Risk adjustment for in-hospital mortality of contemporary patients with acute myocardial infarction: The Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry®-Get With The Guidelines (GWTG)™ acute myocardial infarction mortality model and risk score

被引:137
作者
Chin, Chee Tang [1 ,2 ]
Chen, Anita Y. [1 ]
Wang, Tracy Y. [1 ]
Alexander, Karen P. [1 ]
Mathews, Robin [1 ]
Rumsfeld, John S. [3 ]
Cannon, Christopher P. [4 ,5 ]
Fonarow, Gregg C. [6 ]
Peterson, Eric D. [1 ]
Roe, Matthew T. [1 ]
机构
[1] Duke Clin Res Inst, Durham, NC USA
[2] Natl Heart Ctr Singapore, Singapore, Singapore
[3] Univ Colorado, Denver, CO 80202 USA
[4] Brigham & Womens Hosp, Div Cardiovasc, Boston, MA 02115 USA
[5] Brigham & Womens Hosp, TIMI Study Grp, Boston, MA 02115 USA
[6] Univ Calif Los Angeles, Los Angeles, CA USA
关键词
TASK-FORCE; PREDICTORS; MANAGEMENT; SOCIETY; TRIAL; CARE;
D O I
10.1016/j.ahj.2010.10.004
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Accurate risk adjustment is needed to guide quality improvement initiatives and research to improve care of patients with acute myocardial infarction (MI). We developed and validated a model to predict the risk of in-hospital mortality for contemporary patients with acute MI treated in routine clinical practice. Methods The Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry (R)-Get With The Guidelines (GWTG)(TM) database of patients with acute MI was used to derive (n = 65,668 from 248 US sites) and validate (n = 16,336) a multivariable logistic regression model to predict the likelihood of in-hospital mortality (4.9% in each cohort). Results Factors with the highest independent significance in terms of mortality prediction included age, baseline serum creatinine, systolic blood pressure, troponin elevation, heart failure and/or cardiogenic shock at presentation, ST-segment changes, heart rate, and prior peripheral arterial disease. The model showed very good discrimination, with c statistics of 0.85 and 0.84 in the derivation and validation cohorts, respectively. The model calibrated well overall and in key patient subgroups including males versus females, age < 75 versus >= 75 years, diabetes versus no diabetes, and ST-elevation MI versus non-ST-elevation MI. The ACTION Registry (R)-GWTG (TM) in-hospital mortality risk score was also developed from the model. Patients with a risk score of <= 40 had an observed mortality rate of < 4% compared with those with a risk score of 41-50 (12%) and risk scores > 50 (34%). Conclusion The ACTION Registry (R)-GWTG (TM) in-hospital mortality model and risk score represent simple, accurate risk adjustment tools for contemporary patients with acute MI. (Am Heart J 2011;161:113-122.e2.)
引用
收藏
页码:113 / 122.e2
页数:12
相关论文
共 20 条
  • [11] 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update) A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
    Kushner, Frederick G.
    Smith, Sidney C.
    King, Spencer B.
    Anderson, Jeffrey L.
    Antman, Elliott M.
    Bailey, Steven R.
    Bates, Eric R.
    Blankenship, James C.
    Casey, Donald E.
    Green, Lee A.
    Hochman, Judith S.
    Jacobs, Alice K.
    Krumholz, Harlan M.
    Morrison, Douglass A.
    Ornato, Joseph P.
    Pearle, David L.
    Peterson, Eric D.
    Sloan, Michael A.
    Whitlow, Patrick L.
    Williams, David O.
    [J]. CIRCULATION, 2009, 120 (22) : 2271 - 2306
  • [12] Comparative Effectiveness Research: The View From the NHLBI
    Lauer, Michael S.
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2009, 53 (12) : 1084 - 1086
  • [13] Frail Patients Are at Increased Risk for Mortality and Prolonged Institutional Care After Cardiac Surgery
    Lee, Dana H.
    Buth, Karen J.
    Martin, Billie-Jean
    Yip, Alexandra M.
    Hirsch, Gregory M.
