A novel score to predict in-hospital mortality for patients with acute coronary syndrome and out-of-hospital cardiac arrest

Victor Schweiger (Zürich)1, D. Di Vece (Zürich)2, V. L. Cammann (Zürich)2, M. Würdinger (Zürich)1, T. Gilhofer (Zürich)1, A. Gotschy (Zürich)1, A. Candreva (Zürich)1, B. Stähli (Zürich)2, S. Müller (Zürich)3, J. Stehli (Zürich)2, C. Templin (Zürich)2

1UniversitätsSpital Zürich Klinik für Kardiologie Zürich, Schweiz; 2UniversitätsSpital Zürich Universitäres Herzzentrum Zürich, Schweiz; 3Schutz & Rettung Zürich Zürich, Schweiz


Acute coronary syndromes (ACS) present a significant global healthcare challenge, with the potential to escalate to out-of-hospital cardiac arrest (OHCA) in severe cases. Despite notable medical advancements, survival rates for OHCA patients remain disappointingly low, and predicting outcomes for these individuals poses a challenging task for healthcare providers. This study therefore aimed to develop a scoring system, utilizing variables accessible upon admission, to assess in-hospital mortality risk for OHCA patients undergoing coronary intervention.

All OHCA patients admitted to a tertiary care center in Switzerland, who underwent coronary angiography were included in this study. A multivariate logistic regression analysis was performed to analyze the association between clinical variables and in-hospital all-cause mortality. A scoring system, integrating variables available at admission, was developed to assess individual patients' risk of in-hospital mortality and subsequently validated. A normogram was compiled to graphically assess the individual risk.

A total of 291 patients were included in this study. Patients had a median age of 65 [56 to 73] years, and 47 patients were women (16.2%). The in-hospital mortality rate was 41.2%. A prognostic score was derived from the derivation cohort (n=138), incorporating variables such as age, downtime, first detected rhythm, and administration of epinephrine. The FACTOR score demonstrated an area under the curve of 0.823 (95% CI: 0.737 to 0.894) in the derivation cohort and 0.828 (0.760 to 0.891) in the validation cohort (n=153).

The prognostic score demonstrated to be a reliable prognostic tool to assess in-hospital mortality risk in OHCA patients. Early estimation of the in-hospital prognosis may facilitate improved patient management and resource allocation.
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