A Revised PADMA Scoring System for Predicting in-Hospital Mortality in Acute Coronary Syndrome Patient

Abstract

Background In order to predict in-hospital mortality in ACS (Acute Coronary Syndrome) patients based solely on clinical examination, this study compares the shock index (heart rate divided by systolic blood pressure) variable in PADMA (PADjadjaran Mortality in Acute Coronary Syndrome) with the modified shock index (heart rate divided by mean arterial pressure) score. The predictive efficacy of the PADMA score in predicting in-hospital mortality in ACS patients has been in doubt up until recently. Methods All ACS patients above the age of 18 who were admitted to Dr. Hasan Sadikin Central General Hospital between January 2018 and January 2023 were included in this retrospective observational cohort study. This study did not involve any interventions, and verbal informed permission was obtained with the Hasan Sadikin Hospital Ethic Committee’s approval. Multivariate logistic regression was used to gather and evaluate patient demographic, comorbidity, and clinical presentation data in order to provide two scoring systems (probability and cut-off models) that can be used to predict in-hospital all-cause death. The Fisher Z test was used to assess the area under the curve (AUC) between the PADMA SI (shock index) and PADMA MSI (modified shock index). Results Killip classifications III and IV, tachycardia, a high shock index, and older age were found to be independent mortality predictors and were included to the PADMA MSI score by multivariate regression analysis of 1504 people. PADMA SI score >8 has a sensitivity of 67.92% and a specificity of 84.01% for predicting all-cause death. The range of the PADMA SI score is 0 to 19. The AUC between the PADMA MSI and PADMA SI scores did not differ significantly (p=0.022). Conclusion Similar to the PADMA SI score, the PADMA MSI score >8 demonstrated an accurate discriminative power to forecast in-hospital mortality though it did not have significant statistic difference.

Advancements in Myocardial Infarction Management: Exploring Novel Approaches and Strategies

“…Innovative reperfusion techniques beyond conventional strategies, such as distal embolic protection devices, bioresorbable scaffolds, and microvascular interventions, have been discussed. These techniques optimize reperfusion outcomes by reducing distal embolization, promoting vessel healing, and addressing microvascular dysfunction [29,30]. Innovative reperfusion techniques offer personalized approaches to MI management, reducing complications and improving patient outcomes.…”

“…The use of EPDs has been shown to be particularly beneficial in patients with complex lesion morphology, high thrombus burden, and vulnerable plaques. Clinical trials, such as the EMERALD study, have demonstrated the safety and efficacy of EPDs in improving myocardial perfusion, reducing infarct size, and lowering the risk of major adverse cardiac events [30].…”

“…Reperfusion therapy is the cornerstone of MI management, aimed at restoring blood flow to the ischemic myocardium and salvaging viable cardiac tissue. While conventional reperfusion techniques, such as primary PCI and fibrinolytic therapy, have significantly improved outcomes for MI patients, ongoing research and technological advancements have led to innovative approaches that further optimize reperfusion outcomes and minimize complications [30]. In this discussion, we will explore three innovative reperfusion techniques: distal embolic protection devices, bioresorbable scaffolds, and microvascular interventions, elucidating how these techniques are reshaping the landscape of MI management.…”

“…Digital blood pressure monitors, connected to telehealth platforms, allow healthcare providers to remotely monitor patients' blood pressure trends and adjust medications accordingly. A study published in JAMA Internal Medicine demonstrated that RPM combined with telemonitoring significantly improved blood pressure control and medication adherence in post-MI patients compared to traditional care [30]. Another vital aspect of RPM is the continuous monitoring of ECG data.…”

“…Cardiac rehabilitation programs typically consist of the following components. Supervised exercise sessions tailored to the patient's individual fitness level are a central element of cardiac rehabilitation [30]. These sessions aim to improve cardiovascular fitness, reduce risk factors, and enhance overall physical health.…”