The CADILLAC risk score accurately identifies patients at low risk for in-hospital mortality and adverse cardiovascular events following ST elevation myocardial infarction

Abstract

Background The CADILLAC risk score was developed to identify patients at low risk for adverse cardiovascular events following ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI). Methods We performed a single center retrospective review of STEMI hospitalizations treated with PPCI from 2014 to 2018. Patients were stratified using the CADILLAC risk score into low risk, intermediate risk and high risk groups. Patients presenting with cardiac arrest or cardiogenic shock were excluded from the study. The primary outcome was adverse clinical events during initial hospitalization. Secondary outcomes were adverse clinical events at 30 days and 1 year following index hospitalization. Results The study included 341 patients. Compared to patients with a low CADILLAC score, adverse clinical events were similar in the intermediate risk group during hospitalization (OR 1.23, CI 0.37–4.05, p 0.733) and at 30 days (OR 2.27, CI 0.93–5.56, p 0.0733) while adverse clinical events were significantly elevated in the high risk group during hospitalization (OR 4.75, CI 1.91–11.84, p 0.0008) and at 30 days (OR 8.73, CI 4.02–18.96, p < 0.0001). At 1 year follow-up, compared to the low risk CADILLAC group (9.4% adverse clinical event rate), cumulative adverse clinical events were significantly higher in the intermediate risk group (22.9% event rate, OR 2.86, CI 1.39–5.89, p 0.0044) and in the elevated risk group (58.6% event rate, OR 13.67, CI 6.81–27.43, p < 0.0001). The mortality rate was 0% for patients defined at low risk by CADILLAC score during hospitalization, as well up to 1 year follow up. On receiver operating curve analysis, discrimination of in-hospital adverse clinical events was fair using CADILLAC (C = 0.66, odds ratio 1.18; 95% CI 1.04–1.33; p = 0.0064) with somewhat better discrimination at 30-day follow-up (C = 0.719) and 1-year follow-up (C = 0.715). Conclusion Patients defined as low risk by the CADILLAC score following a STEMI were associated with lower mortality and adverse clinical event rates during hospitalization and up to 1 year following STEMI when compared to those with an intermediate or high CADILLAC score.

Usefulness of the Quick-Sepsis Organ Failure Assessment Score in Cardiovascular Intensive Care Unit to Predict Prognosis in Acute Coronary Syndrome

“…10 Given the limitations of the Zwolle score, the CADILLAC score was developed in the same patient population as the Zwolle score, but with the integration of ejection fraction, TIMI flow at the end of PCI, and number of diseased vessels, derived from the database of the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial, 27 and validated in the database of the Stent-Primary Angioplasty in Myocardial Infarction trial, 28 but with the aim of predicting mortality at 30 days and 1 year, and not of triaging patients according to their risk during hospitalization. 8,11 As we have seen, the Zwolle score remains the only score that can be used to triage patients according to their risk of developing a complication during their stay in the CICU.…”

“…Several scores have been studied to predict the prognosis of patients with ACS, principally the Global Registry of Acute Coronary Events (GRACE) score, 5 the thrombolysis end flow in myocardial infarction (TIMI) score, 6 the Zwolle score, 7 and the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) score. 8 These scores include biological markers, which may be falsely elevated in other conditions, and angiographic elements, which cannot be known prior to coronary angiography and percutaneous coronary intervention (PCI). For these reasons, these scores, although having a good predictive value, cannot be used as admission triage scores to predict the prognosis of patients admitted with ACS who have undergone PCI.…”