title: Defining high-risk patients with ST-segment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention: a comparison among different scoring systems and clinical definitions.
abstract: BACKGROUND
  Identification of high-risk patients with ST-segment elevation acute myocardial infarction (STEMI) is of the utmost importance for adequate patient stratification and evaluation of additive treatments. However, there is no consensus on the optimal definition of high-risk patients.
  
  
  METHODS
  We therefore compared 5 scoring systems in the assessment of the risk of 30-day mortality in 3214 patients with STEMI treated with primary percutaneous coronary intervention (PCI).
  
  
  RESULTS
  Clinical scores showed a large variability in risk stratifying patients. Identification of high-risk patients ranged from 15% (PAMI score ≥ 9) to 66% (McNamara definition). McNamara, Antoniucci and Brodie definitions had the best sensitivity (0.87-0.88 and 95% confidence intervals (CI) ranging from 0.82-0.93) while PAMI ≥ 9 had the best specificity (0.87 with 95% CI of 0.86-0.88), while its sensitivity was quite low (0.42). In a sample size simulation of a trial aimed at demonstrating a 33% difference in 30-day mortality between two hypothetical treatments, the number of STEMI patients needed to be screened varied from 4712 for the Brodie definition to 9038 for the PAMI ≥ 9 score.
  
  
  CONCLUSIONS
  There is a large variability in risk stratification, sensitivity, specificity and predictive values among different scoring systems. These considerations should be taken into account when designing randomised trials.
authors.affiliation: Ospedale Fornaroli, Magenta, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Martinoni
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Politi
authors.forename: Tullio
authors.initials: T
authors.lastname: Palmerini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Musumeci
authors.forename: Federica
authors.initials: F
authors.lastname: Ettori
authors.forename: Roberto
authors.initials: R
authors.lastname: Zanini
authors.forename: Emanuela
authors.initials: E
authors.lastname: Piccaluga
authors.forename: Diego
authors.initials: D
authors.lastname: Sangiorgi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Repetto
authors.forename: Maurizio
authors.initials: M
authors.lastname: D'Urbano
authors.forename: Battistina
authors.initials: B
authors.lastname: Castiglioni
authors.forename: Franco
authors.initials: F
authors.lastname: Fabbiocchi
authors.forename: Marco
authors.initials: M
authors.lastname: Onofri
authors.forename: Giulia
authors.initials: G
authors.lastname: Lauria
authors.forename: Nicoletta
authors.initials: N
authors.lastname: De Cesare
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sangiorgi
authors.forename: Corrado
authors.initials: C
authors.lastname: Lettieri
authors.forename: Guido
authors.initials: G
authors.lastname: Belli
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Poletti
authors.forename: Salvatore
authors.initials: S
authors.lastname: Pirelli
authors.forename: Silvio
authors.initials: S
authors.lastname: Klugman
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality; D004562:Electrocardiography / Q000401:mortality / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D011237:Predictive Value of Tests; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome