Value of serum albumin, age, serum creatinine, and left ventricular ejection fraction for the assessment of 4-year mortality risk in patients with acute myocardial infarction: parsimonious and better performed

Aims: Mortality from acute myocardial infarction (AMI) remains substantial. The current study is aimed at developing a novel simple and easy-to-use risk score for AMI. Methods: The CatLet extended validation trial (ChiCTR2000033730) and the CatLet validation trial (ChiCTR-POC-17013536), both being registered with chictr.org, served as the derivation and validation datasets, respectively. The derivation dataset included 1018 patients, and the validation dataset included 308 ones. They all suffered from AMI and underwent percutaneous intervention (PCI). The 4-year follow-up was 97% completed for the derivation dataset, and 100% completed for the validation dataset. The endpoint was all-cause death. Lasso regression analysis was used for covariate selection and coefficient estimation. Results: Of 26 candidate predictor variables, four strongest predictors for 4-year mortality were included in the BACEF score (serum albumin, age, serum creatinine, and LVEF). This score was well calibrated and yielded an AUC (95%CI) statistics of 0.84(0.80-0.87) in internal validation, 0.89(0.83-0.95) in internal-external (temporal) validation, and 0.83(0.77-0.89) in external validation. Notably, it outperformed the ACEF, ACEFII, GRACE risk scores (0.83(0.77-0.89) vs 0.81(0.75-0.88); 0.83(0.77-0.89) vs 0.79(0.73-0.86); and 0.83(0.77-0.89) vs 0.79(0.72-0.86), respectively). Conclusions: A simple risk score for 4-year mortality risk stratification was developed, extensively validated, and calibrated in patients with AMI. This novel BACEF score outperformed the ACEF, ACEFII, and GRACE scores and may be a useful risk stratification tool for patients with AMI.