Development and Validation of NICVD‐NQ Score for Predicting Short‐Term Outcomes After Primary PCI

BACKGROUND: Despite advances in primary percutaneous coronary intervention (PCI), patients with ST-elevation myocardial infarction (STEMI) continue to experience major adverse cardiovascular events (MACE) in the contemporary era. Existing risk scores (TIMI, GRACE, PAMI, CADILLAC) are outdated, mortality-focused, and largely derived in the fibrinolytic era from high-income settings, limiting their global relevance. AIMS: This prospective study aimed to develop a novel model to predict short-term (approximately 8 months) MACE after primary PCI. METHODS: STEMI patients presenting at the largest cardiac care center in Pakistan were prospectively enrolled to develop a model for predicting short-term (approximately 8 months) MACE. The predictive performance of the newly developed model was compared with the existing scores in the 20% testing cohort. RESULTS: The complete cohort comprised 2839 patients, of whom 2250 (79.3%) were men, with a mean age of 55.6 ± 11.2 years. A total of 580 patients (20.4%) were randomly assigned to the testing cohort. At a median follow-up of 244 175-393 days, MACE was documented in 521 patients (18.4%), with 97 (16.7%) in the testing cohort and 424 (18.8%) in the training cohort. The new additive model yielded an AUC of 0.772 95% CI: 0.72-0.83 with the NRI (net reclassification improvement) of 0.239 (p = 0.003), 0.268 (p = 0.001), 0.086 (p = 0.322), and 0.061 (p = 0.445) against TIMI, PAMI, CADILLAC, and GRACE scores, respectively. CONCLUSIONS: The NICVD predictive instrument outperformed the existing TIMI and PAMI scores and showed accuracy comparable to that of the GRACE and CADILLAC scores in predicting short-term MACE after primary PCI. And the model's enhanced predictive accuracy makes it a valuable tool for clinicians, enabling more enhanced risk stratification of STEMI patients.