Prognostic Value of the Thrombolysis in Myocardial Infarction Risk Score in ST-Elevation Myocardial Infarction Patients With Left Ventricular Dysfunction (from the EPHESUS Trial).
Fiche publication
Date publication
novembre 2016
Journal
The American journal of cardiology
Auteurs
Membres identifiés du Cancéropôle Est :
Pr ROSSIGNOL Patrick
Tous les auteurs :
Popovic B, Girerd N, Rossignol P, Agrinier N, Camenzind E, Fay R, Pitt B, Zannad F
Lien Pubmed
Résumé
The Thrombolysis in Myocardial Infarction (TIMI) risk score remains a robust prediction tool for short-term and midterm outcome in the patients with ST-elevation myocardial infarction (STEMI). However, the validity of this risk score in patients with STEMI with reduced left ventricular ejection fraction (LVEF) remains unclear. A total of 2,854 patients with STEMI with early coronary revascularization participating in the randomized EPHESUS (Epleronone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study) trial were analyzed. TIMI risk score was calculated at baseline, and its predictive value was evaluated using C-indexes from Cox models. The increase in reclassification of other variables in addition to TIMI score was assessed using the net reclassification index. TIMI risk score had a poor predictive accuracy for all-cause mortality (C-index values at 30 days and 1 year ≤0.67) and recurrent myocardial infarction (MI; C-index values ≤0.60). Among TIMI score items, diabetes/hypertension/angina, heart rate >100 beats/min, and systolic blood pressure <100 mm Hg were inconsistently associated with survival, whereas none of the TIMI score items, aside from age, were significantly associated with MI recurrence. Using a constructed predictive model, lower LVEF, lower estimated glomerular filtration rate (eGFR), and previous MI were significantly associated with all-cause mortality. The predictive accuracy of this model, which included LVEF and eGFR, was fair for both 30-day and 1-year all-cause mortality (C-index values ranging from 0.71 to 0.75). In conclusion, TIMI risk score demonstrates poor discrimination in predicting mortality or recurrent MI in patients with STEMI with reduced LVEF. LVEF and eGFR are major factors that should not be ignored by predictive risk scores in this population.
Mots clés
Aged, Cause of Death, trends, Double-Blind Method, Electrocardiography, Female, Follow-Up Studies, France, epidemiology, Humans, Male, Mineralocorticoid Receptor Antagonists, administration & dosage, Myocardial Revascularization, Prognosis, Proportional Hazards Models, Retrospective Studies, Risk Assessment, ST Elevation Myocardial Infarction, complications, Spironolactone, administration & dosage, Stroke Volume, Survival Rate, trends, Thrombolytic Therapy, methods, Time Factors, Ventricular Dysfunction, Left, diagnosis
Référence
Am. J. Cardiol.. 2016 Nov 15;118(10):1442-1447