Development of one-year major adverse cardiac events risk index in patients with acute coronary syndrome and diabetes mellitus who underwent percutaneous coronary intervention

Abstract

Background/Aim. Patients with acute coronary syndrome (ACS) and diabetes mellitus (DM) have an increased risk of major adverse cardiovascular events (MACE) after percuta-neous coronary intervention (PCI), which is not estimated sufficiently-multidimensionally in terms of type and severity of the ACS and/or DM and angiographic findings. The study was intended to validate and develop an index of met-abolic, angiographic, anatomic and clinical risk factors for one-year MACE after conducted PCI in patients with ACS and DM. Methods. A prospective cross-sectional study was performed in patients with DM and ACS. In the PCI period the following risk factors were recorded: 1) age and meta-bolic variables - glycosylated hemoglobin (HbA1c), total cholesterol, and triglycerides levels in the blood; 2) endo-crinological variables - DM therapy and type of DM; 3) ACS modality; 4) radiological/anatomical variable - SYN-TAX score, and 5) clinical variables in modified age, creati-nine, ejection fraction (ACEF) score. One-year MACE were recorded. Results. From a total of 136 consecutive patients, 55 of them developed at least one MACE in one-year follow-up. A high predictive risk index was evaluated that assessed particular or associated risks for one-year MACE (c statistic = 0.879) in the study population, defined by: SYNTAX score > 21, modified ACEF score > 1.38, HbA1c - 8%, triglyceridemia - 2.3 mmol/L in patients with insulin therapy, and ACS modality - unstable angina pectoris. The constructed risk index for one-year MACE (MACERI) had better predictive characteristics than SYN-TAX score (c statistic = 0.798), as well as ACF score (c sta-tistic = 0.744). Conclusion. MACERI can potentially have great application in future risk factors studies for one-year MACE in patients with DM and ACS who underwent PCI, because with it the effects of these factors are measured multidimensionally at valid and accurate manner. © 2020 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.