Evaluation of a novel score for predicting two-year outcomes in patients with acute coronary syndrome after percutaneous coronary intervention.

Abstract

BACKGROUND\nA novel risk model to predict long-term mortality in patients with acute coronary syndrome (ACS), derived from the EPICOR (long-tErm follow uP of antithrombotic management patterns In acute CORonary syndrome patients) registry has been released recently and its performance remains to be assessed. The objective is to evaluate the EPICOR score for two-year mortality risk in ACS patients after percutaneous coronary intervention (PCI).\n\n\nMETHODS\nFrom January to December in 2013, a total of 6087 consecutive patients presenting ACS who were scheduled for PCI were enrolled. Use online simplified EPICOR calculator to assess the expected risk of death.\n\n\nRESULTS\nSixty-eight patients (1.1%) died during two years follow-up. The areas under the ROC curve for mortality in the overall population, ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation ACS were 0.712 [95% confidence interval (CI) 0.650-0.772, p < 0.001], 0.790 (95%CI 0.676-0.903, p < 0.001) and 0.683 (95%CI 0.615-0.751, p < 0.001), respectively. Moreover, it was non-inferior to the updated GRACE (Global Registry of Acute Coronary Events) risk score. Patients were stratified into three categories: low-risk (n = 3382), medium-risk (n = 2547) and high-risk (n = 158). Kaplan-Meier curve demonstrated significant ongoing divergence in both mortality (0.6% versus 1.3% versus 9.5%, p < 0.001) and MACCEs (11.8% versus 12.3% versus 19.6%, p = 0.014) among them. Multivariate Cox analysis revealed that medium- and high-risk groups predicted two- and twelve-folds hazards of death comparing to the lowest. Yet it was not a significant predictor for MACCEs after adjusting confounding factors.\n\n\nCONCLUSIONS\nThe simplified EPICOR score showed fair discriminatory power of two-year mortality in patients with ACS and an improved performance in the STEMI subgroup. It could aid in risk stratification of ACS patients as an independent predictor.This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).