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Inflammatory response – a strong predictor of mortality following acute coronary syndrome (ACS) – FIRE-MI score
Session:
Sessão de Comunicações Orais 07 – Para além do evento agudo: preditores e desfechos após lesão miocárdica
Speaker:
Francisco Rodrigues Dos Santos
Congress:
CPC 2026
Topic:
P. Other
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
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Authors:
Francisco Rodrigues dos Santos; João Gouveia Fiúza; Mariana Duarte Almeida; Gonçalo Ferreira; Oliver Correia Kungel; Luís Afonso Santos; António Costa; Inês Fiúza Pires
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> A pro-inflammatory status is known to increase the risk of cardiovascular events and mortality. Despite robust evidence supporting its deleterious effects, clinical recognition and interpretation of inflammatory activation remain limited in daily practice. This study aimed to develop a practical, clinically applicable risk score, based on routinely available laboratory markers, to predict in-hospital mortality following acute coronary syndrome (ACS).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> This single-centre retrospective study included all patients admitted for ACS between January 2016 and December 2023. The newly developed <strong>FIRE-MI score</strong> (range: 0–5 points) was derived after identifying inflammatory biomarkers independently associated with in-hospital mortality (IHM) in multivariate analysis, with one point assigned per significant variable. The score incorporated the following parameters: C-reactive protein (CRP) > 1.5 mg/dL (p = 0.001), ferritin > 400 µg/L (p = 0.039), fibrinogen > 4.0 g/L (p = 0.021), uric acid (p = 0.041) and neutrophil percentage > 75% (p = 0.023). Patients scoring ≥ 3 were classified as high-risk. The score’s association with IHM was analysed using binary logistic regression and compared with the Killip–Kimball (KK) classification by receiver-operating characteristic (ROC) curve analysis.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> A total of 1714 patients were included; 70.4% (n = 1206) were male, with a mean age of 69.2 ± 13.0 years. STEMI was present in 44.7% (n=765) and 82.6% (n=1415) were in sinus rhythm. Most patients presented as KK class I (69.0%, n = 1,183). Elevated CRP, uric acid, ferritin, fibrinogen, and neutrophilia were observed in 23.7%, 31.0%, 24.3%, 44.2%, and 50.9% of patients, respectively. IHM occurred in 7.2% (n = 124). The mean FIRE-MI score was 1.73 ± 1.14, with 26.5% (n = 454) classified as high-risk, figure 1. IHM was significantly more frequent among high-risk patients (66.9% vs 23.3%; χ² = 112.31; p = 0.001). On multivariate analysis, the FIRE-MI score was an independent predictor of IHM (OR = 5.87, 95% CI 3.94–8.76; p = 0.001). ROC analysis demonstrated a fair discriminative ability, superior to the KK classification (AUC = 0.715 vs 0.698; p = 0.047), figure 2.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong> The FIRE-MI score effectively stratifies patients according to their risk of in-hospital mortality following ACS, outperforming traditional clinical classification systems. Its simplicity and reliance on standard inflammatory biomarkers make it a promising tool for bedside risk assessment, reinforcing the pivotal role of systemic inflammation in adverse cardiovascular outcomes.</span></span></p>
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