PG-HACKER Score  

The PG-HACKER registry

A cohort of 1400 diabetic patients who were admitted due to acute coronary syndrome (ACS), between Nov 2003 and Jan 2017.

They were followed for MACCE events and all-cause mortality.

Definitions:

• MACCE event: either cardiovascular mortality, new myocardial ischemia, sudden cardiac death, cerebrovascular accident or heart failure episode.
• ACS: acute coronary syndrome was defined by the presence of typical clinical symptoms of chest pain and electrocardiographic changes indicative of myocardial ischemia/lesion and/or elevation of serum markers of myocardial damage [Ibanez, 2018].
• LVEF: left ventricle ejection fraction was coded in: no dysfunction (LVEF > 51%) mild (LVEF 41-51%), moderate (LVEF 30-40%) or severe dysfunction (<30%) [Lang, 2015].
• OMT: optimal medical treatment was defined as the joint implementation of these four treatments: antiplatelets, statins, betablockers and angiotensin-converter enzyme inhibitors or mineralocorticoid receptor antagonists (MRAs).

Outcomes:

• 783 patients suffered a MACCE event, from which 417 patients died.
• 143 patients died from non-cardiovascular causes.

Statistical rationale:

• The PG-HACKER score is based in a Fine & Gray model for competing risks.
• A competing risk (CR) is an event whose occurrence either precludes the occurrence of another event under examination or fundamentally alters the probability of occurrence of this other event.
• Kaplan-Meier methods are not suitable for modeling CRs, as they tend to overestimate incidence.
• Fine & Gray models have use in predicting an individual’s incidence of an event (MACCE), taking into account the possibility that a competing event (all-cause mortality) occurs.
• The point-based score transforms the time-to-event model into a simple set of operations, to facilitate its use in the clinical setting.