All clinical events were recorded and reviewed. The medical records of all patients were comprehensively and systematically reviewed, including physician notes, imaging data, laboratory data, and medication records. Patients presenting with cardiogenic shock, cardiac arrest, or need for mechanical circulatory support on admission were excluded from the study. We conducted a single center retrospective review at an academic medical center of all adult patients who presented with a STEMI over a 4-year time period (Januto December 31, 2018). Institutional Review Board (IRB) approval was obtained for the study. We sought to further validate the CADILLAC risk score in patients presenting with a STEMI without cardiac arrest, cardiogenic shock, or need for mechanical support on admission, and determine its ability to risk stratify STEMI patients during their index hospitalization, as well up to 1 year following initial presentation. A previous single center study evaluating 228 total patients presenting with a STEMI, suggested a low event rate and zero percent mortality rate in patient with a low CADILLAC risk score when excluding patients presenting with cardiac arrest or need for mechanical support.

Utilizing the CADILLAC risk score patients were stratified by low (CADILLAC score 0–2), intermediate (CADILLAC score 3–5), and high (CADILLAC score ≥ 6) risk groups. This risk score evaluates several different prognostic variables including: Left Ventricular Ejection Fraction (LVEF), Creatinine Clearance, Killip Class, Final Thrombolysis in Myocardial Infarction (TIMI) flow, Age, Anemia, presence of three vessel disease. The CADILLAC risk score is one of many scoring systems which was developed to further risk stratify this patient population. Given the improvement in outcomes with PPCI, interest has been placed on the ability to further risk stratify patients presenting with STEMI and identify those at highest risk for complications and mortality. When compared to fibrinolysis, PPCI has shown significant reductions in morbidity, mortality, and reduced risk of mechanical and arrhythmic complications. Primary percutaneous coronary intervention (PPCI) has become the cornerstone for management of patients presenting with ST elevation myocardial infarctions (STEMI). Patients defined as low risk by the CADILLAC score following a STEMI were associated with lower mortality and adverse clinical event rates during hospitalization and up to 1 year following STEMI when compared to those with an intermediate or high CADILLAC score. On receiver operating curve analysis, discrimination of in-hospital adverse clinical events was fair using CADILLAC (C = 0.66, odds ratio 1.18 95% CI 1.04–1.33 p = 0.0064) with somewhat better discrimination at 30-day follow-up (C = 0.719) and 1-year follow-up (C = 0.715). The mortality rate was 0% for patients defined at low risk by CADILLAC score during hospitalization, as well up to 1 year follow up. At 1 year follow-up, compared to the low risk CADILLAC group (9.4% adverse clinical event rate), cumulative adverse clinical events were significantly higher in the intermediate risk group (22.9% event rate, OR 2.86, CI 1.39–5.89, p 0.0044) and in the elevated risk group (58.6% event rate, OR 13.67, CI 6.81–27.43, p < 0.0001). Compared to patients with a low CADILLAC score, adverse clinical events were similar in the intermediate risk group during hospitalization (OR 1.23, CI 0.37–4.05, p 0.733) and at 30 days (OR 2.27, CI 0.93–5.56, p 0.0733) while adverse clinical events were significantly elevated in the high risk group during hospitalization (OR 4.75, CI 1.91–11.84, p 0.0008) and at 30 days (OR 8.73, CI 4.02–18.96, p < 0.0001). Secondary outcomes were adverse clinical events at 30 days and 1 year following index hospitalization. The primary outcome was adverse clinical events during initial hospitalization.

Patients presenting with cardiac arrest or cardiogenic shock were excluded from the study. Patients were stratified using the CADILLAC risk score into low risk, intermediate risk and high risk groups. We performed a single center retrospective review of STEMI hospitalizations treated with PPCI from 2014 to 2018. The CADILLAC risk score was developed to identify patients at low risk for adverse cardiovascular events following ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI).

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