eprintid: 10094126 rev_number: 26 eprint_status: archive userid: 608 dir: disk0/10/09/41/26 datestamp: 2020-03-31 18:47:45 lastmod: 2021-10-04 00:47:38 status_changed: 2020-03-31 18:47:45 type: article metadata_visibility: show creators_name: Li, CKH creators_name: Xu, Z creators_name: Ho, J creators_name: Lakhani, I creators_name: Liu, Y creators_name: Bazoukis, G creators_name: Liu, T creators_name: Wong, WT creators_name: Cheng, SH creators_name: Chan, MTV creators_name: Zhang, L creators_name: Gin, T creators_name: Wong, MCS creators_name: Wong, I creators_name: Wu, WKK creators_name: Zhang, Q creators_name: Tse, G title: Association of NPAC score with survival after acute myocardial infarction ispublished: pub divisions: UCL divisions: B02 divisions: C08 divisions: D10 divisions: G11 keywords: Cardiovascular, Heart disease, Mortality, Myocardial infarction, Neutrophil-to-lymphocyte ratio note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. abstract: BACKGROUND AND AIMS: Risk stratification in acute myocardial infarction (AMI) is important for guiding clinical management. Current risk scores are mostly derived from clinical trials with stringent patient selection. We aimed to establish and evaluate a composite scoring system to improve short-term mortality classification after index episodes of AMI, independent of electrocardiography (ECG) pattern, in a large real-world cohort. METHODS: Using electronic health records, patients admitted to our regional teaching hospital (derivation cohort, n = 1747) and an independent tertiary care center (validation cohort, n = 1276), with index acute myocardial infarction between January 2013 and December 2017, as confirmed by principal diagnosis and laboratory findings, were identified retrospectively. RESULTS: Univariate logistic regression was used as the primary model to identify potential contributors to mortality. Stepwise forward likelihood ratio logistic regression revealed that neutrophil-to-lymphocyte ratio, peripheral vascular disease, age, and serum creatinine (NPAC) were significant for 90-day mortality (Hosmer- Lemeshow test, p = 0.21). Each component of the NPAC score was weighted by beta-coefficients in multivariate analysis. The C-statistic of the NPAC score was 0.75, which was higher than the conventional Charlson's score (C-statistic = 0.63). Judicious application of a deep learning model to our dataset improved the accuracy of classification with a C-statistic of 0.81. CONCLUSIONS: The NPAC score comprises four items from routine laboratory parameters to basic clinical information and can facilitate early identification of cases at risk of short-term mortality following index myocardial infarction. Deep learning model can serve as a gatekeeper to facilitate clinical decision-making. date: 2020-05 date_type: published publisher: Elsevier BV official_url: https://doi.org/10.1016/j.atherosclerosis.2020.03.004 oa_status: green full_text_type: other language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1773931 doi: 10.1016/j.atherosclerosis.2020.03.004 lyricists_name: Wong, Ian lyricists_id: ICKWO00 actors_name: Zahnhausen-Stuber, Petra actors_id: PMZAH20 actors_role: owner full_text_status: public publication: Atherosclerosis volume: 301 pagerange: 30-36 citation: Li, CKH; Xu, Z; Ho, J; Lakhani, I; Liu, Y; Bazoukis, G; Liu, T; ... Tse, G; + view all <#> Li, CKH; Xu, Z; Ho, J; Lakhani, I; Liu, Y; Bazoukis, G; Liu, T; Wong, WT; Cheng, SH; Chan, MTV; Zhang, L; Gin, T; Wong, MCS; Wong, I; Wu, WKK; Zhang, Q; Tse, G; - view fewer <#> (2020) Association of NPAC score with survival after acute myocardial infarction. Atherosclerosis , 301 pp. 30-36. 10.1016/j.atherosclerosis.2020.03.004 <https://doi.org/10.1016/j.atherosclerosis.2020.03.004>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10094126/3/Wong_Atherosclerosis%20Accepted%20Manuscript.pdf