Specific and non-specific prognostic scores in patients with out-of-hospital cardiac arrest caused by ST-segment elevation myocardial infarction: A comparative study.

Abstract

Background: Patients resuscitated after out-of-hospital cardiac arrest (OHCA) have a poor prognosis, with high death rates. Multiple scoring systems have been developed to predict survival in all-comers with OHCA. Acute coronary syndromes and ST-segment elevation myocardial infarction (STEMI) are the primary causes of OHCA. Recently, a specific prognostic score (Tran risk model) was developed for patients with STEMI-related OHCA.

Aim: To compare the accuracy of established non-STEMI-specific prognostic scores (OHCA, modified CAHP and NULL-PLEASE) with the Tran risk model in predicting in-hospital death among patients with STEMI-related OHCA.

Methods: This was an observational single-centre study including 315 consecutive patients treated for STEMI-related OHCA. The OHCA score was calculated for 310 patients (98.4%), the NULL-PLEASE and modified CAHP (mCAHP) scores were calculated for 308 patients (97.8%) and the Tran risk model score was calculated for 306 patients (97.1%). A C-statistic analysis was performed to determine score performance.

Results: The area under the curve (AUC) for the Tran risk model was 0.75 (95% confidence interval [CI] 0.69-0.79). The AUCs for the OHCA, mCAHP and NULL-PLEASE scores were 0.74 (95% CI 0.69-0.80), 0.74 (95% CI 0.69-0.80) and 0.76 (95% CI 0.71-0.82), respectively. There was no significant difference in AUCs between the Tran risk model and the mCAHP score (P=0.95), the NULL-PLEASE score (P=0.42) or the OHCA score (P=0.93). Similarly, no significant difference was observed between the mCAHP, NULL-PLEASE and OHCA scores. Predictors of death were no-flow duration, diabetes, blood lactate, femoral access and age>75 years.

Conclusions: The OHCA, NULL-PLEASE and mCAHP scores and the Tran risk model showed moderate to good performance in predicting in-hospital death in patients with STEMI-related OHCA. No differences in accuracy were found between non-STEMI-specific scores and the Tran risk model developed for patients with STEMI-related OHCA.