title: Development and validation of clinical risk score to predict the cardiac rupture in patients with STEMI.
abstract: BACKGROUND
  Cardiac rupture (CR) is a fatal complication of ST-elevation myocardial infarction (STEMI) with poor prognosis. The aim of this study was to develop and validate practical risk score to predict the CR after STEMI.
  
  
  METHODS
  A total of 11,234 STEMI patients from 7 centers in China were enrolled in our study, we firstly developed a simplified fast-track CR risk model from 7455 STEMI patients, and then prospectively validated the CR risk model using receiver-operating characteristic (ROC) curves by the other 3779 consecutive STEMI patients. This trial is registered with ClinicalTrials.gov, number NCT02484326.
  
  
  RESULTS
  The incidence of CR was 2.12% (238/11,234), and the thirty-day mortality in CR patients was 86%. We developed a risk model which had 7 independent baseline clinical predictors (female sex, advanced age, anterior myocardial infarction, delayed admission, heart rate, elevated white blood cell count and anemia). The CR risk score system differentiated STEMI patients with incidence of CR ranging from 0.2% to 13%. The risk score system demonstrated good predictive value with area under the ROC of 0.78 (95% CI 0.73-0.84) in validation cohort. Primary percutaneous coronary intervention decreased the incidence of CR in high risk group (3.9% vs. 6.2%, p<0.05) and very high risk group (8.0% vs. 15.2%, p<0.05).
  
  
  CONCLUSIONS
  A simple risk score system based on 7 baseline clinical variables could identify patients with high risk of CR, for whom appropriate treatment strategies can be implemented.
authors.affiliation: Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Geng
authors.initials: G
authors.lastname: Qian
authors.affiliation: Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Rong-Jie
authors.initials: RJ
authors.lastname: Jin
authors.affiliation: Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Zhen-Hong
authors.initials: ZH
authors.lastname: Fu
authors.affiliation: Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Yong-Qiang
authors.initials: YQ
authors.lastname: Yang
authors.affiliation: Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Hong-Liang
authors.initials: HL
authors.lastname: Su
authors.affiliation: Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Dong
authors.affiliation: Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Guo
authors.affiliation: Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Jing
authors.affiliation: Department of Cardiology, Beijing Fuwai Hospital, Beijing, China.
authors.forename: Yuan-Lin
authors.initials: YL
authors.lastname: Guo
authors.affiliation: Department of Cardiology, Chinese PLA General Hospital, Beijing, China. Electronic address: qiangeng9396@263.net.
authors.forename: Yun-Dai
authors.initials: YD
authors.lastname: Chen
mesh_terms: D000367:Age Factors; D000368:Aged; D000740:Anemia / Q000453:epidemiology*; D056988:Anterior Wall Myocardial Infarction / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D002681:China / Q000453:epidemiology; D005260:Female; D006339:Heart Rate; D006342:Heart Rupture, Post-Infarction / Q000453:epidemiology* / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007964:Leukocytosis / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D012737:Sex Factors; D013997:Time Factors
keywords: Cardiac rupture; Risk assessment; ST-elevation myocardial infarction