The Prognostic Value of the Age–D-Dimer–Albumin Score in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Abstract

Background The Age–D-dimer–Albumin (ADA), the CREDO-Kyoto, and the PARIS scores have been established to predict thrombotic events. However, the prognostic performance of these scores compared to the GRACE score in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) has not been reported.

Methods Consecutive AMI patients treated with PCI were retrospectively enrolled at a teaching hospital in China from January 2016 to December 2019. The primary endpoint was all-cause mortality and the secondary endpoint was cardiac death. Harrell's C-index and net reclassification improvement (NRI) were used to compare the prognostic value of these scores with the GRACE score for mortality.

Results Of the 1,578 patients enrolled, the mean age was 62.5 years, and 23.5% were female. During a median follow-up of 3.8 years, 146 all-cause deaths and 80 cardiac deaths occurred. The ADA score showed a better prognostic performance than the GRACE (Harrell's C-index: 0.800 vs. 0.749; p = 0.003), the CREDO-Kyoto (Harrell's C-index: 0.800 vs. 0.765; NRI = 0.348, p < 0.001), and the PARIS scores (Harrell's C-index: 0.800 vs. 0.694; NRI = 0.556, p < 0.001). In the multivariable Cox regression analysis, the ADA score was independently associated with all-cause mortality (hazard ratio [HR] = 1.641 per 10-point increment, 95% confidence interval [CI]: 1.397–1.929) and cardiac death (HR = 1.636 per 10-point increment, 95% CI: 1.325–2.020). The risk of all-cause mortality and cardiac death increased with the rising of the ADA score.

Conclusion The ADA score showed a better prognostic performance than the GRACE, the CREDO-Kyoto, and the PARIS scores in patients with AMI undergoing PCI, which was a potential predictive tool for mortality.

Keywords

acute myocardial infarction - percutaneous coronary intervention - GRACE - mortality

