Validation of the Passive Surveillance Stroke Severity score in three Canadian provinces
Yu AYX, Austin PC, Park AL, Fang J, Hill MD, Kamal N, Field TS, Joundi RA, Peterson S, Zhao Y, Kapral MK. Can J Neurol Sci. 2024; Mar 6 [Epub ahead of print].
Background — Identification of coronary ischemia may enable targeted diagnostic and therapeutic strategies for acute heart failure (AHF). We determined the risk of 30-day mortality associated with ischemic ECG abnormalitiesin patients with AHF.
Methods and Results — Among 8772 patients (53.4% women, median 78 years [Q1,Q3 68,84]) presenting with AHF to 86 hospital emergency departments in Ontario, Canada, Q-waves, T-wave inversion, or ST-depression were present in 51.8% of subjects. However, presence of ST-depression was the only finding associated with 30-day mortality with adjusted odds ratio 1.24 (95% CI; 1.02-1.50). Using continuous net reclassification improvement, addition of ST-depression to the Emergency Heart failure Mortality Risk Grade (EHMRG) model reclassified 16.9% of patients overall, and 29.3% of those with a history of ischemic heart disease (both p<0.001). By adding ST-depression to the model, the EHMRG was extended to predict 30-day death with high discrimination (c-statistic 0.801), with mortality rate in the lowest risk decile of 0.57%. Adjusted odds ratios for 30-day mortality were 2.81 (95% CI; 1.48-5.31; p=0.002) in quintile 2, 7.41 (95% CI; 4.13-13.30; p<0.001) in quintile 3, and 14.47 (95% CI; 8.20-25.54; p<0.001) in quintile 4 compared to the lowest risk quintile. When the highest risk quintile was subdivided into two equally-sized risk strata (deciles 9 and 10), the adjusted odds ratios for 30-day mortality were 27.20 (95% CI; 15.33-48.27; p<0.001) in decile 9 and 58.96 (95% CI; 33.54-103.65; p<0.001) in highest risk decile 10.
Conclusions — Presence of ST-depression on the ECG reclassified risk of 30-day mortality in patients with AHF, identifying both high- and low-risk subsets.
Greig D, Austin PC, Zhou L, Tu JV, Pang PS, Ross HJ, Lee DS. Circ Heart Fail. 2014; 7(6):986-93. Epub 2014 Oct 3.
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