| Purpose:To establish a novel score system,the CAMI-NSTEMI score system to evaluate the risk of in-hospital mortality of China NSTEMI patients.Methods:Data were extracted from the CAMI registry study,from January 2013 to September 2014,6209 patients were diagnosed with NSTEMI.393 patients with critical data missing were excluded.A total of 5816 patients with NSTEMI were included in the present study.Based on the admission time to the study,all these patients were divided into a test cohort of 4362 patients for the construction of the risk model,and a validation group of 1454 patients for validation of the model.The primary endpoint was in-hospital mortality,which was defined as all-cause mortality during hospitalization.The CAMI-NSTEMI risk score was derived in the test cohort by selection of independent prognostic variables using multivariate logistic regression.A multivariable risk score was constructed with incremental weights attributed to each component variable according to their estimated coefficients.The calibration and discrimination of the model were then assessed in the validation dataset.Receiver operating characteristic(ROC)analyses was performed to compare the capability of risk prediction of in-hospital mortality between the GRACE score and NSTEMI score.Results:A total of 352 patients died during hospitalization,the in hospital mortality was 6.05%.The 12 NSTEMI risk score predictor variables were age(OR=1.027;95%confidence interval[CI]:1.014～1.041;P<0.01),body mass index(OR=0.943;95%CI:0.900～0.988;P<0.01),systolic blood pressure(OR=0.983;95%CI:0.978～0.988;P<0.01),Killip classification(OR=1.565;95%CI:1.370-1.786;P<0.01),heart arrest(OR=3.118;95%CI:1.339～7.262;P<0.01),ST segment depression of ECG(OR=1.571;95%Cl:1.169-2.110;P<0.01),new onset of left bundle branch block(OR=4.579;95%CI:1.876-11.177;P<0.01),serum creatinine(OR=1.004;95%CI:1.002-1.005;P<0.01),white blood cell(OR=1.100 95%CI;1.071～1.130;P<0.01),never smoke(OR=2.080;95%CI:1.460-2.962;P<0.01),previous MI(OR=1.913;95%CI:1.298-2.820;P<0.01)and previous percutaneous coronary intervention(OR=0.322;95%CI:0.142～0.729;P<0.01).Within the test cohort,the C-statistic for this model was 0.81(95%CI:0.78 to 0.84)and excellent calibration was observed(Hosmer-Lemeshow p=0.30).Within the validation cohort,the C-statistic for this model was 0.88(95%CI:0.84 to 0.92)and excellent calibration was observed(Hosmer-Lemeshow p=0.22).The CAMI-NSTEMI score ranged from 0 to 35.The in hospital mortality increased significantly as the CAMI-NSTEMI score increased in the test cohort:1.16%for a score of 0-10;2.97%for 11-13;13.11%for≥14,(P<0.01).The pattern of increasing event rates with increasing CAMI-NSTEMI risk score was confirmed in the validation group(P<0.01).For all the 5816 patients,the area under the ROC curve of CAMI-NSTEMI score was 0.81(95%CI:0.79 to 0.83),which was significantly higher than that of.the GRACE score 0.72(95%CI:0.69 to 0.75),P<0.01.Conclusions:The CAMI-NSTEMI score is able to accurately predict the risk of in-hospital mortality in China patients with NSTEMI,and its predictive power is stronger than the GRACE score. |
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