[Prognostic value of Charlson comorbidity index at 30 days and 1 year after acute myocardial infarction].
OBJECTIVE
The Charlson comorbidity index (CCI), an indicator of comorbidity, has been used as an adjusting variable in multivariate models. Because of its prognostic value per se for cardiovascular complications after acute myocardial infarction (AMI), we sought to determine the predictive value of the CCI for all-cause mortality and recurrent AMI 30 days and 1 year after the index event.


METHODS
We analyzed 1035 consecutive patients admitted with the diagnosis of AMI (ST elevation=508 and non-ST elevation=527). The composite endpoint was determined after 30 days (13.9%) and 1 year (26.3%) of follow-up. The CCI was calculated on admission, and other variables with prognostic value were also recorded. CCI was stratified in 4 categories: 1: CCI=0 (control), 2: CCI=1, 3: CCI=2,4: CCI> or =3. Cox proportional risks analysis was used for the multivariate analysis, and the C-statistic was calculated to assess the discriminative power of the models.


RESULTS
Hazard ratios (95% CI) estimated for each category of CCI were: 2=1.69 (1.10-2.59), 3=1.78 (1.08-2.92) and 4=1.57 (0.87-2.83) at 30 days; 2=1.62 (1.18-2.23), 3=2.00 (1.39-2.89) and 4=2.24 (1.50-3.36) at 1 year. Comparisons with the C-statistic between the nested multivariate models (with and without CCI) yielded values of 0.765 vs 0.750 after 30 days, and 0.751 vs 0.735 after 1 year.


CONCLUSIONS
Our data indicate that CCI is an independent predictor of mortality or recurrent AMI 30 days and 1 year after the index AMI.
Núñez
Julio E
JE
Servei de Cardiologia, Hospital Clínic i Universitari, Universitat de València, València, Spain. julionv@terra.es
Núñez
Eduardo
E
Fácila
Lorenzo
L
Bertomeu
Vicente
V
Llàcer
Angel
A
Bodí
Vicent
V
Sanchis
Juan
J
Sanjuán
Rafael
R
Blasco
María L
ML
Consuegra
Luciano
L
Martínez
Angel
A
Chorro
Francisco J
FJ
D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
Papel del índice de Charlson en el pronóstico a 30 días y 1 año tras un infarto agudo de miocardio.