The CADILLAC Score in Predicting In-hospital Major Adverse Cardiovascular Events in Acute Myocardial Infarction Patients undergoing Percutaneous Coronary Intervention

Abstract

Background: Currently, the GRACE and TIMI risk scores are recommended by the European Society of Cardiology and the American College of Cardiology for risk stratification in patients with acute myocardial infarction. However, these two scores are based on patient risk factors before coronary intervention, and therefore do not reflect the differences between those receiving medical therapy and those undergoing coronary intervention. Using the CADILLAC risk score, patients are stratified into low-risk (CADILLAC score 0–2), intermediate-risk (CADILLAC score 3–5), and high-risk groups (CADILLAC score ≥ 6). For patients classified as low-risk according to the CADILLAC score, the in-hospital mortality rate is 0%, as well as after 1 year of follow-up, and these patients can be safely discharged within 3 days. When compared to the TIMI, PAMI, and Zwolle scores, the CADILLAC score more accurately predicts 30-day mortality and 1-year mortality. In Vietnam, there are currently not many studies on the CADILLAC score. Therefore, we decided to conduct the study “The CADILLAC Score in Predicting In-hospital Major Adverse Cardiovascular Events (MACE) in Acute Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention with two objectives: 1.The prevalence of in-hospital MACE according to risk stratification using the CADILLAC score in acute myocardial infarction patients undergoing percutaneous coronary intervention. 2. Determine the sensitivity, specificity, AUCROC, and cut-off point of the CADILLAC score in predicting in-hospital MACE in acute myocardial infarction patients undergoing percutaneous coronary intervention.

Materials and Methods: We conducted a cohort study involving 138 acute myocardial infarction patients at the Thong Nhat Hospital between January 1, 2024, and September 1, 2024.

Results: Among the patients, 27 cases (prevalence: 19.6%) had in-hospital MACE. The mean age was 69.3 ± 11.7 years, with men comprising 72.5% of the cohort. The CADILLAC score, with a cut-off point of 3, has a good ability to predict MACE, with an AUC = 0.841, sensitivity of 88.9%, specificity of 65.8%, positive predictive value of 38.8%, and negative predictive value of 96.1%. The CADILLAC score also shows a good ability to predict in-hospital mortality and acute heart failure events, comparable to the GRACE score.

Conclusion: The CADILLAC score, with a cut-off value of 3, demonstrates a strong prognostic capability for in-hospital MACE, reflected by an area under the curve (AUC) of 0.841, a sensitivity of 88.9%, and a specificity of 65.8%. The score also exhibits a positive predictive value (PPV) of 38.8% and a negative predictive value (NPV) of 96.1%, indicating its robust utility in identifying patients at lower risk for adverse outcomes.