Validation of TIMI and CADILLAC Risk Scores Along with Other Variables in Predicting In-Hospital Mortality in Patients with STEMI Undergoing Primary Percutaneous Coronary Intervention

Abstract

Objectives: Risk stratification in ST-elevation myocardial infarction (STEMI) is critical for predicting clinical outcomes and guiding treatment strategies. This study aims to evaluate the validity of the TIMI and CADILLAC risk scores in predicting in-hospital mortality in a Pakistani population undergoing primary percutaneous coronary intervention (PPCI).

Methodology: This cross-sectional study included all patients presenting to the emergency department of RIC with STEMI who underwent PPCI. The TIMI and CADILLAC risk scores were calculated, along with other key determinants of mortality. The primary endpoint was all cause in-hospital mortality.

Results: A total of 1,029 patients were included in the study. The presence of specific risk factors at presentation significantly increased the incidence of in-hospital mortality. These risk factors included ventricular arrhythmias (VT/VF) (OR 12.697, 95% CI 3.7-42.7), cardiogenic shock (OR 17.2, 95% CI 7.98-37.10), left ventricular failure (OR 11.64, 95% CI 5.1-26.6), and complete heart block (CHB) (OR 5.9, 95% CI 2.3-15.4). Diabetic patients (OR 2.19, 95% CI 1.116-4.318) and smokers (OR 0.314, 95% CI 0.121-0.815) were also at higher risk, along with females, who demonstrated increased mortality compared to males. The TIMI and CADILLAC risk scores had areas under the curve (AUC) of 0.729 and 0.701, respectively, indicating that both models were fair in predicting in-hospital mortality.

Conclusion: This study demonstrates that while the TIMI and CADILLAC risk scores provide moderate predictive value in the Pakistani population, their utility may be limited. The findings underscore the need for the development of new, region-specific risk models to improve the prediction of in-hospital mortality in STEMI patients undergoing PPCI.