A novel 30-day mortality risk prediction scale in patients with acute inferior myocardial infarction with electrical extension to the right ventricle undergoing a reperfusion strategy

Abstract Introduction Mortality risk prediction scales encompass the entire spectrum of acute coronary syndrome. We developed and propose a novel predictive risk model focused on patients with acute inferior myocardial infarction with electrical extension to the right ventricle. Purpose To develop a novel mortality risk prediction scale with at least 70% precision to predict mortality at 30 days. Methods Single-centre, cohort, observational, non-experimental, cross-sectional, analytical, and ambilective study. Patients with a diagnosis of acute inferior myocardial infarction with ST-segment elevation and electrical extension to the right ventricle according to the fourth universal definition of acute myocardial infarction admitted to the emergency department in a third-tier cardiology hospital. Based on the logistic regression model, we performed univariate analysis to examine the relationship between mortality and clinical, electrocardiographic, biochemical, and echocardiographic variables. We then further considered variables with a score of p 0.05 in a multivariate analysis and according to the beta coefficients we granted a score value at discretion and established a scale. We measured the assigned score in the same cohort of patients studied, and by performing an ROC curve, we determined the cut-off value between the greatest sensitivity and specificity of the novel scale. Results We found statistically significant differences in echocardiographic parameters, the pharmaco-invasive strategy group registered better values than those in the PCI group: LVEF 46 ± 7.49, p 0.002), TAPSE (18 ± 4.58, p 0.002), and S wave (10.41 ± 2.70, p 0.001). Wire crossing time was notably longer for the pharmaco-invasive strategy group with 173 minutes (80–437, p0.001); biomarkers were also higher in this group, with high-sensitivity troponin, 3608 (1192–9597, p0.001). Mortality rates were similar (10.4% for the PCI group vs. 9.8% for the pharmaco-invasives group, p = 0.85). We established the novel scale with 5 items, and we assigned a value for each given item. (Fig. 1). We set a cut-off value for the novel mortality risk prediction scale, defined by maximum sensitivity and specificity reached, that being a score greater than or equal to 5 to predict mortality at 30 days (Fig. 2). For patients scoring between 0 and 4, a mortality rate of 37.5% is estimated; for those patients scoring a result greater than or equal to 5 (maximum possible result of 8 points), a mortality rate of 62.5% is estimated. Conclusions The proposed novel mortality risk prediction scale is the result of the analysis of each individual variable involved in the pathophysiology of acute inferior myocardial infarction with electrical extension to the right ventricle conjugated in a single model that also involves clinical, electrocardiographically, biochemical and echocardiographic aspects, as well as its direct relation with an opportunistic reperfusion strategy and a successful angiographic result.