External validation of the ProACS score for risk stratification of patients with acute coronary syndromes

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• 作者：Ana Teresa Tim&oacute ; teo^a ; ^{ana_timoteo@yahoo.com" class="auth_mail" title="E-mail the corresponding author} ; S&iacute ; lvia Aguiar Rosa^a ; Marta Afonso Nogueira^a ; Adriana Belo^b ; Rui Cruz Ferreira^a
• 关键词：ProACS ; Risk stratification ; Acute coronary syndrome ; Prognosis
• 刊名：Revista Portuguesa de Cardiologia (English Edition)
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：35
• 期：6
• 页码：323-328
• 全文大小：315 K

文摘

The ProACS risk score is an early and simple risk stratification score developed for all-cause in-hospital mortality in acute coronary syndromes (ACS) from a Portuguese nationwide ACS registry. Our center only recently participated in the registry and was not included in the cohort used for developing the score. Our objective was to perform an external validation of this risk score for short- and long-term follow-up.

Methods

Consecutive patients admitted to our center with ACS were included. Demographic and admission characteristics, as well as treatment and outcome data were collected. The ProACS risk score variables are age (≥72 years), systolic blood pressure (≤116 mmHg), Killip class (2/3 or 4) and ST-segment elevation. We calculated ProACS, Global Registry of Acute Coronary Events (GRACE) and Canada Acute Coronary Syndrome risk score (C-ACS) risk scores for each patient.

Results

A total of 3170 patients were included, with a mean age of 64±13 years, 62% with ST-segment elevation myocardial infarction. All-cause in-hospital mortality was 5.7% and 10.3% at one-year follow-up. The ProACS risk score showed good discriminative ability for all considered outcomes (area under the receiver operating characteristic curve >0.75) and a good fit, similar to C-ACS, but lower than the GRACE risk score and slightly lower than in the original development cohort. The ProACS risk score provided good differentiation between patients at low, intermediate and high mortality risk in both short- and long-term follow-up (p<0.001 for all comparisons).

Conclusions

The ProACS score is valid in external cohorts for risk stratification for ACS. It can be applied very early, at the first medical contact, but should subsequently be complemented by the GRACE risk score.