Over a 4-year period (from January 1, 2014 to December 31, 2018), a total of 441 patients presented with an STEMI. Of studied patients, 100 individuals at time of presentation had cardiac arrest, cardiogenic shock, or need for mechanical circulatory support on admission and were excluded from the study (22.7%). Of the remaining 341 patients included in the study, 213 had a low risk CADILLAC score (0–2), while 128 had an intermediate-high risk CADILLAC score (> 2).
Table 2 shows a comparison of the medical history and clinical risk factors along with cardiac catheterization and echocardiographic findings for the low risk and intermediate-high risk groups. The median CADILLAC score in the low risk group was 0.78, and the median score in the intermediate-high risk group was 5.8
Table 2
Baseline Patient Characteristics by CADILLAC Risk Group
Characteristic | CADILLAC Score† <=2 (n = 213) | CADILLAC Score‡ >2 (n = 128) | P-Value |
| n (%) | n (%) | |
Medical History | | | |
Age (years) | 57.6 | 66.8 | < 0.0001 |
Male | 161 (75.6) | 94 (73.4) | 0.65 |
HTN | 112 (52.8) | 91 (71.7) | 0.0006 |
HLD | 78 (36.6) | 72 (56.7) | 0.0003 |
DM | 38 (17.8) | 43 (33.6) | 0.0009 |
Insulin use | 7 (18.4) | 14 (33.3) | 0.13 |
Current Smoking | 103 (48.4) | 38 (29.9) | 0.0008 |
Anemia | 20 (9.4) | 50 (39.1) | < 0.0001 |
CKD (GFR < 60) | 0 (0.0) | 35 (27.6) | < 0.0001 |
Dialysis | 0 (0.0) | 2 (5.9) | n/a |
Previous CAD | 34 (16.0) | 46 (35.9) | < 0.0001 |
Killip Class¥ | | | |
I | 208 (98.6) | 96 (75.0) | < 0.0001 |
II | 0 (0) | 23 (18.0) | n/a |
III | 0 (0) | 6 (4.7) | n/a |
IV | 3 (1.4) | 3 (2.3) | 0.54 |
TTE LVEF | 55 | 44 | 0.0500 |
Catherization | | | |
Multivessel Dx | 76 (35.7) | 61 (47.7) | 0.0289 |
Final TIMI Flow | 2.93 | 2.83 | 0.0510 |
Culprit Lesion: | | | |
Left main | 3 (1.4) | 0 (0) | n/a |
LAD (or branch off) | 73 (34.3) | 59 (46.1) | 0.0306 |
LCx (or branch off) | 31 (14.6) | 15 (11.7) | 0.45 |
RCA | 105 (49.3) | 52 (40.6) | 0.12 |
Ramus | 1 (0.5) | 0 (0) | n/a |
Other or none | 2 (0.9) | 0 (0) | n/a |
†Low Risk group |
‡Intermediate/High Risk group |
¥Killip Class at presentation |
MACE events were significantly less frequent in the CADILLAC low risk group compared to the intermediate-high risk group during the index hospitalization (4.7% vs. 11.7%, P = 0.0163) (Table 3). Nine individuals had 10 adverse events in the low risk group, compared with 12 individuals having 15 adverse events in the intermediate-high risk group. There were no in-hospital deaths in the low risk CADILLAC group, compared to 1 death in the intermediate-high risk group. Individuals with a low CADILLAC risk score were significantly less likely to have an exacerbation of congestive heart failure requiring intravenous diuretics complicating their initial hospital stay (1.4% vs. 4.7%, P = 0.068).
