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A simplified risk score for mortality after anterior ST-elevation myocardial infarction using relative apical strain: the RASK score
Session:
Sessão de Posters 02 - Síndromes coronárias agudas: vias, atrasos e impacto das recomendações
Speaker:
João Gouveia Fiuza
Congress:
CPC 2026
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters Eletrónicos
FP Number:
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Authors:
João Gouveia Fiuza; Mariana Duarte Almeida; Francisco Rodrigues dos Santos; Oliver Kungel; Luís Afonso Santos; Gonçalo RM Ferreira; Júlio Gil; Nuno Craveiro; António Costa
Abstract
<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Introduction: </strong>In anterior ST-elevation myocardial infarction (AMI), myocardial injury frequently involves the apex. Global longitudinal strain (GLS) predicts adverse outcomes but averages segment deformation, potentially masking critical regional disparities. We hypothesized that a relative apical strain index (RASi), reflecting the apical to non-apical gradient, combined with clinical variables, would improve prediction of all-cause mortality (ACM) compared with conventional parameters.</span></span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Methods:</strong> Retrospective single-centre cohort study of 45 patients admitted with anterior AMI who underwent transthoracic echocardiography (median 3 days post-admission). Left ventricular longitudinal strain (LS) was measured in apical, mid and basal segments to derive RASi (average apical LS/(average basal LS + mid-LS)). We then developed the RASK score (Risk Assessment using Age, relative Strain and Killip class), a 0-3 point tool. We assigned 1 point for each of the following variables: abnormal apical strain pattern (RASi≤0), age>70 years, and Killip class ≥II at admission. The primary endpoint was 12-month ACM. Discriminative performance was assessed using receiver operating characteristic (ROC) analysis and compared with left ventricular ejection fraction (LVEF) and GLS.</span></span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Results:</strong> The study population had a mean age of 66±14 years, 77.8% were male, and a mean LVEF of 42±9%. All-cause mortality was 13.3% (n=6). LVEF (42±9% vs 40±9%, p=0.53) and GLS (−8.9±3.1% vs −7.3±2.9%, p=0.27) did not differ significantly between survivors and non-survivors. In contrast, non-survivors were older (80±7 vs 65±14 years, p=0.012) and presented more negative RASi values (−0.23±0.34 vs 0.10±0.32, p=0.028), indicating inversion of the usual base-to-apex gradient. Higher Killip class showed a trend towards increased mortality (2.2±0.9 vs 1.5±0.7, p=0.087). The RASK Score showed excellent discrimination for mortality (AUC 0.86; 95% CI 0.75-0.97, p<0.01), outperforming LVEF (AUC 0.42) and GLS (AUC 0.69). A score ≥2 identified all non-survivors (100% sensitivity). Mortality was 0% for low scores (0-1) versus 33.3% for high scores (≥2; p=0.014), indicating effective risk stratification.</span></span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Conclusion: </strong>In patients with AMI, this simple three-item score showed superior discrimination for ACM compared with LVEF and GLS in this cohort. Low scores (0-1) identified patients with excellent short-term prognosis. Given the small sample size, external validation in larger cohorts is required before clinical use.</span></span></span></p>
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