A Revised PADMA Scoring System for Predicting in-Hospital Mortality in Acute Coronary Syndrome Patient

Figures & data

Table 1 Baseline Characteristic of the Study Participants

Variable	Total n=1504	Non-Survivor n=159	Survivor n=1345	P value
Gender
Female	360 (23.9)	54 (34)	306 (22.8)	0.002
Male	1144 (76.1)	105 (66)	1039 (77.2)
Age (years)
Mean ± SD	58 ± 11	65 ± 11	57 ± 11	<0.001
Usia (tahun)
<65	1088 (72.3)	76 (47.8)	1012 (75.2)	<0.001
65–75	315 (20.9)	51 (32.1)	264 (19.6)
>75	101 (6.7)	32 (20.1)	69 (5.1)
BMI (kg/m^2)
Mean ± SD	24.4 ± 3.5	23.9 ± 3.6	24.4 ± 3.5	0.084
BMI (kg/m^2)
<30.0	1399 (93)	153 (96.2)	1246 (92.6)	0.093
≥30.0	105 (7)	6 (3.8)	99 (7.4)
Smoking	859 (57.1)	81 (50.9)	778 (57.8)	0.096
Diabetes melitus	378 (25.1)	49 (30.8)	329 (24.5)	0.081
Hypertension	973 (64.7)	106 (66.7)	867 (64.5)	0.582
Family history of CAD	190 (12.6)	19 (11.9)	171 (12.7)	0.784
History of cerebrovascular	239 (15.9)	29 (18.2)	210 (15.6)	0.392
History of angina	537 (35.7)	63 (39.6)	474 (35.2)	0.276
History of revascularization	306 (20.3)	25 (15.7)	281 (20.9)	0.126
SBP (mmHg)
Mean ± SD	123 ± 24	110 ± 30	125 ± 22	<0.001
SBP (mmHg)
≤100	344 (22.9)	69 (43.4)	275 (20.4)	<0.001
>100	1160 (77.1)	90 (56.6)	1070 (79.6)
HR (beats per minute)
Mean ± SD	78 ± 21	81 ± 33	78 ± 20	0.004
HR (beats per minute)
≤100	1349 (89.7)	121 (76.1)	1228 (91.3)	<0.001
>100	155 (10.3)	38 (23.9)	117 (8.7)
MSI
Mean ± SD	0.88 ± 0.29	1.01 ± 0.50	0.86 ± 0.25	<0.001
MSI
<=0.56	126 (8.4)	31 (19.5)	95 (7.1)
0.57–0.97	938 (62.4)	42 (26.4)	896 (66.6)
>0.97	440 (29.3)	86 (54.1)	354 (26.3)
ACS
STEMI	920 (61.2)	110 (69.2)	810 (60.2)	0.028
NSTEMI/UAP	584 (38.8)	49 (30.8)	535 (39.8)
KILIP
I	1073 (71.3)	58 (36.5)	1015 (75.5)	<0.001
II	239 (15.9)	25 (15.7)	214 (15.9)
III	41 (2.7)	13 (8.2)	28 (2.1)
IV	151 (10)	63 (39.6)	88 (6.5)

Abbreviations: BMI, body mass index; CAD, coronary artery disease; SBP, systolic blood pressure; HR, heart rate.

Table 2 Logistic Regression Analysis of in-Hospital Mortality Risk

Variable	Crude OR (95% CI)	p-value	AOR (95% CI)	p-value
Gender
Female	1.746 (1.228–2.483)	0.002	1.489 (0.937–2.366)	0.092
Male	1 (ref)		1 (ref)
Age (years)
<65	1 (ref)		1 (ref)
65–75	2.572 (1.760–3.761)	<0.001	2.461 (1.602–3.78)	<0.001
>75	6.175 (3.823–9.976)	<0.001	4.883 (2.707–8.806)	<0.001
BMI (kg/m^2)
<30.0	1 (ref)		1 (ref)
≥30.0	0.494 (0.213–1.144)	0.093	0.644 (0.26–1.597)	0.342
Smoking	0.757 (0.545–1.052)	0.096	1.102 (0.716–1.696)	0.660
Diabetes melitus	1.376 (0.961–1.969)	0.081	1.129 (0.732–1.742)	0.582
Hypertension	1.103 (0.778–1.562)	0.582	1.208 (0.792–1.844)	0.380
Family history of CAD	0.932 (0.562–1.544)	0.784	1.012 (0.541–1.892)	0.970
History of cerebrovascular	1.206 (1.785–1.851)	0.392	1.211 (0.681–2.154)	0.514
History of angina	1.206 (0.861–1.689)	0.276	1.73 (1.114–2.688)	0.015
History of revascularization	0.706 (0.452–1.104)	0.126	2.096 (1.132–3.879)	0.018
SBP (mmHg)
≤100	2.983 (2.122–4.193)	<0.001	1.081 (0.676–1.727)	0.745
>100	1 (ref)		1 (ref)
HR (bpm)
≤100	1 (ref)		1 (ref)
>100	3.296 (2.186–4.971)	<0.001	1.426 (0.834–2.439)	0.195
Modified score index (MSI)
≤0.56	6.961 (4.180–11.593)	<0.001	4.399 (2.474–7.823)	<0.001
0.57–0.97	1 (ref)		1 (ref)
>0.97	5.183 (3.513–7.647)	<0.001	2.967 (1.824–4.825)	<0.001
ACS
STEMI	1.483 (1.041–2.112)	0.028	1.284 (0.848–1.944)	0.238
NSTEMI/UAP	1 (ref)		1 (ref)
KILIP
I	1 (ref)		1 (ref)
II	2.044 (1.251–3.342)	0.004	1.361 (0.803–2.308)	0.252
III	8.125 (3.999–16.510)	<0.001	4.433 (2.025–9.703)	<0.001
IV	12.528 (8.249–19.028)	<0.001	7.132 (4.267–11.919)	<0.001

