Abstract 3800: Predicting Post-infarct Heart Failure: Forget TIMI, Forget GRACE, All You Need is C2ASH!
BACKGROUND: Regarding prognosis, acute coronary syndrome (ACS) patients are a very heterogeneous population, with varying risks of early and long-term adverse events, like heart failure. Metabolic factors are known to have a pivotal role in determining prognosis.
AIM: We sought to compare a new metabolic risk score with the well established Global Registry of Acute Coronary Events (GRACE) and Thrombolysis In Myocardial Infarction (TIMI) scores regarding its ability to predict post-discharge heart failure.
METHODS AND RESULTS: We studied 837 consecutive patients admitted to our coronary care unit with an ACS [age: 67.3±12.3 years, 31.9% female, 80.8% with myocardial infarction (MI)]. For each patient, TIMI and GRACE risk scores (RS) were calculated using specific variables collected at admission. A simple age-adjusted metabolic RS was derived by dividing in 5 quintiles the admission values of the C-reactive protein, CreAtinine clearance, glycemia (Sugar), and Hemoglobin (C2ASH). Each variable was divided in quintiles; each quintile was graded (1 to 5) according to its relative risk, resulting in a combined sum of 5 to 25 (5 being the best possible score and 25 the worst). As endpoint we used 18-month post-ACS admission for decompensated heart failure, which occurred in 7.2% of our patients. Among the RS, the best predictive accuracy for intra-hospital death was obtained by the C2ASH RS [area under the curve (AUC): 0.761; confidence interval (CI: 0.729 – 0.792)], better than GRACE (AUC: 0.744; CI: 0.711– 0.775) and TIMI (AUC: 0.705; CI: 0.671– 0.738) RS. Mean C2ASH was 14.7±3.8; the best cut-off value for identifying high risk patients was >15 (76.7% sensitivity, 62.9% specificity); these patients comprised 47.2% of the population and the end-point rate was 12.7%, compared with 2.3% in the low-risk patients [odds-ratio 6.26; 95%CI (3.1–12.5)]. There was a steep gradient for admission with decompensated heart failure for higher values of the RS.
CONCLUSION: The 5-variable simple to calculate C2ASH metabolic score demonstrated a good predictive accuracy for admission for decompensated heart failure post-ACS, better than the established GRACE and TIMI scores, identifying of a high-risk subset of ACS patients.