Comorbidity assessment for mortality risk stratification in elderly patients with acute coronary syndrome

Autores de INCLIVA

• 

  Juan Sanchis Fores

  Autor

• 

  Julio Nuñez Villota

  Autor

• Vicente Ruiz Ros

  Autor

• 

  Clara Bonanad Lozano

  Autor

• Ernesto Valero Picher

  Autor

• Sergio Garcia Blas

  Autor

• Gema Miñana Escriva

  Autor

Participantes ajenos a INCLIVA

• Soler, M
• Formiga, F
• Martinez-Selles, M
• Marin, F
• Ruescas, A
• Abu-Assi, E
• Bueno, H
• Ariza-Sole, A

Grupos y Plataformas de I+D+i

• Grupo de investigación en Cardiología Clínica

  

  Leading Researcher

  Juan Sanchis Fores

• Grupo de Investigación Traslacional en Cardiopatía Isquémica

  

  Leading Researcher

  Vicent Bodí Peris

Abstract

Background: The Charlson's is the most used comorbidity index. It comprises 19 comorbidities, some of which are infrequent in elderly patients with acute coronary syndrome (ACS), while some others are manifestations of cardiac disease rather than comorbidities. Our goal was to simplify comorbidity assessment in elderly non-ST-segment elevation ACS patients. Methods: The study group consisted of 1 training (n = 920, 76 +/- 7 years) and 1 testing (n = 532; 84 +/- 4 years) cohorts. The end-point was all-cause mortality at 1-year follow-up. Comorbidities were assessed selecting those medical disorders other than cardiac disease that were independently associated with mortality by multivariable analysis. Results: A total of 130 (14%) patients died in the training cohort. Six comorbidities were predictive: renal failure, anemia, diabetes, peripheral artery disease, cerebrovascular disease and chronic lung disease. The increase in the number of comorbidities yielded a gradient of risk on top of well-known clinical predictors: >= 3 comorbidities (27% mortality, HR = 1.90, 95% CI 1.20-3.03, p = .006); 2 comorbidities (16% mortality, HR = 1.29, 95% CI 0.81-2.04, p = .30); and 0-1 comorbidities (7.6% mortality, reference category). The discrimination accuracy (C-statistic = 0.80) and calibration (Hosmer-Lemeshow test, p = .20) of the predictive model using the 6 comorbidities was comparable to the predictive model using the Charlson index (C-statistic = 0.80; Hosmer-Lemeshow test, p = .70). Similar results were reproduced in the testing cohort (>= 3 co- morbidities: 24% mortality, HR = 2.37, 95% CI 1.25-4.49, p = .008; 2 comorbidities: 14% mortality, HR = 1.59, 95% CI 0.82-3.07, p = .20; 0-1 comorbidities: 7.5% reference category). Conclusion: A simplified comorbidity assessment comprising 6 comorbidities provides useful risk stratification in elderly patients with ACS.

© 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved

Keywords

• Acute coronary syndrome; Elderly; Comorbidity