title: Comparison of clinical and angiographic prognostic risk scores in elderly patients presenting with acute coronary syndrome and referred for percutaneous coronary intervention.
abstract: BACKGROUND
  Multiple risk prediction models have been validated in all-age patients presenting with acute coronary syndrome (ACS) and treated with percutaneous coronary intervention (PCI); however, they have not been validated specifically in the elderly.
  
  
  METHODS
  We calculated the GRACE (Global Registry of Acute Coronary Events) score, the logistic EuroSCORE, the AMIS (Acute Myocardial Infarction Swiss registry) score, and the SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) score in a consecutive series of 114 patients ≥75 years presenting with ACS and treated with PCI within 24 hours of hospital admission. Patients were stratified according to score tertiles and analysed retrospectively by comparing the lower/mid tertiles as an aggregate group with the higher tertile group. The primary endpoint was 30-day mortality. Secondary endpoints were the composite of death and major adverse cardiovascular events (MACE) at 30 days, and 1-year MACE-free survival. Model discrimination ability was assessed using the area under receiver operating characteristic curve (AUC).
  
  
  RESULTS
  Thirty-day mortality was higher in the upper tertile compared with the aggregate lower/mid tertiles according to the logistic EuroSCORE (42% vs 5%; odds ratio [OR] = 14, 95% confidence interval [CI] = 4-48; p <0.001; AUC = 0.79), the GRACE score (40% vs 4%; OR = 17, 95% CI = 4-64; p <0.001; AUC = 0.80), the AMIS score (40% vs 4%; OR = 16, 95% CI = 4-63; p <0.001; AUC = 0.80), and the SYNTAX score (37% vs 5%; OR = 11, 95% CI = 3-37; p <0.001; AUC = 0.77).
  
  
  CONCLUSIONS
  In elderly patients presenting with ACS and referred to PCI within 24 hours of admission, the GRACE score, the EuroSCORE, the AMIS score, and the SYNTAX score predicted 30 day mortality. The predictive value of clinical scores was improved by using them in combination.
authors: Fondazione Cardiocentro Ticino, Lugano, Switzerland, and Dept. of Cardiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
authors: Giuseppe
authors: G
authors: Vassalli
authors: Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors: Ilaria
authors: I
authors: d'Angeli
authors: Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors: Frank
authors: F
authors: Scherff
authors: Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors: Daniel
authors: D
authors: Sürder
authors: Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors: Antonio
authors: A
authors: Mantovani
authors: Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors: Elena
authors: E
authors: Pasotti
authors: Fondazione IRCCS, Policlinico San Matteo, Department of Biometry and Statistics, Pavia, Italy.
authors: Catherine
authors: C
authors: Klersy
authors: Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors: Angelo
authors: A
authors: Auricchio
authors: Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors: Tiziano
authors: T
authors: Moccetti
authors: Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors: Giovanni B
authors: GB
authors: Pedrazzini
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology*; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D015897:Comorbidity; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology