risk stratification is crucial for managing post-PCI MACEs in STEMI patients, as highlighted in clinical guidelines. Existing risk scoring systems, including the Age, Creatinine, and Ejection Fraction (ACEF) score, Thrombolysis in Myocardial Infarction (TIMI) score, Zwolle score, Primary Angioplasty in Myocardial Infarction (PAMI) score, and Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) score, vary in their predictive utility for the long-term prognosis post-PCI in STEMI patients. Objective This study aims to analyze the risk factors for long-term MACEs post-PCI in STEMI patients in China and compare the predictive value of the commonly used ACEF, TIMI, Zwolle, PAMI, and CADILLAC risk scoring systems. Methods A retrospective cohort of 687 STEMI patients who underwent their first PCI between June 2016 and June 2020 at Gansu Provincial Hospital was selected. Patient demographics, laboratory, and imaging results were collected, and risk scores were assigned using the ACEF, TIMI, Zwolle, PAMI, and CADILLAC systems. Patients were followed up annually via phone or clinic visits until August 2023, with a focus on the occurrence of MACEs. Multivariable Logistic regression analysis was used to explore the factors influencing the occurrence of MACEs post-PCI. Receiver operating characteristic (ROC) curves for the different risk scoring systems were plotted, and their areas under the curve (AUC) were compared using the DeLong test. Results Out of the 687 patients who underwent PCI, 44 were excluded due to incomplete data, leaving 643 for analysis. The median follow-up period was 37 (range 25-49) months. By the end of the follow-up, 134 patients had experienced MACEs, representing a 20.8% incidence rate. The MACEs group differed significantly from the non-MACEs group in terms of age, hospital stay duration, Killip class, N-terminal pro b-type natriuretic peptide, fibrinogen, anemia, left ventricular ejection fraction, estimated glomerular filtration rate, and creatinine levels (P<0.05). Multivariable Logistic regression revealed prolonged hospital stay (OR=1.071, 95%CI=1.012-1.134, P=0.018), elevated creatinine (OR=1.018, 95%CI=1.006-1.030, P=0.003), and increased fibrinogen (OR=1.226, 95%CI=1.066-1.409, P=0.004) as risk factors for MACEs, while higher left ventricular ejection fraction (OR=0.980, 95%CI=0.960-1.000, P=0.045), mild (OR=0.377, 95%CI=0.151-0.938, P=0.036), and moderate regurgitation (OR=0.164, 95%CI=0.051-0.522, P=0.002) were protective. The ACEF, TIMI, Zwolle, PAMI, and CADILLAC scores were significantly higher in the MACEs group (P<0.05). The ROC curves for predicting MACEs post-PCI in STEMI patients showed no significant differences among the five risk scoring systems (P>0.05) . Conclusion Hospital stay duration, creatinine levels, fibrinogen, left ventricular ejection fraction, and valvular regurgitation status are significant factors affecting the occurrence of long-term MACEs post-PCI in STEMI patients. While all five risk scoring systems—ACEF, TIMI, Zwolle, PAMI, and CADILLAC—can predict the occurrence of long-term MACEs in these patients, the CADILLAC score is recommended for its distinctiveness and sensitivity.

Keywords

• st-segment elevation myocardial infarction|percutaneous coronary intervention|major adverse cardiovascular events|risk factors|risk scoring