Combined Value of Left Ventricular Ejection Fraction and HAS-BLED Score for Predicting Mortality in Patients with St-Elevation Myocardial Infarction Who Were Undergoing Primary Percutaneous Coronary Intervention

Abstract

Objective: The HAS-BLED score and left ventricular ejectionfraction(LVEF) can both independently predict clinicaloutcomes in patients having acute coronary syndromes. Westudied the predictive value of LVEF as well as HAS-BLEDscore for mortality in ST segment elevation myocardialinfarction (STEMI) patients undergoing primary percutenouscoronary intervention (PPCI).Material-Method: We investigated 588 sequential STEMIpatient undergoing PPCI. For each patients, HAS-BLEDscores were calculated and the stipulated ability for mortalitywas analysed by means of area under curve (AUC). Thepatients were considered in four different groups in termsof the their HAS-BLED score. Their groups of HAS-BLEDscore were very/low risk? 0, low risk? 1, moderate risk? 2,high risk ? 3. Primary endpoint was total mortality.Results: By multivariate cox regression analysis, HAS-BLEDscore (p < 0.001) and LVEF(p < 0.001) were independentpredictors of total mortality. When HAS-BLED score wasused singly, AUC for total mortality was 0.71 [95%CI? 0.66-0.76 ]. The AUC for total mortality increased to 0.77 ( p <0.001) after adding LVEF. The incremental predictive valueof combining LVEF and HAS-BLED score was significantlyimproved, also shown by the the net reclassificationimprovement (NRI = 27.2%, p < 0.001) and integrateddiscrimination improvement (IDI = 0.061, p < 0.001).Conclusions: Adding LVEF to HAS-BLED scoreindependently improved the estimated value for all mortalityin STEMI patients undergoing PPCI.