alpha score in stemi

2. • Mortality risk of STEMI patients shows high variability -need for scoring
systems
• time-consuming imaging/laboratory studies, and findings/results of the
coronary intervention (“discharge models”)
• most common variables used in existing models are age
• Killip class
• heart rate
• SBP at admission
• ECG localization of the infarction
• ischemia time
• GFR
• occurrence of TVD
• final TIMI flow

6. risk model

7. GRACE risk predictor (GRACE score 2.0)

9. • Previous risk models have not considered access site as a candidate
predictor
• existing scoring systems were constructed using low risk populations
of trials excluding cardiogenic shock

10. • single center
• prospective cohort study
• predicting 30-day mortality of STEMI patients undergoing PPCI.
Study Design
• 1,255 consecutive STEMI patients treated with PPCI
• September 2007 through December 2011
• followed-up for a minimum of one year
• Role of eight candidate variables readily available at or soon after
presentation
• 30-day all-cause mortality using logistic regression

11. continuous
parameters
• Age
• onset-to-door (ischemia) time
• heart rate
• SBP at admission
categorical
variables
• Gender
• ECG localization of the infarction
• need for life support on or prior to admission
• vascular access site

12. ALPHA
Age,
Life support,
Pressure,
Heart rate,
Access site

13. 1. development (September 2007 through March 2010, 750 patients,
≈60%)
2. validation (between April 2010 and December 2011, 505 cases,
≈40%)

14. • UFH (70 IU/kg, for PCI with planned use of the glycoprotein IIb/IIIa
receptor inhibitor eptifibatide or 100 IU/kg, for PCI without planned
use of eptifibatide)
• pretreated with ASA and a loading dose of 600 mg clopidogrel, i.e.
none of them received prasugrel or ticagrelor
• Interventional cardiologists were high-volume operators (>200
PCIs/year) skilled in both femoral and radial techniques.

15. • 30-day mortality was independently associated with older age, faster
heart rate, need for life support on or prior to admission, and femoral
access while it was inversely related to SBP as a non-linear parameter
• High discriminatory power and good calibration

22. Discussion
• first STEMI risk model that employs access site as a variable.
• mortality benefit of transradial PPCI -RCT (RIVAL (RadIal Vs. femorAL)
trial, RIFLE-STEACS (Radial Versus Femoral Randomized Investigation
in ST-Elevation Acute Coronary Syndrome) trial, MORTAL (Mortality
benefit Of Reduced Transfusion after percutaneous intervention via
Arm or Leg) trial )
• decrease in all-cause mortality with radial access could be mediated
by a reduction of bleeding events
• European guidelines favor transradial access in both STEMI and non-
STE ACS patients

23. • ALPHA employs only five immediately available and easy-to-measure
variables enabling risk assessment at presentation.
• Despite its simplicity, ALPHA achieved the numerically highest c-index
for 30-day mortality(validated c-statistic: 0.87) and its discriminatory
power was stable over multiple time points

24. • prospective registry data of a single institution.
• may not be valid for populations/centers of other geographic regions
with different baseline risk, resources, and experience.
• limited sample size of the validation cohort did not allow the
detection of some clinically potentially relevant differences during
comparative validation
• exclusively used clopidogrel