PhD Scientific Days 2022

Clinical Medicine II.

Admission lactate level and the GRACE 2.0 score are independent and additive predictors of 30-day mortality of STEMI patients treated with primary PCI – preliminary results of a real-world registry

Előadó neve

Dr. Szabó, Dominika

Előadó munkahelye

Heart and Vascular Centre, Semmelweis University

Előadó telefonszáma

+36309199565

Előadó e-mail címe

dominikadomokos@gmail.com

Az előadás címe

Admission lactate level and the GRACE 2.0 score are independent and additive predictors of 30-day mortality of STEMI patients treated with primary PCI – preliminary results of a real-world registry

Szerző(k) neve és munkahelye

Dominika Szabó, András Szabó, Levente Magyar, Anita Pintér, Szilvia Kugler, Vencel Juhász, Mihály Ruppert, Attila Oláh, István Édes, Dávid Becker, Béla Merkely, István Hizoh
Heart and Vascular Centre, Semmelweis University

Bemutatás módja

Szóbeli

Szekció

Clinical Medicine II.

Language of the presentation

Hungarian

Preferred session

Clinical Medicine

Összefoglaló szövege

Aims:
In many of the current risk estimation algorithms for patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI), heart rate and systolic blood pressure are key predictors. Yet, these parameters may also be influenced by the actual medical treatment / circulatory support, thereby decreasing the discriminatory power of the models. Therefore we aimed to investigate whether venous lactate level, a marker of microcirculatory failure, may have an added prognostic value beyond conventional predictors.

Methods:
In a pilot real-world registry, 174 cases were studied. Venous blood gas analysis was performed in all patients at hospital admission. Nested logistic regression models were built using the extensively validated “Global Registry of Acute Coronary Events” (GRACE) 2.0 score alone (base model) or with the addition of venous lactate level (expanded model) using 30-day all-cause mortality as outcome measure. Independence of predictors (lack of collinearity) was evaluated by the variance inflation factor (VIF). Instead of the insensitive c-statistic, difference in performance of the nested models was analyzed by the likelihood ratio test and the integrated discrimination improvement (IDI).

Results:
The VIF was 1.0684, indicating independence of the measured lactate values from the calculated GRACE 2.0 scores. Both base and expanded models showed high discriminatory power: c-statistic=0.88 and 0.89, respectively, p=0.68). Nevertheless, addition of venous lactate level to the GRACE 2.0 score improved predictions of 30-day mortality significantly as assessed by both likelihood ratio test (chi-square=8.97, p=0.0027) and IDI (IDI=0.1029, 95% CI: 0.0002-0.2055, p=0.0494).

Conclusions:
Venous lactate level is an independent predictor of 30-day mortality of STEMI patients treated with primary PCI. The addition of this marker to the GRACE 2.0 model may improve mortality prediction of these patients.

Funding:
„Development of scientific workshops of medical, health sciences and pharmaceutical educations” Project identification number: EFOP-3.6.3-VEKOP-16-2017-00009

University and Doctoral School

Semmelweis University, Doctoral School of Theoretical and Translational Medicine

Supervisor

István Hizoh

Publication of my abstract

I give consent to the publication of my abstract on the website of the congress.

Kind

Szabad

Status

elfogadva

Accepted presentation method

szóbeli

Előadás fájl jóváhagyás

nem rendelkezett róla

Előadó

4687

Start

14:45

End

15:00

Authors (legacy)

Dominika Szabó, András Szabó, Levente Magyar, Anita Pintér, Szilvia Kugler, Vencel Juhász, Mihály Ruppert, Attila Oláh, István Édes, Dávid Becker, Béla Merkely, István Hizoh
Heart and Vascular Centre, Semmelweis University