Performance of the thrombolysis in myocardial infarction risk index in the national registry of myocardial infarction-3 and-4 - A simple index that predicts mortality in ST-segment elevation myocardial infarction

被引:82
作者
Wiviott, SD
Morrow, DA
Frederick, PD
Giugliano, RP
Gibson, CM
McCabe, CH
Cannon, CP
Antman, EM
Braunwald, E
机构
[1] Brigham & Womens Hosp, Div Cardiovasc, TIMI Study Grp, Boston, MA 02115 USA
[2] Ovat Res, Seattle, WA USA
[3] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA
关键词
D O I
10.1016/j.jacc.2004.05.045
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES We sought to evaluate a simple risk index based on age and vital signs in a community sample of patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND A simple risk index based on age and vital signs (heart rate X [age/10](2)/systolic blood pressure) developed from patients with STEMI accurately predicts mortality in clinical trials of fibrinolysis. The application of such a tool in an unselected population is necessary to evaluate its utility in clinical practice. METHODS To evaluate the Thrombolysis In Myocardial Infarction (TIMI) risk index for routine practice, we tested it in the National Registry of Myocardial Infarction (NRMI)-3 and -4. The risk index was evaluated as a continuous variable in patients with STEMI from NRMI and in subgroups based on age and reperfusion status. RESULTS A total of 153,486 patients with STEMI were eligible. As anticipated, STEMI patients in NRMI had a higher risk index profile, as compared with those in the clinical trial (median 26.9 vs. 20, p < 0.0001). Classification of NRMI patients with STEMI into risk groups revealed a significant graded relationship with mortality (0.9% to 53.2%, P-trend < 0.0001, c statistic 0.79). The discriminatory capacity of the risk index was particularly strong in the 81,679 patients receiving reperfusion therapy (0.6% to 60%, P-trend < 0.0001, c statistic 0.81). For the 71,807 patients not receiving reperfusion therapy, a strong graded relationship remained (1.9% to 52.2%, p(trend) < 0.0001, c statistic 0.71). Among the elderly, although the distribution of scores was shifted toward higher risk, the performance remained (0% to 53.1%, P-trend < 0.0001, c statistic 0.71). CONCLUSIONS A simple risk index from baseline clinical variables routinely obtained at the first patient encounter predicted mortality in a large unselected heterogeneous group of patients with STEMI. (C) 2004 by the American College of Cardiology Foundation.
引用
收藏
页码:783 / 789
页数:7
相关论文
共 29 条
[1]   The TIMI risk score for unstable angina/non-ST elevation MI - A method for prognostication and therapeutic decision making [J].
Antman, EM ;
Cohen, M ;
Bernink, PJLM ;
McCabe, CH ;
Horacek, T ;
Papuchis, G ;
Mautner, B ;
Corbalan, R ;
Radley, D ;
Braunwald, E .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2000, 284 (07) :835-842
[2]  
Arntz HR, 1998, EUR HEART J, V19, P1140
[3]   Predictors of outcome in patients with acute coronary syndromes without persistent ST-segment elevation results from an international trial of 9461 patients [J].
Boersma, E ;
Pieper, KS ;
Steyerberg, EW ;
Wilcox, RG ;
Chang, WC ;
Lee, KL ;
Akkerhuis, KM ;
Harrington, RA ;
Deckers, JW ;
Armstrong, PW ;
Lincoff, AM ;
Califf, RM ;
Topol, EJ ;
Simoons, ML .
CIRCULATION, 2000, 101 (22) :2557-2567
[4]  
Braunwald E, 2000, EUR HEART J, V21, P2005
[5]   ACC/AHA guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction-2002: Summary article - A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina) [J].
Braunwald, E ;
Antman, EM ;
Beasley, JW ;
Califf, RM ;
Cheitlin, MD ;
Hochman, JS ;
Jones, RH ;
Kereiakes, D ;
Kupersmith, J ;
Levin, TN ;
Pepine, CJ ;
Schaeffer, JW ;
Smith, EE ;
Steward, DE ;
Theroux, P ;
Gibbons, RJ ;
Alpert, JS ;
Faxon, DP ;
Fuster, V ;
Gregoratos, G ;
Hiratzka, LF ;
Jacobs, AK ;
Smith, SC .
CIRCULATION, 2002, 106 (14) :1893-1900
[6]  
Brice J H, 2001, Prehosp Emerg Care, V5, P65, DOI 10.1080/10903120190940362
[7]   Benefit of clopidogrel in patients with acute coronary syndromes without ST-segment elevation in various risk groups [J].
Budaj, A ;
Yusuf, S ;
Mehta, SR ;
Fox, KAA ;
Tognoni, G ;
Zhao, F ;
Chrolavicius, S ;
Hunt, D ;
Keltai, M ;
Franzosi, MG .
CIRCULATION, 2002, 106 (13) :1622-1626
[8]   Selection of thrombolytic therapy for individual patients: Development of a clinical model [J].
Califf, RM ;
Woodlief, LH ;
Harrell, FE ;
Lee, KL ;
White, HD ;
Guerci, A ;
Barbash, GI ;
Simes, RJ ;
Weaver, WDD ;
Simoons, ML ;
Topol, EJ .
AMERICAN HEART JOURNAL, 1997, 133 (06) :630-639
[9]   Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. [J].
Cannon, CP ;
Weintraub, WS ;
Demopoulos, LA ;
Vicari, R ;
Frey, MJ ;
Lakkis, N ;
Neumann, FJ ;
Robertson, DH ;
DeLucca, PT ;
DiBattiste, PM ;
Gibson, CM ;
Braunwald, E .
NEW ENGLAND JOURNAL OF MEDICINE, 2001, 344 (25) :1879-1887
[10]   OUTCOME OF PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION WHO ARE INELIGIBLE FOR THROMBOLYTIC THERAPY [J].
CRAGG, DR ;
FRIEDMAN, HZ ;
BONEMA, JD ;
JAIYESIMI, IA ;
RAMOS, RG ;
TIMMIS, GC ;
ONEILL, WW ;
SCHREIBER, TL .
ANNALS OF INTERNAL MEDICINE, 1991, 115 (03) :173-177