TY - JOUR
T1 - Risk score to predict need for intensive care in initially hemodynamically stable adults with non-ST-segment-elevation myocardial infarction
AU - Fanaroff, Alexander C.
AU - Chen, Anita Y.
AU - Thomas, Laine E.
AU - Pieper, Karen S.
AU - Garratt, Kirk N.
AU - Peterson, Eric D.
AU - Newby, L. Kristin
AU - de Lemos, James A
AU - Kosiborod, Mikhail N.
AU - Amsterdam, Ezra A.
AU - Wang, Tracy Y.
N1 - Funding Information:
Fanaroff reports grants from the National Institutes of Health (5T32HL069749-13) and American Heart Association (17FTF33661087) during the conduct of the study, and Gilead Sciences outside the submitted work. Garratt reports receiving consulting fees/honoraria from Abbott Vascular, CeloNova, and Jarvk Heart, holding equity in LifeCuff, Inc, and GDS, and performing legal reviews for Swensen, Perer & Kontos all outside of the submitted work. Peterson reports receiving consulting fees from AstraZeneca, Merck, Janssen,
Funding Information:
This study was funded by the Agency for Healthcare Research and Quality, grant U19H2021092 (Wang).
Funding Information:
For categorical variables, missing values were imputed by the most frequent group. Rates of missing values were <1% for all candidate variables. All statistical analyses were performed at the Duke Clinical Research Institute using SAS software, version 9.4 (SAS Institute). This project was supported by a grant from the Agency for Healthcare Research and Quality (U19H2O21092). The Duke University Medical Center Institutional Review Board approved this study and granted a waiver of informed consent and authorization.
Publisher Copyright:
© 2018 The Authors.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - Background--Intensive care unit (ICU) use for initially stable patients presenting with non-ST-segment-elevation myocardial infarction (NSTEMI) varies widely across hospitals and minimally correlates with severity of illness. We aimed to develop a bedside risk score to assist in identifying high-risk patients with NSTEMI for ICU admission. Methods and Results--Using the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry linked to Medicare data, we identified patients with NSTEMI aged ≥65 years without cardiogenic shock or cardiac arrest on presentation. Complications requiring ICU care were defined as subsequent development of cardiac arrest, shock, high-grade atrioventricular block, respiratory failure, stroke, or death during the index hospitalization. We developed and validated a model and integer risk score (Acute Coronary Treatment and Intervention Outcomes Network (ACTION) ICU risk score) that uses variables present at hospital admission to predict requirement for ICU care. Of 29 973 patients with NSTEMI, 4282 (14%) developed a complication requiring ICU-level care, yet 12 879 (43%) received care in an ICU. Signs or symptoms of heart failure, initial heart rate, initial systolic blood pressure, initial troponin, initial serum creatinine, prior revascularization, chronic lung disease, ST-segment depression, and age had statistically significant associations with requirement for ICU care after adjusting for other risk factors. The ACTION ICU risk score had a C-statistic of 0.72. It identified 11% of patients as having very high risk (> 30%) of developing complications requiring ICU care and 49% as having low likelihood (< 10%) of requiring an ICU. Conclusions--The ACTION ICU risk score quantifies the risk of initially stable patients with NSTEMI developing a complication requiring ICU care, and could be used to more effectively allocate limited ICU resources.
AB - Background--Intensive care unit (ICU) use for initially stable patients presenting with non-ST-segment-elevation myocardial infarction (NSTEMI) varies widely across hospitals and minimally correlates with severity of illness. We aimed to develop a bedside risk score to assist in identifying high-risk patients with NSTEMI for ICU admission. Methods and Results--Using the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry linked to Medicare data, we identified patients with NSTEMI aged ≥65 years without cardiogenic shock or cardiac arrest on presentation. Complications requiring ICU care were defined as subsequent development of cardiac arrest, shock, high-grade atrioventricular block, respiratory failure, stroke, or death during the index hospitalization. We developed and validated a model and integer risk score (Acute Coronary Treatment and Intervention Outcomes Network (ACTION) ICU risk score) that uses variables present at hospital admission to predict requirement for ICU care. Of 29 973 patients with NSTEMI, 4282 (14%) developed a complication requiring ICU-level care, yet 12 879 (43%) received care in an ICU. Signs or symptoms of heart failure, initial heart rate, initial systolic blood pressure, initial troponin, initial serum creatinine, prior revascularization, chronic lung disease, ST-segment depression, and age had statistically significant associations with requirement for ICU care after adjusting for other risk factors. The ACTION ICU risk score had a C-statistic of 0.72. It identified 11% of patients as having very high risk (> 30%) of developing complications requiring ICU care and 49% as having low likelihood (< 10%) of requiring an ICU. Conclusions--The ACTION ICU risk score quantifies the risk of initially stable patients with NSTEMI developing a complication requiring ICU care, and could be used to more effectively allocate limited ICU resources.
KW - Intensive care unit
KW - Model
KW - Non-ST-segment acute coronary syndrome
KW - Risk prediction risk score
KW - Risk score
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U2 - 10.1161/JAHA.118.008894
DO - 10.1161/JAHA.118.008894
M3 - Article
C2 - 29802146
AN - SCOPUS:85047974228
SN - 2047-9980
VL - 7
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 11
M1 - e008894
ER -