Abbreviations: BMI, body mass index; CAD, coronary artery disease; SBP, systolic blood pressure; STEMI, ST-elevation myocardial infarction; NSTEMI, non-ST segment elevation myocardial infarction; UAP, unstable angina pectoris; OR, odds ratio; AOR, adjusted odds ratio; bpm: beat per minute.

Table 3 Assessment of the Score Value from Each Independent Predictor Factor

Variable	B	SE	B/SE		Score
Age (years)
<65 (ref)
65–75	0.952	0.214	4.45	3.42	3
>75	1.676	0.288	5.82	4.48	4
History of angina	0.504	0.22	2.29	1.76	2
No history of revascularization	0.659	0.284	2.32	1.79	2
Modified shock index
≤0.70 (ref)
0.71–1.00	1.557	0.289	5.39	4.15	4
>1.00	1.232	0.219	5.63	4.33	4
Killip class
I (ref)
II	0.343	0.264	1.30	1.00	1
III	1.593	0.389	4.10	3.15	3
IV	2.031	0.234	8.68	6.68	7

Notes: Modified shock index is calculated by heart rate divided by mean arterial pressure.

Table 4 Scoring System Based on Patient’s Probability on Mortality Event

Scoring	Probability (%)
0	1.1
1	1.6
2	2.1
3	2.9
4	3.9
5	5.2
6	7.0
7	9.3
8	12.3
9	16.1
10	20.7
11	26.3
12	32.8
13	40.0
14	47.7
15	55.4
16	62.9
17	69.9
18	76.0
19	81.2

Table 5 ROC Analysis as Mortality Scoring System Model

Variable	AUC (95% CI)	p-value	Cut-off Value	Diagnostic Value
Score	0.820 (0.800–0.839)	<0.001	>8	Sensitivity: 67.92%
				Specificity: 84.01%
				PPV: 33.4%
				NPV: 95.7%
				LR+: 4.25
				LR-: 0.38

Abbreviations: AUC, area under curve; PPV, positive predictive value; NPV, negative predictive value; LR, likelihood ratio.

Figure 1 ROC curve score to predict mortality.

Table 6 Scoring System Model Validation Analysis on Mortality

Variable	Diagnostic Value	Derivation (n=1504)	Validation (n=156)
Score>8	Sensitivity	67.92%	38.46%
	Specificity	84.01%	90.91%
	PPV	33.4%	27.8%
	NPV	95.7%	94.2%
	LR+	4.25	4.23
	LR-	0.38	0.68

Abbreviations: PPV, positive predictive value; NPV, negative predictive value; LR, likelihood ratio.

Table 7 PADMA MSI Scoring System Based on Patient’s Probability on Mortality Event

Risk Category (Tertiles)	PADMA MSI Score	Probability of Death
Low	0−2	<2.1
Intermediate	3−6	2.9–7.0
High	7−19	>7.0

Abbreviation: PADMA, PADjadjaran Mortality in Acute coronary syndrome.

Table 8 ROC Analysis Result Between PADMA MSI and PADMA Scoring System Based on Mortality

Variable	AUC (95% CI)	AUC Difference (95% CI)	p-value
PADMA MSI score	0.820 (0.800–0.839)	−0.022 (−0.073–0.029)	0.388
PADMA score	0.842 (0.821–0.861)

Abbreviations: PADMA, PADjadjaran Mortality in Acute coronary syndrome; AUC, area under curve.

Figure 2 Comparison of AUC of PADMA MSI score with PADMA SI risk scores to predict in-hospital mortality.