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Validity of Charlson Comorbidity Index in patients hospitalised with acute coronary syndrome. Insights from the nationwide AMIS Plus registry 2002–2012
  1. Dragana Radovanovic1,
  2. Burkhardt Seifert2,
  3. Philip Urban3,
  4. Franz R Eberli4,
  5. Hans Rickli5,
  6. Osmund Bertel6,
  7. Milo A Puhan2,
  8. Paul Erne7,
  9. on behalf of the AMIS Plus Investigators
  1. 1AMIS Plus Data Center, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
  2. 2Division of Biostatistics, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
  3. 3Cardiovascular Department, Hôpital de La Tour, Geneva, Switzerland
  4. 4Division of Cardiology, Stadtspital Triemli, Zurich, Switzerland
  5. 5Division of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
  6. 6Cardiology Centre, Klinik Im Park, Zurich, Switzerland
  7. 7Department of Cardiology, Luzerner Kantonsspital Luzern, Lucerne, Switzerland
  1. Correspondence to Dr Dragana Radovanovic, AMIS Plus Data Center, Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, Zurich 8001, Switzerland; dragana.radovanovic{at}


Objective This study aimed to assess the impact of individual comorbid conditions as well as the weight assignment, predictive properties and discriminating power of the Charlson Comorbidity Index (CCI) on outcome in patients with acute coronary syndrome (ACS).

Methods A prospective multicentre observational study (AMIS Plus Registry) from 69 Swiss hospitals with 29 620 ACS patients enrolled from 2002 to 2012. The main outcome measures were in-hospital and 1-year follow-up mortality.

Results Of the patients, 27% were female (age 72.1±12.6 years) and 73% were male (64.2±12.9 years). 46.8% had comorbidities and they were less likely to receive guideline-recommended drug therapy and reperfusion. Heart failure (adjusted OR 1.88; 95% CI 1.57 to 2.25), metastatic tumours (OR 2.25; 95% CI 1.60 to 3.19), renal diseases (OR 1.84; 95% CI 1.60 to 2.11) and diabetes (OR 1.35; 95% CI 1.19 to 1.54) were strong predictors of in-hospital mortality. In this population, CCI weighted the history of prior myocardial infarction higher (1 instead of −0.4, 95% CI −1.2 to 0.3 points) but heart failure (1 instead of 3.7, 95% CI 2.6 to 4.7) and renal disease (2 instead of 3.5, 95% CI 2.7 to 4.4) lower than the benchmark, where all comorbidities, age and gender were used as predictors. However, the model with CCI and age has an identical discrimination to this benchmark (areas under the receiver operating characteristic curves were both 0.76).

Conclusions Comorbidities greatly influenced clinical presentation, therapies received and the outcome of patients admitted with ACS. Heart failure, diabetes, renal disease or metastatic tumours had a major impact on mortality. CCI seems to be an appropriate prognostic indicator for in-hospital and 1-year outcomes in ACS patients. Identifier NCT01305785

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