ACUTE PHYSIOLOGY AND CHRONIC HEALTH EVALUATION-II SCORING SYSTEM IN ACUTE MYOCARDIAL-INFARCTION - A PROSPECTIVE VALIDATION-STUDY

Objective: To study the usefulness of the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system for prognostication of inhospital mortality in acute myocardial infarction. Design: A prospective validation study. Setting: A medical intensive care unit (ICU) at a university hospital. Patients: Over a 3-yr period, 2,007 admissions of 1,714 patients with acute myocardial infarction were studied. In readmissions to the medical ICU during the same hospital stay, only the first admission was studied. Measurements and Main Results: Mean age of the patients was 72 +/- 10 yrs. The medical ICU mortality rate was 13% and total hospital mortality rate was 16%. Mean APACHE II score was 11.6 +/- 6.5. There was a close correlation between observed and predicted mortality rates in classes of patients with various APACHE II scores. Observed mortality in patients with scores of 20 to 24 was higher than the predicted mortality (p < .03). In this subgroup, 25% of the patients had a length of stay in the medical ICU of <8 hrs. Conclusions: Inhospital mortality in patients with acute myocardial infarction could be accurately predicted with APACHE II scores. Prognostication was not as good in patients with a length of stay in the medical ICU of <8 hrs.