Study of a modified REMS score for prediction of the risk o f death for patients with ST segment elevation myocardial infarction

doi:10.3969/j.issn.1002-1949.2015.04.005

Abstract：Objective To establish a modified REMS evaluation system and assess the new scoring system by using a retrospective data, comparing the predictive value of the modified REMS score, GRCAE and REMS scoring system in patients with ST segment elevation myocardial infarction ( STEMI) with recent mortality risk.Methods A retrospective review of patients of 394 cases with STEMI were collected from April 2013 to December 2014 in the Department of Emergency and Department of Cardiology of CCU in our hospital, to screening out independent risk factors for increasing 30 day mortality rate with STEMI by univariate and multivariate logistic regression analysis and establish a modified REMS scoring system, the lowest sore value were recorded for a modified REMS evaluation system, GRACE risk scores and REMS risk scores for each patient within 2 hour.Death cases during 30 days after onset were evaluated.To comparing the predictive value of the three scoring system to the sererity with STEMI and the incidence of 30 days by ROC curve.Results A total of 49 patients died from cardiovascular disease within 30 days ( the mortality rate of 12.4%) .Two hundred and seventy-two cases underwent reperfusion therapy in all STEMI cases,including 31 cases of emergency thrombolic therapy (7.8%) and 57cases with emergency PCI treatment (14.5%).Multiple regression analysis showed that age, systolic blood pressure, killip classification ,ST elevation, arrhythmia and cTnI concentration were independent predictors of death in patients with STEMI .Modified REMS risk scores, GRACE risk scores and REMS risk scores were higher in non survivors in comparison with survivors [Modified REMS (points):16.71 ±2.14 vs 12.95 ±3.26; GRACE (points): 196.29 ±36.79 vs 163.23 ±33.14; REMS ( points): 7.57 ±2.71 vs 5.21 ±2.65].Area under the curve for the modified REMS, GRACE and REMS scores to patients with STEMI died from heart cerebrovascular disease within 30 days were 0.841, 0.737 and 0.633, cut-off values respectively: 19 points, 185 points, 5 points;the sensitivity was 97.3%, 71.4%, 71.4%; specificity was 51.8%, 67.9%and 57.1%, respectively.Different segments of value:the modified REMS group with 0~12 points had no death (0/150);the mortality rate with 13~18 group was 14.22% (31/218); the mortality rate with 19~22 group was 69.20% (18/26), the difference was significant among the three groups (P <0.01).Conclusion The modified REMS scores in predicting the prognosis of STEMI is superior than the GRACE risk scores, there is a more severe disease with higher mortality with a higher score.