The ACTION ICU risk score predicted the need for intensive care in initially stable older adults with NSTEMI with a C-statistic of 0.72, identifying 49% of patients as low risk (<10%).
Cohort (n=29,973)
Yes
Can the ACTION ICU risk score predict the need for ICU care in initially hemodynamically stable adults aged ≥65 years with NSTEMI?
The ACTION ICU risk score effectively predicts the need for ICU care in initially stable older adults with NSTEMI, which could help optimize ICU resource allocation.
Effect estimate: C-statistic 0.72
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.
Fanaroff et al. (2018) conducted a cohort in Non-ST-segment-elevation myocardial infarction (NSTEMI) (n=29,973). ACTION ICU risk score was evaluated on Complications requiring ICU care (cardiac arrest, shock, high-grade atrioventricular block, respiratory failure, stroke, or death) (C-statistic 0.72). The ACTION ICU risk score predicted the need for intensive care in initially stable older adults with NSTEMI with a C-statistic of 0.72, identifying 49% of patients as low risk (<10%).