8-item score predicts death, MI risks in patients with acute coronary syndrome

Researchers have recently developed and validated an 8-item score to calculate the risk of cardiovascular (CV) death and myocardial infarction (MI) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention.

Dubbed as ABC-ACS ischemia, the model demonstrated satisfactory calibration and discrimination, which renders it suitable for risk prediction and decision support in patients with ACS.

A total of 10,713 patients from the PLATO (A Comparison of Ticagrelor [AZD6140] and Clopidogrel in Patients With Acute Coronary Syndrome) trial were included in the development cohort. The researchers then externally validated the ABC-ACS ischemia in 3,508 patients from the TRACER (Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome) trial.

Cox regression models were used to assess variables associated with the risk of CV death and MI. The researchers then derived a score using subsets of variables resembling the full model.

Overall, 632 episodes of CV death/MI occurred in the development cohort and 190 in the validation cohort. The most significant predictors of CV death/MI were the biomarkers growth differentiation factor 15, and N-terminal pro‒B-type natriuretic peptide, which showed a higher prognostic value than other candidate variables.

Eight items made it to the final model of ABC-ACS ischemia: age, biomarkers (growth differentiation factor 15 and N-terminal pro–B-type natriuretic peptide), and clinical variables (extent of coronary artery disease, previous vascular disease, Killip class, ACS type, P2Y₁₂ inhibitor).

The 8-item score was well calibrated and had acceptable discriminatory ability for 1-year risk of CV death and MI, with C-indices of 0.71 and 0.72 in the development and validation cohorts, respectively. Of note, the model performed better in predicting CV death, with C-indices of 0.80 in the development cohort and 0.84 in the validation cohort.