Key result
A prognostic model using baseline clinical and ECG variables accurately predicted 90-day mortality (c-index 0.82) among STEMI patients undergoing primary PCI, who had an overall mortality of 4.7%.
Cohort (n=5,745)
A prognostic model utilizing baseline clinical and ECG variables accurately predicts 90-day mortality in patients with STEMI undergoing primary PCI.
May support 90-day risk stratification in STEMI-PCI; leaves open external validation before clinical use.
Background— Accurate models to predict mortality are needed for risk stratification in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods and Results— We examined 5745 patients with STEMI undergoing primary PCI in the Assessment of Pexelizumab in Acute Myocardial Infarction Trial within 6 hours of symptom onset. A Cox proportional hazards model incorporating regression splines to accommodate nonlinearity in the log hazard ratio (HR) scale was used to determine baseline independent predictors of 90-day mortality. At 90 days, 271 (4.7%) of 5745 patients died. Independent correlates of 90-day mortality were (in descending order of statistical significance) age (HR, 2.03/10-y increments; 95% CI, 1.80 to 2.29), systolic blood pressure (HR, 0.86/10-mm Hg increments; 95% CI, 0.82 to 0.90), Killip class (class 3 or 4 versus 1 or 2) (HR, 4.24; 95% CI, 2.97 to 6.08), heart rate (>70 beats per minute) (HR, 1.45/10-beat increments; 95% CI, 1.31 to 1.59), creatinine (HR, 1.23/10-μmol/L increments >90 μmol/L; 95% CI, 1.13 to 1.34), sum of ST-segment deviations (HR, 1.25/10-mm increments; 95% CI, 1.11 to 1.40), and anterior STEMI location (HR, 1.47; 95% CI, 1.12 to 1.93) (c-index, 0.82). Internal validation with bootstrapping confirmed minimal overoptimism (c-index, 0.81). Conclusions— Our study provides a practical method to assess intermediate-term prognosis of patients with STEMI undergoing primary PCI, using baseline clinical and ECG variables. This model identifies key factors affecting prognosis and enables quantitative risk stratification that may be helpful in guiding clinical care and for risk adjustment for observational analyses.
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Stebbins et al. (2010) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=5,745). Baseline clinical and ECG variables was evaluated on 90-day mortality. A prognostic model using baseline clinical and ECG variables accurately predicted 90-day mortality (c-index 0.82) among STEMI patients undergoing primary PCI, who had an overall mortality of 4.7%.
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