Defining high-risk patients with ST-segment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention

A comparison among different scoring systems and clinical definitions

Alessandro Martinoni, Stefano De Servi, Alessandro Politi, Tullio Palmerini, Giuseppe Musumeci, Federica Ettori, Roberto Zanini, Emanuela Piccaluga, Diego Sangiorgi, Alessandra Repetto, Maurizio D'Urbano, Battistina Castiglioni, Franco Fabbiocchi, Marco Onofri, Giulia Lauria, Nicoletta De Cesare, Giuseppe Sangiorgi, Corrado Lettieri, Guido Belli, Fabrizio Poletti & 2 others Salvatore Pirelli, Silvio Klugman

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Identification of high-risk patients with ST-segment elevation acute myocardial infarction (STEMI) is of the utmost importance for adequate patient stratification and evaluation of additive treatments. However, there is no consensus on the optimal definition of high-risk patients. Methods: We therefore compared 5 scoring systems in the assessment of the risk of 30-day mortality in 3214 patients with STEMI treated with primary percutaneous coronary intervention (PCI). Results: Clinical scores showed a large variability in risk stratifying patients. Identification of high-risk patients ranged from 15% (PAMI score ≥ 9) to 66% (McNamara definition). McNamara, Antoniucci and Brodie definitions had the best sensitivity (0.87-0.88 and 95% confidence intervals (CI) ranging from 0.82-0.93) while PAMI ≥ 9 had the best specificity (0.87 with 95% CI of 0.86-0.88), while its sensitivity was quite low (0.42). In a sample size simulation of a trial aimed at demonstrating a 33% difference in 30-day mortality between two hypothetical treatments, the number of STEMI patients needed to be screened varied from 4712 for the Brodie definition to 9038 for the PAMI ≥ 9 score. Conclusions: There is a large variability in risk stratification, sensitivity, specificity and predictive values among different scoring systems. These considerations should be taken into account when designing randomised trials.

Original languageEnglish
Pages (from-to)207-211
Number of pages5
JournalInternational Journal of Cardiology
Volume157
Issue number2
DOIs
Publication statusPublished - May 31 2012

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Percutaneous Coronary Intervention
Myocardial Infarction
Confidence Intervals
Mortality
ST Elevation Myocardial Infarction
Sample Size
Sensitivity and Specificity
Therapeutics

Keywords

  • Myocardial infarction
  • Primary angioplasty
  • Risk stratification

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Defining high-risk patients with ST-segment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention : A comparison among different scoring systems and clinical definitions. / Martinoni, Alessandro; De Servi, Stefano; Politi, Alessandro; Palmerini, Tullio; Musumeci, Giuseppe; Ettori, Federica; Zanini, Roberto; Piccaluga, Emanuela; Sangiorgi, Diego; Repetto, Alessandra; D'Urbano, Maurizio; Castiglioni, Battistina; Fabbiocchi, Franco; Onofri, Marco; Lauria, Giulia; De Cesare, Nicoletta; Sangiorgi, Giuseppe; Lettieri, Corrado; Belli, Guido; Poletti, Fabrizio; Pirelli, Salvatore; Klugman, Silvio.

In: International Journal of Cardiology, Vol. 157, No. 2, 31.05.2012, p. 207-211.

Research output: Contribution to journalArticle

Martinoni, A, De Servi, S, Politi, A, Palmerini, T, Musumeci, G, Ettori, F, Zanini, R, Piccaluga, E, Sangiorgi, D, Repetto, A, D'Urbano, M, Castiglioni, B, Fabbiocchi, F, Onofri, M, Lauria, G, De Cesare, N, Sangiorgi, G, Lettieri, C, Belli, G, Poletti, F, Pirelli, S & Klugman, S 2012, 'Defining high-risk patients with ST-segment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention: A comparison among different scoring systems and clinical definitions', International Journal of Cardiology, vol. 157, no. 2, pp. 207-211. https://doi.org/10.1016/j.ijcard.2010.12.007
Martinoni, Alessandro ; De Servi, Stefano ; Politi, Alessandro ; Palmerini, Tullio ; Musumeci, Giuseppe ; Ettori, Federica ; Zanini, Roberto ; Piccaluga, Emanuela ; Sangiorgi, Diego ; Repetto, Alessandra ; D'Urbano, Maurizio ; Castiglioni, Battistina ; Fabbiocchi, Franco ; Onofri, Marco ; Lauria, Giulia ; De Cesare, Nicoletta ; Sangiorgi, Giuseppe ; Lettieri, Corrado ; Belli, Guido ; Poletti, Fabrizio ; Pirelli, Salvatore ; Klugman, Silvio. / Defining high-risk patients with ST-segment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention : A comparison among different scoring systems and clinical definitions. In: International Journal of Cardiology. 2012 ; Vol. 157, No. 2. pp. 207-211.
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T2 - A comparison among different scoring systems and clinical definitions

AU - Martinoni, Alessandro

AU - De Servi, Stefano

AU - Politi, Alessandro

AU - Palmerini, Tullio

AU - Musumeci, Giuseppe

AU - Ettori, Federica

AU - Zanini, Roberto

AU - Piccaluga, Emanuela

AU - Sangiorgi, Diego

AU - Repetto, Alessandra

AU - D'Urbano, Maurizio

AU - Castiglioni, Battistina

AU - Fabbiocchi, Franco

AU - Onofri, Marco

AU - Lauria, Giulia

AU - De Cesare, Nicoletta

AU - Sangiorgi, Giuseppe

AU - Lettieri, Corrado

AU - Belli, Guido

AU - Poletti, Fabrizio

AU - Pirelli, Salvatore

AU - Klugman, Silvio

PY - 2012/5/31

Y1 - 2012/5/31

N2 - Background: Identification of high-risk patients with ST-segment elevation acute myocardial infarction (STEMI) is of the utmost importance for adequate patient stratification and evaluation of additive treatments. However, there is no consensus on the optimal definition of high-risk patients. Methods: We therefore compared 5 scoring systems in the assessment of the risk of 30-day mortality in 3214 patients with STEMI treated with primary percutaneous coronary intervention (PCI). Results: Clinical scores showed a large variability in risk stratifying patients. Identification of high-risk patients ranged from 15% (PAMI score ≥ 9) to 66% (McNamara definition). McNamara, Antoniucci and Brodie definitions had the best sensitivity (0.87-0.88 and 95% confidence intervals (CI) ranging from 0.82-0.93) while PAMI ≥ 9 had the best specificity (0.87 with 95% CI of 0.86-0.88), while its sensitivity was quite low (0.42). In a sample size simulation of a trial aimed at demonstrating a 33% difference in 30-day mortality between two hypothetical treatments, the number of STEMI patients needed to be screened varied from 4712 for the Brodie definition to 9038 for the PAMI ≥ 9 score. Conclusions: There is a large variability in risk stratification, sensitivity, specificity and predictive values among different scoring systems. These considerations should be taken into account when designing randomised trials.

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KW - Primary angioplasty

KW - Risk stratification

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