IMR Press / RCM / Volume 22 / Issue 4 / DOI: 10.31083/j.rcm2204179
Open Access Original Research
A simple combination of biomarkers for risk stratification in octogenarians with acute myocardial infarction
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1 Department of Cardiology, Joan XXIII University Hospital of Tarragona, 43005 Tarragona, Spain
2 Pere Virgili Health Research Institute (IISPV), Parc Sanitari Joan XXIII, 43005 Tarragona, Spain
3 Department of Medicine and Surgery, Rovira i Virgili University, 43003 Tarragona, Spain
*Correspondence: esanz.hj23.ics@gencat.cat (Esther Sanz-Girgas); gbonet.hj23.ics@gencat.cat (Gil Bonet)
These authors contributed equally.
Academic Editor: Manuel Martínez-Sellés
Rev. Cardiovasc. Med. 2021, 22(4), 1711–1720; https://doi.org/10.31083/j.rcm2204179
Submitted: 9 September 2021 | Revised: 29 October 2021 | Accepted: 29 October 2021 | Published: 22 December 2021
(This article belongs to the Special Issue Acute Coronary Syndromes in the Octogenarians)
Copyright: © 2021 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/).
Abstract

The aim of this observational study was to assess long-term prognosis of a contemporary octogenarian population admitted to an Intensive Cardiac Care Unit with acute myocardial infarction (MI), and the prognostic value of two simple biomarkers obtained at admission: glucose blood level (ABG) and estimated glomerular filtration rate (eGFR). A total of 293 consecutive patients were included (202 with ST elevation MI and 91 with non-ST elevation MI) with median age 83.9 years, 172 (58.7%) male. The optimal cut-off points for all-cause death defined by ROC curves were ABG >186 mg/dL and eGFR <50 mL/min/1.73 m2. The cohort was segregated into 3 groups according to these values: no biomarker present (group 1), either of the two biomarkers present (group 2) or both biomarkers present (group 3). Patients in group 3 were more frequently female, with worse Charlson index, Killip class and ventricular function, and higher GRACE scores. PCI was performed in 248 patients (84.6%). The highest in-hospital and long-term mortality, and composite MACE was observed in groups 2 and 3. All-cause mortality (median follow-up 2.2 years) was 44%. In multivariate analysis, ABG >186 mg/dL and eGFR <50 mL/min/1.73 m2 were associated with a 4.2 odds ratio (OR) (Model 1: medical history variables) and 2.6 OR (Model 2: admission event variables) of mortality. The addition of these variables to ROC curves improved long-term risk prediction for Model 1 (C-statistics 0.718 versus 0.780, p = 0.006) and reclassification and discrimination in both models.

Keywords
Elderly
Acute coronary syndrome
Mortality
Hyperglycaemia
Estimated glomerular filtration rate
Acute myocardial infarction
Octogenarian
Long-term outcome
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