Abstract
OBJECTIVE: Emerging evidence suggests that systemic inflammation is a predictor of poor prognosis in acute myocardial infarction (AMI). In this study, we sought to assess whether inflammation-based prognostic scores are associated with in-hospital outcomes in elderly patients with AMI. METHODS: In this retrospective study, patients who were over 75-years-old and met the diagnostic criteria for AMI were consecutively recruited from January 1, 2016, to March 31, 2019. Logistic regression and receiver-operating characteristic (ROC) analyses were performed to evaluate the predictive value of the inflammation-based Glasgow Prognostic Score (GPS), Prognostic Index (PI) and Prognostic Nutritional Index (PNI). RESULTS: A total of 273 patients were enrolled. The incidence of major cardiovascular adverse events (MACEs) and mortality during hospitalization increased significantly with increasing GPS and PI scores. Multiple logistic regression showed that the GPS was independently associated with MACEs (score 1, RR: 6.711, 95% CI: 1.409-31.968; score 2, RR: 14.063, 95% CI: 3.018-65.535) and mortality (score 1, RR: 8.656, 95% CI: 1.068-70.126; score 2, RR: 10.549, 95% CI: 1.317-84.465). The PI was also independently predictive of MACEs (score 2, RR: 5.132, 95% CI: 1.451-18.148). No significant difference was observed in the PNI between patients with different in-hospital outcomes. When in-hospital MACEs were used as an endpoint, the area under the curve (AUC) of the GPS was 0.740 (95% CI 0.678-0.802), and the AUC of the PI was 0.703 (95% CI 0.634-0.773). When mortality was used as an endpoint, the AUC of the GPS was 0.677 (95% CI 0.602-0.753), and the AUC of the PI was 0.667 (95% CI 0.577-0.757). CONCLUSION: The severity of systemic inflammation is a strong predictor of poor prognosis in elderly patients with AMI. Among these three inflammation-based prognostic scores, the GPS has a better predictive value than the PI and PNI for in-hospital MACEs and mortality.