title: A novel risk model including vascular access site for predicting 30-day mortality after primary PCI: The ALPHA score.
abstract: BACKGROUND
  The mortality benefit of transradial primary PCI has been shown by several studies. Previous risk models have not considered access site as a candidate predictor and many of them were developed using low risk populations of randomized trials. We conducted a prospective cohort study to construct and validate an admission risk model including access site as candidate variable for predicting 30-day mortality after primary PCI.
  
  
  METHODS
  We analyzed data of 1255 patients using variables readily available at presentation. Predictor selection was based on backward logistic regression combined with bootstrap resampling. The model has been validated internally and temporally externally.
  
  
  RESULTS
  Thirty-day mortality was independently associated with older age, faster heart rate, need for life support on or prior to admission, and femoral access while it was inversely related to systolic blood pressure. ROC curve analysis revealed high discriminatory power, which was preserved in the validation set (c-statistic: 0.88 and 0.87, respectively). For the new score the acronym ALPHA (Age, Life support, Pressure, Heart rate, Access site) has been coined. Compared with previous models, our score achieved the highest c-statistic (0.87) followed by the GRACE 2.0 (0.86), APEX-AMI (0.86), and CADILLAC (0.85) models, the other scoring systems (TIMI, Zwolle, and PAMI) performed less well. The ALPHA, GRACE 2.0, APEX-AMI, and CADILLAC models predicted 30-day mortality better than the PAMI score (p=0.005, 0.004, 0.01, and 0.02, respectively).
  
  
  CONCLUSIONS
  Using this tool, mortality risk may be precisely assessed at admission and patients who may benefit most from transradial access may be identified.
authors.affiliation: Department of Cardiology, Medical Center, Hungarian Defense Forces, Budapest, Hungary. Electronic address: istvan.hizoh@alumni.uni-heidelberg.de.
authors.forename: Istvan
authors.initials: I
authors.lastname: Hizoh
authors.affiliation: Department of Cardiology, Medical Center, Hungarian Defense Forces, Budapest, Hungary.
authors.forename: Zalan
authors.initials: Z
authors.lastname: Gulyas
authors.affiliation: Department of Cardiology, Medical Center, Hungarian Defense Forces, Budapest, Hungary.
authors.forename: Dominika
authors.initials: D
authors.lastname: Domokos
authors.affiliation: Department of Cardiology, Medical Center, Hungarian Defense Forces, Budapest, Hungary.
authors.forename: Gyongyver
authors.initials: G
authors.lastname: Banhegyi
authors.affiliation: Department of Cardiology, Medical Center, Hungarian Defense Forces, Budapest, Hungary.
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Majoros
authors.affiliation: Department of Cardiology, Medical Center, Hungarian Defense Forces, Budapest, Hungary.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Major
authors.affiliation: Department of Cardiology, Medical Center, Hungarian Defense Forces, Budapest, Hungary.
authors.forename: Timea
authors.initials: T
authors.lastname: Ratkai
authors.affiliation: Department of Cardiology, Medical Center, Hungarian Defense Forces, Budapest, Hungary.
authors.forename: Robert Gabor
authors.initials: RG
authors.lastname: Kiss
mesh_terms: D000368:Aged; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000401:mortality*; D003661:Decision Support Techniques; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D053208:Kaplan-Meier Estimate; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017711:Nonlinear Dynamics; D010343:Patient Admission; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011677:Punctures; D017534:Radial Artery / Q000000981:diagnostic imaging; D012042:Registries; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome
keywords: Access site; Mortality; Primary percutaneous coronary intervention; Risk model