    [J]. CIRCULATION, 2010, 121 (08) : 973 - 978
  • [14] Lloyd-Jones D, 2009, CIRCULATION, V119, pE21, DOI 10.1161/CIRCULATIONAHA.108.191261
  • [15] TIMI risk score for ST-elevation myocardial infarction: A convenient, bedside, clinical score for risk assessment at presentation - An intravenous nPA for treatment of infarcting myocardium early II trial substudy
    Morrow, DA
    Antman, EM
    Charlesworth, A
    Cairns, R
    Murphy, SA
    de Lemos, JA
    Giugliano, RP
    McCabe, CH
    Braunwald, E
    [J]. CIRCULATION, 2000, 102 (17) : 2031 - 2037
  • [16] A Call to ACTION (Acute Coronary Treatment and Intervention Outcomes Network) A National Effort to Promote Timely Clinical Feedback and Support Continuous Quality Improvement for Acute Myocardial Infarction
    Peterson, Eric D.
    Roe, Matthew T.
    Rumsfeld, John S.
    Shaw, Richard E.
    Brindis, Ralph G.
    Fonarow, Gregg C.
    Cannon, Christopher P.
    [J]. CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES, 2009, 2 (05): : 491 - 499
  • [17] Patterns of transfer for patients with non-ST-segment elevation acute coronary syndrome from community to tertiary care hospitals
    Roe, Matthew T.
    Chen, Anita Y.
    Delong, Elizabeth R.
    Boden, William E.
    Calvin, James E., Jr.
    Cairns, Charles B.
    Smith, Sidney C., Jr.
    Pollack, Charles V., Jr.
    Brindis, Ralph G.
    Califf, Robert M.
    Gibler, W. Brian
    Ohman, Magnus
    Peterson, Eric D.
    [J]. AMERICAN HEART JOURNAL, 2008, 156 (01) : 185 - 192
  • [18] Relationship between risk stratification by cardiac troponin level and adherence to guidelines for non-ST-segment elevation acute coronary syndromes
    Roe, MT
    Peterson, ED
    Li, Y
    Pollack, CV
    Christenson, RH
    Peacock, WF
    Fesmire, FM
    Newby, LK
    Jesse, RL
    Hockstra, JW
    Gibler, WB
    Ohman, EM
    [J]. ARCHIVES OF INTERNAL MEDICINE, 2005, 165 (16) : 1870 - 1876
  • [19] Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation
    Van de Werf, Frans
    Bax, Jeroen
    Betriu, Amadeo
    Blomstrom-Lundqvist, Carina
    Crea, Filippo
    Falk, Volkmar
    Filippatos, Gerasimos
    Fox, Keith
    Huber, Kurt
    Kastrati, Adnan
    Rosengren, Annika
    Steg, P. Gabriel
    Tubaro, Marco
    Verheugt, Freek
    Weidinger, Franz
    Weis, Michael
    Vahanian, Alec
    Camm, John
    De Caterina, Raffaele
    Dean, Veronica
    Dickstein, Kenneth
    Filippatos, Gerasimos
    Funck-Brentano, Christian
    Hellemans, Irene
    Kristensen, Steen Dalby
    McGregor, Keith
    Sechtem, Udo
    Silber, Sigmund
    Tendera, Michal
    Widimsky, Petr
    Zamorano, Jose Luis
    Silber, Sigmund
    Aguirre, Frank V.
    Al-Attar, Nawwar
    Alegria, Eduardo
    Andreotti, Felicita
    Benzer, Werner
    Breithardt, Ole
    Danchin, Nicholas
    Mario, Carlo Di
    Dudek, Dariusz
    Gulba, Dietrich
    Halvorsen, Sigrun
    Kaufmann, Philipp
    Kornowski, Ran
    Lip, Gregory Y. H.
    Rutten, Frans
    [J]. EUROPEAN HEART JOURNAL, 2008, 29 (23) : 2909 - 2945
  • [20] LONGITUDINAL DATA-ANALYSIS FOR DISCRETE AND CONTINUOUS OUTCOMES
    ZEGER, SL
    LIANG, KY
    [J]. BIOMETRICS, 1986, 42 (01) : 121 - 130