Study population
This retrospective, single-center, cross-sectional and observational study was performed at the cardiology clinic of Adana City Training and Research Hospital between January 2022 and June 2022. The files of patients admitted to the coronary intensive care unit of the Department of Cardiology with a diagnosis of NSTEMI on the specified dates were retrospectively examined.
The diagnosis of NSTEMI has been made based on current clinical guidelines including positive cardiac markers including high-sensitivity cardiac troponin-I levels (hs-cTnT-I) (the upper limit of troponin-I in our laboratory was 0.16 ng/mL) without ST-segment elevation on routine electrocardiogram [8]. Clinical histories include hypertension (HT) and obstructive pulmonary disease, hyperlipidemia (HL), chronic renal disease (CKD), diabetes mellitus (DM), smoking, peripheral arterial disease, CAD, ischemic stroke/transient ischemic attack (TIA) were obtained and recorded in the national health record system, and medical files of each patient were also captured for retrospective evaluation. We excluded patients with coronary artery bypass graft, chronic obstructive pulmonary disease, severe liver and kidney disease, active cancer, and/or systemic infection (Fig. 1).
Routine blood samples were routinely obtained from all patients in the emergency triage unit or coronary intensive care unit. Laboratory analysis of routine venous blood samples was performed using an automated chemistry analyzer (Roche Diagnostic Modular Systems, Tokyo, Japan). The estimated glomerular filtration rate (eGFR) was measured using the Modification of Diet in Renal Disease formula.
The definitions of scores
The PRECISE-DAPT score was determined for each patient using the web calculator (http://www.precisedaptscore.com). Unfortunately, we did not have data on the patients' previous bleeding history; therefore, this parameter could not be included when calculating the score.
CAG was performed on all subjects in our research. The femoral route was used for standard angiograms of the left and right coronary arteries to collect images. Coronary lesions with lumen diameter > 1.5 mm and at least 50% stenosis were analyzed separately, and the SX score was calculated using www.syntaxscore.com (version 2.10) [9]. The CHADS2 score consists of the following parameters; heart failure (HF) (1 point); HT (1 point); age ≥ 75 years (1 point); and history of stroke/TIA, or systemic embolism (2 points). The CHA2DS2-VASc score is calculated by assigning 2 points for age ≥ 75 years and history of stroke, TIA, or thromboembolism and 1 point for HF, HT, DM, vascular disease aged 65–75 years, and female gender [10]. The R2CHA2DS2-VASc score is determined by adding 2 points to the CHA2DS2-VASc score for renal failure defined as eGFR below 60 calculated from the Chronic Kidney Disease Epidemiology equation [2]. The ATRIA score assigns one point for the female sex, DM, HT, HF, proteinuria, and kidney dysfunction (eGFR < 45 mL/min/1.73 m2 or end-stage renal disease), and age classes (< 65, 65–74, 75–84, and ≥ 85 years) are assigned different scores based on stroke history (between 0 and 9) [11]. All scores were determined as previously described by two cardiologists blinded to patient survival data. The study population was divided into two groups by in-hospital mortality status: mortality (+) (n = 31) and mortality (−) (n = 312).
Ethics approval and consent to participate
The study was carried out according to the recommendations set forth by the Declaration of Helsinki on biomedical research involving human subjects. The study was approved by the ethics committee of Adana City Training and Research Hospital (date: 08.08.2022, decision No: 2062). Due to the retrospective design, informed consent was not obtained by the ethics committee rules.
Statistical analysis
Data analyses were performed using IBM SPSS Statistics for Windows, Version 22.0 software (IBM Corp., Armonk, NY, USA). Continuous variables with normal distribution have been expressed as mean ± standard deviation, whereas those with abnormal distribution have been expressed as median and interquartile range (IQR). Categorical variables have been expressed as numbers (n) and percentages (%). Student t test or Mann–Whitney U-test was used to compare continuous variables. The Chi-square test or Fisher’s exact test was used to compare categorical variables. The odds ratio (OR) and 95% confidence interval (CI) were calculated for each independent variable. Multivariate logistic regression analysis was performed to identify independent predictors of in-hospital all-cause mortality. Variables with significant p values (< 0.05) in univariate analysis were entered into multivariate analysis. The results of univariate and multivariate regression analyses were presented as OR with 95% CI. The area under the curve (AUC) and receiver operating characteristics (ROC) curve analyses were used to examine the prediction accuracy and performance of PRECISE-DAPT and SX scores for in-hospital mortality. Statistical significance has been defined as p < 0.05 throughout the study.