Table 3
Cumulative Adverse Cardiovascular Events
| Hospitalization | 30 Day Follow-Up | 1 Year Follow-Up |
| CADILLAC Score < = 2 | CADILLAC Score > 2 | | CADILLAC Score < = 2 | CADILLAC Score > 2 | | CADILLAC Score < = 2 | CADILLAC Score > 2 | |
n of patients | 213 | 128 | | 172 | 101 | | 154 | 86 | |
Complications | n (%) | n (%) | P-value | n (%) | n (%) | P-value | n (%) | n (%) | P-value |
VF/VT | 3 (1.4) | 5 (3.9) | 0.14 | 3 (1.4) | 5 (3.9) | 0.14 | 3 (1.4) | 6 (4.7) | 0.0678 |
MI or UA† | 2 (0.9) | 2 (1.6) | 0.61 | 4 (1.9) | 5 (3.9) | 0.26 | 10 (4.7) | 11 (8.6) | 0.15 |
CHF | 3 (1.4) | 6 (4.7) | 0.0678 | 4 (1.9) | 15 (11.7) | 0.0001 | 5 (2.4) | 28 (21.9) | < 0.0001 |
Stroke | 2 (0.9) | 1 (0.8) | 0.88 | 2 (0.9) | 1 (0.8) | 0.88 | 2 (0.9) | 1 (0.8) | 0.88 |
Death | 0 (0) | 1 (0.8) | n/a | 0 (0) | 3 (2.3) | n/a | 0 (0) | 3 (2.3) | n/a |
Total Events | 10 (4.7) | 15 (11.7) | 0.0163 | 13 (6.1) | 29 (22.7) | < 0.0001 | 20 (9.4) | 49 (38.3) | < 0.0001 |
†Recurrent MI or Unstable Angina |
The secondary analysis involved cumulative MACE and mortality rates at 30-day and 1-year follow-up. At 30-day follow-up, patient in the low risk CADILLAC group had significantly less cumulative adverse events compared to those in the intermediate-high risk group (6.1% vs. 22.7%, P < 0.001 (Table 2). Cumulatively, 12 patients had 13 adverse events in the low risk group compared to 21 patients having 29 adverse events in the intermediate-high risk group. No mortality events were seen in the low risk CADILLAC group at 30 days. Patients in the low risk CADILLAC group were significantly less likely to have congestive heart failure exacerbations (1.9% vs. 11.7%, P < 0.001). The cumulative rise of adverse clinical events at 30-days compared to hospitalization in low risk and intermediate-high risk groups were 1.4% and 11%, respectively (Fig. 1). While the rise in mortality rates in low risk and intermediate to high-risk groups were 0% and 1.6%, respectively.
At 1-year follow-up, patients in the low risk CADILLAC group had significantly less cumulative adverse events compared to the intermediate-high risk group (9.39% vs. 38.3%, P < 0.001. Individuals in the low risk group were significantly less likely to have congestive heart failure exacerbations (2.4% vs. 21.9%, P < 0.001) or ventricular arrhythmias (1.4% vs. 4.7%, P = 0.068). The cumulative rise in adverse events at 1-year compared to hospitalization in low risk and intermediate-high risk groups were 4.7% and 26.6%, respectively (Fig. 1). Overall, 19 total patients had 20 adverse events in the low risk CADILLAC group compared with 34 patients having 49 total events in the intermediate-high risk group. The complication that attributed the highest rise of adverse events in the low risk CADILLAC group was myocardial infarction or unstable angina (2 at time of index hospitalization, 4 at 30-day, and 10 at 1-year), while in the intermediate-high risk group it was congestive heart failure complications (6 at time of index hospitalization, 15 at 30-day, 28 at 1-year).
The low risk CADILLAC group had 0 deaths across all 3 timeframes (Table 3), while the intermediate-high risk group recorded deaths both in-hospital (1 death) and 30-day follow up (2 additional deaths). There were no deaths in either group after 30-day follow-up. Follow-up retention was similar between low risk and intermediate to high-risk groups, (80.7% at 30-day, 72.3% at 1-year vs. 78.9% at 30-day, 67.2% at 1-year).
The ability of the CADILLAC risk score to predict in-hospital adverse events was calculated by ROC curve (C = 0.66, odds ratio 1.18; 95% CI 1.04–1.33; p = 0.0064). The CADILLAC score prediction accuracy improved at 30-day (C = 0.719) and remained consistent at 1-year (C = 0.715), Fig. 2.