title: Validity of Charlson Comorbidity Index in patients hospitalised with acute coronary syndrome. Insights from the nationwide AMIS Plus registry 2002-2012.
abstract: OBJECTIVE
  This study aimed to assess the impact of individual comorbid conditions as well as the weight assignment, predictive properties and discriminating power of the Charlson Comorbidity Index (CCI) on outcome in patients with acute coronary syndrome (ACS).
  
  
  METHODS
  A prospective multicentre observational study (AMIS Plus Registry) from 69 Swiss hospitals with 29 620 ACS patients enrolled from 2002 to 2012. The main outcome measures were in-hospital and 1-year follow-up mortality.
  
  
  RESULTS
  Of the patients, 27% were female (age 72.1 ± 12.6 years) and 73% were male (64.2 ± 12.9 years). 46.8% had comorbidities and they were less likely to receive guideline-recommended drug therapy and reperfusion. Heart failure (adjusted OR 1.88; 95% CI 1.57 to 2.25), metastatic tumours (OR 2.25; 95% CI 1.60 to 3.19), renal diseases (OR 1.84; 95% CI 1.60 to 2.11) and diabetes (OR 1.35; 95% CI 1.19 to 1.54) were strong predictors of in-hospital mortality. In this population, CCI weighted the history of prior myocardial infarction higher (1 instead of -0.4, 95% CI -1.2 to 0.3 points) but heart failure (1 instead of 3.7, 95% CI 2.6 to 4.7) and renal disease (2 instead of 3.5, 95% CI 2.7 to 4.4) lower than the benchmark, where all comorbidities, age and gender were used as predictors. However, the model with CCI and age has an identical discrimination to this benchmark (areas under the receiver operating characteristic curves were both 0.76).
  
  
  CONCLUSIONS
  Comorbidities greatly influenced clinical presentation, therapies received and the outcome of patients admitted with ACS. Heart failure, diabetes, renal disease or metastatic tumours had a major impact on mortality. CCI seems to be an appropriate prognostic indicator for in-hospital and 1-year outcomes in ACS patients. ClinicalTrials.gov Identifier: NCT01305785.
authors.affiliation: AMIS Plus Data Center, Institute of Social and Preventive Medicine, University of Zurich, , Zurich, Switzerland.
authors.forename: Dragana
authors.initials: D
authors.lastname: Radovanovic
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.forename: Philip
authors.initials: P
authors.lastname: Urban
authors.forename: Franz R
authors.initials: FR
authors.lastname: Eberli
authors.forename: Hans
authors.initials: H
authors.lastname: Rickli
authors.forename: Osmund
authors.initials: O
authors.lastname: Bertel
authors.forename: Milo A
authors.initials: MA
authors.lastname: Puhan
authors.forename: Paul
authors.initials: P
authors.lastname: Erne
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology* / Q000628:therapy; D000368:Aged; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D009204:Myocardial Revascularization / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012042:Registries; D015996:Survival Rate / Q000639:trends; D013557:Switzerland / Q000453:epidemiology