Abstract
Objectives. Acute coronary syndrome (ACS) is associated with high mortality. Charlson comorbidity index (CCI) was designed over 30 years ago to measure the impact of pre-existing comorbidities on long-term survival of the patient. We wanted to re-evaluate the performance of CCI and its components in modern setting. Design. This is a retrospective study of 1576 consecutive patients undergoing invasive evaluation and treated for ACS in single tertiary center between 2015–2016. Mortality was analyzed in timeframes of 1, 6 and 24 months. CCI-scores were retrieved from written medical records and complimented with data from electronic sources. The performance of CCI and its components was compared to the GRACE-score measuring patients’ status upon hospital admission. Results. Population mean age at baseline was 69.3 (SD 11.8) years and 69.1% of the patients were male (n = 1089). Most of the components of CCI associated significantly with mortality at all timeframes despite adjusting for age but only diabetes and congestive heart failure associated with mortality at all time points after adjusting for GRACE-score. CCI associated with mortality [GRACE adjusted HR-values of single unit increase of CCI after 1, 6 and 24-month follow-up: 1.12(95% CI:1.00–1.25), 1.17(1.07–1.29) and 1.24(1.16–1.33)]. CCI performed modestly with its AUC-values ranging between 0.755 and 0.784, with prognostic performance increasing with longer follow-up. Adding components of CCI did not significantly improve risk prediction over GRACE-score. Conclusions. In conclusion, CCI or its individual components measuring the impact of comorbidities on overall mortality does not provide any significant value compared to GRACE–score during up to 2 years of follow-up.
Original language | English |
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Pages (from-to) | 146-152 |
Number of pages | 7 |
Journal | Scandinavian Cardiovascular Journal |
Volume | 54 |
Issue number | 3 |
Early online date | 28 Nov 2019 |
DOIs | |
Publication status | Published - Jun 2020 |
MoE publication type | A1 Journal article-refereed |
Funding
This study is supported by Business Finland research funding (Grant no. 4197/31/2015) as apart of a collaboration between Tays Heart Hospital, University of Tampere, VTT Technical Research Centre of Finland Ltd, Politecnico di Milano, GE Healthcare Finland Ltd, Fimlab laboratories Ltd and Bittium Medanalytics Ltd. TL has been supported by the Academy of Finland (grants no. 286284, 322098); Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital (grant X51001); Finnish Foundation for Cardiovascular Research; Tampere Tuberculosis Foundation; Emil Aaltonen Foundation; Yrjö Jahnsson Foundation; Signe and Ane Gyllenberg Foundation; Diabetes Research Foundation of Finnish Diabetes Association; Tampere University Hospital supporting Foundation, and EU Horizon 2020 (grant 755320 for TAXINOMISIS). The other authors declare that they do not have any conflicts of interests.
Keywords
- Charlson comorbidity index
- Comorbidity
- GRACE
- mortality
- myocardial infarction
- prognosis
- survival