• References

• 1 Reed GW, Rossi JE, Cannon CP. Acute myocardial infarction. Lancet 2017; 389 (10065): 197-210
• 2 Alfonso F, Gonzalo N, Rivero F, Escaned J. The year in cardiovascular medicine 2020: interventional cardiology. Eur Heart J 2021; 42 (10) 985-1003
• 3 Moledina SM, Kontopantelis E, Wijeysundera HC. et al. Ethnicity-dependent performance of the Global Registry of Acute Coronary Events risk score for prediction of non-ST-segment elevation myocardial infarction in-hospital mortality: nationwide cohort study. Eur Heart J 2022; 43 (24) 2289-2299
• 4 Raposeiras-Roubín S, Abu-Assi E, Cabanas-Grandío P. et al. Walking beyond the GRACE (Global Registry of Acute Coronary Events) model in the death risk stratification during hospitalization in patients with acute coronary syndrome: what do the AR-G (ACTION [Acute Coronary Treatment and Intervention Outcomes Network] Registry and GWTG [Get With the Guidelines] Database), NCDR (National Cardiovascular Data Registry), and EuroHeart Risk Scores Provide?. JACC Cardiovasc Interv 2012; 5 (11) 1117-1125
• 5 Alnasser SM, Huang W, Gore JM. et al; GRACE Investigators. Late consequences of acute coronary syndromes: Global Registry of Acute Coronary Events (GRACE) Follow-up. Am J Med 2015; 128 (07) 766-775
• 6 Collet JP, Thiele H, Barbato E. et al; ESC Scientific Document Group. 2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021; 42 (14) 1289-1367
• 7 Natsuaki M, Morimoto T, Yamaji K. et al; CREDO-Kyoto PCI/CABG Registry Cohort 2, RESET, and NEXT trial investigators. Prediction of thrombotic and bleeding events after percutaneous coronary intervention: CREDO-Kyoto thrombotic and bleeding risk scores. J Am Heart Assoc 2018; 7 (11) e008708
• 8 Baber U, Mehran R, Giustino G. et al. Coronary thrombosis and major bleeding after PCI with drug-eluting stents: risk scores from PARIS. J Am Coll Cardiol 2016; 67 (19) 2224-2234
• 9 Zhao X, Li J, Tang X. et al. Prognostic value of the PARIS thrombotic risk score for 2-year mortality after percutaneous coronary intervention. Clin Appl Thromb Hemost 2019; 25: 1076029619853638
• 10 Akama J, Shimizu T, Ando T. et al. Clinical usefulness of the pattern of non-adherence to anti-platelet regimen in stented patients (PARIS) thrombotic risk score to predict long-term all-cause mortality and heart failure hospitalization after percutaneous coronary intervention. PLoS One 2022; 17 (09) e0274287
• 11 Violi F, Pignatelli P, Vestri AR. et al; ADA GROUP. The ADA (Age-D-Dimer-Albumin) Score to predict thrombosis in SARS-CoV-2. Thromb Haemost 2022; 122 (09) 1567-1572
• 12 Chi G, Violi F, Pignatelli P. et al. External validation of the ADA score for predicting thrombosis among acutely ill hospitalized medical patients from the APEX Trial. J Thromb Thrombolysis 2023; 55 (02) 211-221
• 13 Thygesen K, Alpert JS, Jaffe AS. et al; Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol 2018; 72 (18) 2231-2264
• 14 Granger CB, Goldberg RJ, Dabbous O. et al; Global Registry of Acute Coronary Events Investigators. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med 2003; 163 (19) 2345-2353
• 15 Nakamura M, Kimura K, Kimura T. et al. JCS 2020 guideline focused update on antithrombotic therapy in patients with coronary artery disease. Circ J 2020; 84 (05) 831-865
• 16 Yamashita D, Saito Y, Sato T. et al. Impact of PARIS and CREDO-Kyoto thrombotic and bleeding risk scores on clinical outcomes in patients with acute myocardial infarction. Circ J 2022; 86 (04) 622-629
• 17 Kyrle PA, Eichinger S. D-Dimer for long-term risk prediction in patients after acute coronary syndrome: jack of all trades, or master of none?. Circulation 2018; 138 (07) 724-726
• 18 Xiao L, Jia Y, Wang X, Huang H. The impact of preoperative fibrinogen-albumin ratio on mortality in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Clin Chim Acta 2019; 493: 8-13
• 19 Klingenberg R, Aghlmandi S, Räber L. et al. Cysteine-rich angiogenic inducer 61 improves prognostic accuracy of GRACE (Global Registry of Acute Coronary Events) 2.0 risk score in patients with acute coronary syndromes. J Am Heart Assoc 2021; 10 (20) e020488
• 20 Weitz JI, Fredenburgh JC, Eikelboom JW. A test in context: D-dimer. J Am Coll Cardiol 2017; 70 (19) 2411-2420
• 21 Folsom AR, Lutsey PL, Heckbert SR, Cushman M. Serum albumin and risk of venous thromboembolism. Thromb Haemost 2010; 104 (01) 100-104
• 22 Wada H, Dohi T, Miyauchi K. et al. Independent and combined effects of serum albumin and C-reactive protein on long-term outcomes of patients undergoing percutaneous coronary intervention. Circ J 2017; 81 (09) 1293-1300
• 23 Zeymer U, Hochadel M, Karcher AK. et al; ALKK Study Group. Procedural success rates and mortality in elderly patients with percutaneous coronary intervention for cardiogenic shock. JACC Cardiovasc Interv 2019; 12 (18) 1853-1859
• 24 Collet JP, Kerneis M, Lattuca B. et al; ATLANTIC Investigators. Impact of age on the effect of pre-hospital P2Y12 receptor inhibition in primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: the ATLANTIC-Elderly analysis. EuroIntervention 2018; 14 (07) 789-797
• 25 Antman EM, Cohen M, Bernink PJ. et al. The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA 2000; 284 (07) 835-842