Development and Validation of NICVD-NQ Score for Predicting Short-Term Outcomes After Primary PCI.

BACKGROUND

Despite advances in primary percutaneous coronary intervention (PCI), patients with ST-elevation myocardial infarction (STEMI) continue to experience major adverse cardiovascular events (MACE) in the contemporary era. Existing risk scores (TIMI, GRACE, PAMI, CADILLAC) are outdated, mortality-focused, and largely derived in the fibrinolytic era from high-income settings, limiting their global relevance.

AIMS: This prospective study aimed to develop a novel model to predict short-term (approximately 8 months) MACE after primary PCI.

METHODS

STEMI patients presenting at the largest cardiac care center in Pakistan were prospectively enrolled to develop a model for predicting short-term (approximately 8 months) MACE. The predictive performance of the newly developed model was compared with the existing scores in the 20% testing cohort.

RESULTS

The complete cohort comprised 2839 patients, of whom 2250 (79.3%) were men, with a mean age of 55.6 ± 11.2 years. A total of 580 patients (20.4%) were randomly assigned to the testing cohort. At a median follow-up of 244 [175-393] days, MACE was documented in 521 patients (18.4%), with 97 (16.7%) in the testing cohort and 424 (18.8%) in the training cohort. The new additive model yielded an AUC of 0.772 [95% CI: 0.72-0.83] with the NRI (net reclassification improvement) of 0.239 (p = 0.003), 0.268 (p = 0.001), 0.086 (p = 0.322), and 0.061 (p = 0.445) against TIMI, PAMI, CADILLAC, and GRACE scores, respectively.

CONCLUSIONS

The NICVD predictive instrument outperformed the existing TIMI and PAMI scores and showed accuracy comparable to that of the GRACE and CADILLAC scores in predicting short-term MACE after primary PCI. And the model's enhanced predictive accuracy makes it a valuable tool for clinicians, enabling more enhanced risk stratification of STEMI patients.