Adding value of the Charlson comorbidity index to the Grace score for mortality risk prediction in patients with acute coronary syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background The Global Registry Acute Coronary Events (GRACE) risk score is widely recommended for assessment in patients with acute coronary syndrome (ACS). Charlson Comorbidity Index (CCI) a recognized measure comorbid burden, and useful tool estimating prognosis multiple coexisting illnesses. Despite it has been validated the context ACS-related mortality, scarce conflicting data still exist about role CCI when added to traditional GRACE outcome prediction Purpose potential predictive value both short, long term all-cause contemporary ACS population, its adding beyond score. Methods All consecutive admission due ST-elevation myocardial infarction-STEMI, non ST elevated infarction-NSTEMI, unstable angina-UA, from 01/01/2018 31/12/2020 were retrospectively reviewed an internal database tertiary cardiac center Italy. Logistic Cox proportional regression analysis performed order assess contribution on short mortality. In specify score, several measures improvement discrimination (increase area under receiver-operating characteristic curve-AUC, integrated improvement-IDI, continuous net reclassification improvement-cNRI>0) , implemented. Robustness results assessed through validation procedure bootstrapping. Results A total 1310 (646 STEMI, 588 NSTEMI, 76 UA) identified. Almost 28% female, median age was 68 (58-78). 97 (7,4%) 136 (11,2%) deaths occurred, respectively, hospital during follow-up (median time: 12 months; IQR: 8-23). After multivariate logistic not associated in-hospital death, while significantly independently long-term mortality along (HR: 1,33, 95% CI: 1,22-1,43; p<0,001, Fig.1). An additive effect observed predicting AUC 0,762 0.821 (p < 0,001). incremental combining improved, as shown by (cNRI>0: 0.678, p 0.001, Table 1) (IDI: 0.08, 0.001). Conclusion predictor improves stratification over