Elixhauser outperformed Charlson comorbidity index in prognostic value after ACS: insights from a national registry


      • The first study to compare performance of the ECS and CCI comorbidity scores in predicting ACS outcomes.
      • ECS had superior prognostic value compared to the CCI in terms of statistical performance of models predicting all in-hospital outcomes.
      • ECS should be routinely adopted in clinical practice to inform the risk stratification and management of ACS.



      To compare the performance of risk adjustment models using the Elixhauser and Charlson comorbidity scores in predicting in-hospital outcomes of ACS patients from a nationwide administrative database.

      Study Design and Setting

      All hospitalizations for ACS in the United States between 2004 and 2014 (n = 7,201,900) were retrospectively analyzed. We used ECS and CCI score based on ICD-9 codes to define comorbidity variables. Logistic regression models were fitted to three in-hospital outcomes, including mortality, Major Acute Cardiovascular & Cerebrovascular Events (MACCE) and bleeding. The prognostic values of ECS and CCI after adjusting for known confounders, were compared using the C-statistic, Akaike information criterion (AIC), and Bayesian information criterion (BIC).


      The statistical performance of models predicting all in-hospital outcomes demonstrated that the ECS had superior prognostic value compared to the CCI, with higher C-statistics and lower AIC and BIC values associated with the former.


      This is the first study that compared the prognostic value of the ECS and CCI scores in predicting multiple ACS outcomes, based on their scoring systems. Better discrimination and goodness of fit was achieved with the Elixhauser method across all in-hospital outcomes studied.


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