Abstract 3481: Increase in Predictive Value of the TIMI Risk Index for 30 Day Mortality by Addition of Two “Basic” Biomarkers: Plasma Fasting Glucose and Creatinine Levels. Results from the “Registre Franc Comtois des Syndrome Coronariens Aigus”
Background: TIMI Risk Index (TRI) can be used as a simple and effective tool for risk assessment in acute coronary syndromes. Stress hyperglycemia (SH), (defined as the first fasting glucose value >6.3mmol/l after admission without history of diabetes) and level of serum creatinine level influence mortality but also acute management. Their impact on 1-year mortality, when TRI and quality of care is taken into account, is poorly documented.
Methods: Prospective study including patients with acute myocardial infarction. Quality of care was defined as the percent of use of guidelines recommended treatments in eligible patients. SH, creatinine levels, TRI (calculated as heart rate*(age/10)2/systolic pressure), Quality of care and 1-month mortality were recorded.
Results: 647 STEMI and 743 NSTEMI patients were included. 483 (45%) patients has SH,median creatinine was 121 [83;121] μmol/l and median TIMI Risk Index was 50.4 [32.5–62.4]. At 1 month, mortality was 54/647 (8.3%) in STEMI patients and 35/743 (4.7%) in NSTEMI. Univariable logistic regression showed that both SH and creatinine level were predictors of mortality. Multivariable analysis showed that, even after ajustment on the TRI and on the quality of care, SH and creatinine level remained related with mortality. Adding glucose and creatinine values to a model with TRI and quality of care significantly increased the discriminatory capacity of the model (c statistic).
Conclusions: In patients admitted with acute MI, the first fasting glucose value and the creatinine level allow better assessment of risk level at admission and are independent predictors of 1 month mortality.