A large derivation and validation study developed a clinical risk score to estimate long-term mortality in patients with ST-elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI). The study was published in Heart.

The derivation cohort included 23,086 patients from a STEMI network. Time-to-event regression analysis was used to identify independent predictors of mortality, which were incorporated into the PREDICT-STEMI score ranging from 0 to 206 points.

External validation was performed in two independent cohorts: the EXAMINATION-EXTEND study (n=1,498) and the Coronary Artery disease Tracking registry (n=1,112). Model performance was evaluated using concordance indices, and optimal cut-off values were determined through outcome-based analyses.

The final score included seven variables: age, diabetes mellitus, prior myocardial infarction, prior ischemic stroke or transient ischemic attack, hemodynamic status, presence of three-vessel disease, and use of mechanical circulatory support. The model demonstrated strong discrimination for long-term mortality, with a concordance index of 0.81 (95% CI 0.80–0.81) in the derivation cohort and 0.81 (95% CI 0.78–0.84) and 0.84 (95% CI 0.81–0.87) in the validation cohorts.

A cut-off value of 60 points was identified as optimal for risk stratification. Patients with scores above this threshold had a six fold higher risk of long-term mortality compared with those below the cut-off across cohorts.

The PREDICT-STEMI score demonstrated consistent predictive performance across cohorts. The model enables stratification of long-term mortality risk based on clinical characteristics.