title: Predictors of one-year mortality at hospital discharge after acute coronary syndromes: A new risk score from the EPICOR (long-tErm follow uP of antithrombotic management patterns In acute CORonary syndrome patients) study.
abstract: OBJECTIVE
  A reliable prediction tool is needed to identify acute coronary syndrome (ACS) patients with high mortality risk after their initial hospitalization.
  
  
  METHODS
  EPICOR (long-tErm follow uP of antithrombotic management patterns In acute CORonary syndrome patients: NCT01171404) is a prospective cohort study of 10,568 consecutive hospital survivors after an ACS event (4943 ST-segment elevation myocardial infarction (STEMI) and 5625 non-ST-elevation ACS (NSTE-ACS)). Of these cases, 65.1% underwent percutaneous coronary intervention (PCI) and 2.5% coronary artery bypass graft (CABG). Post-discharge mortality was recorded for up to two years. From over 50 potential predictor variables a new risk score for one-year mortality was developed using forward stepwise Cox regression, and examined for goodness-of-fit, discriminatory power, and external validation.
  
  
  RESULTS
  A total of 407 patients (3.9%) died within one year of discharge. We identified 12 highly significant independent predictors of mortality (in order of predictive strength): age, lower ejection fraction, poorer EQ-5D quality of life, elevated serum creatinine, in-hospital cardiac complications, chronic obstructive pulmonary disease, elevated blood glucose, male gender, no PCI/CABG after NSTE-ACS, low hemoglobin, peripheral artery disease, on diuretics at discharge. When combined into a new risk score excellent discrimination was achieved (c-statistic=0.81) and this was also validated on a large similar cohort (9907 patients) in Asia (c=0.78). For both STEMI and NSTE-ACS there was a steep gradient in one-year mortality ranging from 0.5% in the lowest quintile to 18.2% in the highest decile. NSTE-ACS contributes over twice as many high-risk patients as STEMI.
  
  
  CONCLUSIONS
  Post-discharge mortality for ACS patients remains of concern. Our new user-friendly risk score available on www.acsrisk.org can readily identify who is at high risk.
authors.affiliation: London School of Hygiene and Tropical Medicine, UK Stuart.Pocock@lshtm.ac.uk.
authors.forename: Stuart
authors.initials: S
authors.lastname: Pocock
authors.affiliation: Hospital General Universitario Gregorio Marañón, Spain.
authors.forename: Héctor
authors.initials: H
authors.lastname: Bueno
authors.affiliation: Medical Department, AstraZeneca France, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Licour
authors.affiliation: AstraZeneca Observational Research Center, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Medina
authors.affiliation: AstraZeneca Medical Evidence Center, USA.
authors.forename: Lin
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Interuniversity Centre for Health Economics Research UGent, Vrije Universiteit Brussel, Belgium.
authors.forename: Lieven
authors.initials: L
authors.lastname: Annemans
authors.affiliation: Hôpital Européen Georges Pompidou, René Descartes University, France.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Danchin
authors.affiliation: Peking University First Hospital, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Huo
authors.affiliation: University Hospitals Leuven, Belgium.
authors.forename: Frans
authors.initials: F
authors.lastname: Van de Werf
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality* / Q000601:surgery; D001026:Coronary Artery Bypass / Q000401:mortality; D003661:Decision Support Techniques; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors
chemical_list: D005343:Fibrinolytic Agents
keywords: Acute coronary syndrome; hospital discharge; mortality; prognostic model; risk score