TY - JOUR
T1 - Predicting In-Hospital Mortality in Patients With Acute Myocardial Infarction
AU - McNamara, Robert L.
AU - Kennedy, Kevin F.
AU - Cohen, David J.
AU - Diercks, Deborah B.
AU - Moscucci, Mauro
AU - Ramee, Stephen
AU - Wang, Tracy Y.
AU - Connolly, Traci
AU - Spertus, John A.
N1 - Funding Information:
Dr. Cohen has received research grant support from Abbott Vascular, AstraZeneca, Biomet, Boston Scientific, Cardiovascular Systems, Inc., Daiichi-Sankyo, Edwards Lifesciences, Eli Lilly, Medtronic, Merck; has received consulting income from Edwards Lifesciences, Medtronic, and AstraZeneca; and speaking honoraria from AstraZeneca. Dr. Diercks has received consulting honoraria from Janssen, Novartis, and Siemens; and research grant support from Roche. Dr. Moscucci has received book royalties from Lippincott Williams and Wilkins; and owns stocks of Gilead Sciences. Dr. McNamara serves on a clinical trials endpoint adjudication committee for Pfizer. Dr. Ramee receives consulting honoraria from Edwards and has an ownership interest in Large Bore, Ocular Therapeutics, and Marvenray. Dr. Wang reports research grant support to her institution from AstraZeneca, Boston Scientific, Bristol-Myers Squibb, Eli Lilly/Daiichi-Sankyo Alliance, Gilead, GlaxoSmithKline, Regeneron; and consulting honoraria from AstraZeneca, Eli Lilly, and Premier. Dr. Spertus has received research grants and contracts from the American College of Cardiology Foundation, Eli Lilly, Gilead, and Genentech; has consulted for Novartis, Regeneron, Bayer, and Amgen; holds the copyright to the SAQ, KCCQ, and PAQ; and has an equity interest in Health Outcomes Sciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Ralph D’Agostino, MD, served as Guest Editor for this paper.
Publisher Copyright:
© 2016 American College of Cardiology Foundation
PY - 2016/8/9
Y1 - 2016/8/9
N2 - Background As a foundation for quality improvement, assessing clinical outcomes across hospitals requires appropriate risk adjustment to account for differences in patient case mix, including presentation after cardiac arrest. Objectives The aim of this study was to develop and validate a parsimonious patient-level clinical risk model of in-hospital mortality for contemporary patients with acute myocardial infarction. Methods Patient characteristics at the time of presentation in the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry–GWTG (Get With the Guidelines) database from January 2012 through December 2013 were used to develop a multivariate hierarchical logistic regression model predicting in-hospital mortality. The population (243,440 patients from 655 hospitals) was divided into a 60% sample for model derivation, with the remaining 40% used for model validation. A simplified risk score was created to enable prospective risk stratification in clinical care. Results The in-hospital mortality rate was 4.6%. Age, heart rate, systolic blood pressure, presentation after cardiac arrest, presentation in cardiogenic shock, presentation in heart failure, presentation with ST-segment elevation myocardial infarction, creatinine clearance, and troponin ratio were all independently associated with in-hospital mortality. The C statistic was 0.88, with good calibration. The model performed well in subgroups based on age; sex; race; transfer status; and the presence of diabetes mellitus, renal dysfunction, cardiac arrest, cardiogenic shock, and ST-segment elevation myocardial infarction. Observed mortality rates varied substantially across risk groups, ranging from 0.4% in the lowest risk group (score <30) to 49.5% in the highest risk group (score >59). Conclusions This parsimonious risk model for in-hospital mortality is a valid instrument for risk adjustment and risk stratification in contemporary patients with acute myocardial infarction.
AB - Background As a foundation for quality improvement, assessing clinical outcomes across hospitals requires appropriate risk adjustment to account for differences in patient case mix, including presentation after cardiac arrest. Objectives The aim of this study was to develop and validate a parsimonious patient-level clinical risk model of in-hospital mortality for contemporary patients with acute myocardial infarction. Methods Patient characteristics at the time of presentation in the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry–GWTG (Get With the Guidelines) database from January 2012 through December 2013 were used to develop a multivariate hierarchical logistic regression model predicting in-hospital mortality. The population (243,440 patients from 655 hospitals) was divided into a 60% sample for model derivation, with the remaining 40% used for model validation. A simplified risk score was created to enable prospective risk stratification in clinical care. Results The in-hospital mortality rate was 4.6%. Age, heart rate, systolic blood pressure, presentation after cardiac arrest, presentation in cardiogenic shock, presentation in heart failure, presentation with ST-segment elevation myocardial infarction, creatinine clearance, and troponin ratio were all independently associated with in-hospital mortality. The C statistic was 0.88, with good calibration. The model performed well in subgroups based on age; sex; race; transfer status; and the presence of diabetes mellitus, renal dysfunction, cardiac arrest, cardiogenic shock, and ST-segment elevation myocardial infarction. Observed mortality rates varied substantially across risk groups, ranging from 0.4% in the lowest risk group (score <30) to 49.5% in the highest risk group (score >59). Conclusions This parsimonious risk model for in-hospital mortality is a valid instrument for risk adjustment and risk stratification in contemporary patients with acute myocardial infarction.
KW - cardiac arrest
KW - cardiogenic shock
KW - creatinine clearance
KW - model
KW - risk prediction
KW - systolic blood pressure
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U2 - 10.1016/j.jacc.2016.05.049
DO - 10.1016/j.jacc.2016.05.049
M3 - Article
C2 - 27491907
AN - SCOPUS:84992151923
SN - 0735-1097
VL - 68
SP - 626
EP - 635
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 6
ER -