Mortality discrimination in acute myocardial infarction: Comparison between APACHE III and SAPS II prognosis systems

Objective:To compare the Acute Physiology, Age and Chronic Health Evaluation (APACHE) III with the Simplified Acute Physiology Score (SAPS II) in discriminating in-hospital mortality for intensive care unit (ICU) patients with acute myocardial infarction (AMI). Design: Prospective, observational, multicenter study. Setting: 70 Spanish ICUs. Patients and participants: 1711 patients with AMI and representative of Spanish ICUs. Measurements and results: APACHE III score, APACHE III system probability of death (APACHE III probability), SAPS II score and in-hospital mortality were noted for each patient. Two hundred and twenty three (13.0 %) patients died in the hospital. The sensitivity (+/- SE), specificity (+/- SE), and accuracy (+/- SE) for the APACHE III score were, respectively, 75.8 +/- 2.9, 75.9 +/- 1.1, and 75.9 +/- 1.0. The corresponding figures for APACHE III probability were 75.3 +/- 2.9, 79.2 +/- 1.1, and 78.7 +/- 1.0, and for SAPS II 72.2 +/- 3.0, 75.9 +/- 1.1, and 75.4 +/- 1.0. Conclusions: The results indicate good discrimination by the three tests. APACHE III probability shows a statistically significant improvement in accuracy and specificity when compared with the two scores.