Department of Medicine, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, Box H047, Hershey, PA, 17033, USA.
BMC Cardiovasc Disord. 2021 Nov 12;21(1):533. doi: 10.1186/s12872-021-02348-0.
The CADILLAC risk score was developed to identify patients at low risk for adverse cardiovascular events following ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI).
We performed a single center retrospective review of STEMI hospitalizations treated with PPCI from 2014 to 2018. Patients were stratified using the CADILLAC risk score into low risk, intermediate risk and high risk groups. Patients presenting with cardiac arrest or cardiogenic shock were excluded from the study. The primary outcome was adverse clinical events during initial hospitalization. Secondary outcomes were adverse clinical events at 30 days and 1 year following index hospitalization.
The study included 341 patients. Compared to patients with a low CADILLAC score, adverse clinical events were similar in the intermediate risk group during hospitalization (OR 1.23, CI 0.37-4.05, p 0.733) and at 30 days (OR 2.27, CI 0.93-5.56, p 0.0733) while adverse clinical events were significantly elevated in the high risk group during hospitalization (OR 4.75, CI 1.91-11.84, p 0.0008) and at 30 days (OR 8.73, CI 4.02-18.96, p < 0.0001). At 1 year follow-up, compared to the low risk CADILLAC group (9.4% adverse clinical event rate), cumulative adverse clinical events were significantly higher in the intermediate risk group (22.9% event rate, OR 2.86, CI 1.39-5.89, p 0.0044) and in the elevated risk group (58.6% event rate, OR 13.67, CI 6.81-27.43, p < 0.0001). The mortality rate was 0% for patients defined at low risk by CADILLAC score during hospitalization, as well up to 1 year follow up. On receiver operating curve analysis, discrimination of in-hospital adverse clinical events was fair using CADILLAC (C = 0.66, odds ratio 1.18; 95% CI 1.04-1.33; p = 0.0064) with somewhat better discrimination at 30-day follow-up (C = 0.719) and 1-year follow-up (C = 0.715).
Patients defined as low risk by the CADILLAC score following a STEMI were associated with lower mortality and adverse clinical event rates during hospitalization and up to 1 year following STEMI when compared to those with an intermediate or high CADILLAC score.
CADILLAC 风险评分旨在识别接受直接经皮冠状动脉介入治疗（PPCI）治疗的 ST 段抬高型心肌梗死（STEMI）患者发生不良心血管事件的低危患者。
我们对 2014 年至 2018 年接受 PPCI 治疗的 STEMI 住院患者进行了单中心回顾性研究。患者使用 CADILLAC 风险评分分为低危、中危和高危组。排除因心脏骤停或心源性休克而就诊的患者。主要结局是初次住院期间的不良临床事件。次要结局是 30 天和 1 年时的不良临床事件。
本研究共纳入 341 例患者。与 CADILLAC 评分低的患者相比，中危组患者住院期间（OR 1.23，95%CI 0.37-4.05，p 0.733）和 30 天时（OR 2.27，95%CI 0.93-5.56，p 0.0733）不良临床事件相似，而高危组患者住院期间（OR 4.75，95%CI 1.91-11.84，p 0.0008）和 30 天时（OR 8.73，95%CI 4.02-18.96，p < 0.0001）不良临床事件显著升高。在 1 年随访时，与 CADILLAC 低危组（9.4%不良临床事件发生率）相比，中危组（22.9%事件发生率，OR 2.86，95%CI 1.39-5.89，p 0.0044）和高危组（58.6%事件发生率，OR 13.67，95%CI 6.81-27.43，p < 0.0001）累积不良临床事件发生率显著更高。CADILLAC 评分低危患者住院期间及 1 年随访期间死亡率为 0%。在接受者操作特征曲线分析中，CADILLAC 对住院期间不良临床事件的区分度为中等（C=0.66，OR 1.18；95%CI 1.04-1.33；p=0.0064），30 天随访（C=0.719）和 1 年随访（C=0.715）时区分度稍好。
与中危或高危 CADILLAC 评分患者相比，STEMI 后 CADILLAC 评分低危患者住院期间及 STEMI 后 1 年死亡率和不良临床事件发生率较低。
