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

Introduction:
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.

Method:
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.

Results:
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).



Conclusion:
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.