Canada acute coronary syndrome score was a stronger baseline predictor than age ≥75 years of in-hospital mortality in acute coronary syndrome patients in western Romania
Authors Pogorevici A, Citu I, Bordejevic D, Caruntu F, Tomescu M
Received 24 January 2016
Accepted for publication 23 February 2016
Published 26 April 2016 Volume 2016:11 Pages 481—488
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Carl Fortin
Peer reviewer comments 2
Editor who approved publication: Dr Richard Walker
Antoanela Pogorevici, Ioana Mihaela Citu, Diana Aurora Bordejevic, Florina Caruntu, Mirela Cleopatra Tomescu
Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
Background: Several risk scores were developed for acute coronary syndrome (ACS) patients, but their use is limited by their complexity.
Purpose: The purpose of this study was to identify predictors at admission for in-hospital mortality in ACS patients in western Romania, using a simple risk-assessment tool – the new Canada acute coronary syndrome (C-ACS) risk score.
Patients and methods: The baseline risk of patients admitted with ACS was retrospectively assessed using the C-ACS risk score. The score ranged from 0 to 4; 1 point was assigned for the presence of each of the following parameters: age ≥75 years, Killip class >1, systolic blood pressure <100 mmHg, and heart rate >100 bpm.
Results: A total of 960 patients with ACS were included, 409 (43%) with ST-segment elevation myocardial infarction (STEMI) and 551 (57%) with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). The C-ACS score predicted in-hospital mortality in all ACS patients with a C-statistic of 0.95 (95% CI: 0.93–0.96), in STEMI patients with a C-statistic of 0.92 (95% confidence interval [CI]: 0.89–0.94), and in NSTE-ACS patients with a C-statistic of 0.97 (95% CI: 0.95–0.98). Of the 960 patients, 218 (22.7%) were aged ≥75 years. The proportion of patients aged ≥75 years was 21.7% in the STEMI subgroup and 23.4% in the NSTE-ACS subgroup (P>0.05). Age ≥75 years was significantly associated with in-hospital mortality in ACS patients (odds ratio [OR]: 3.25, 95% CI: 1.24–8.25) and in the STEMI subgroup (OR >3.99, 95% CI: 1.28–12.44). Female sex was strongly associated with mortality in the NSTE-ACS subgroup (OR: 27.72, 95% CI: 1.83–39.99).
Conclusion: We conclude that C-ACS score was the strongest predictor of in-hospital mortality in all ACS patients while age ≥75 years predicted the mortality well in the STEMI subgroup.
Keywords: elderly, acute coronary syndrome, mortality
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