A new simplified immediate prognostic risk score for patients with acute myocardial infarction

Abstract

Background: Immediate risk stratification of patients with myocardial infarction in the emergency department (ED) at the time of initial presentation is important for their optimal emergency treatment. Current risk scores for predicting mortality following acute myocardial infarction (AMI) are potentially flawed, having been derived from clinical trials with highly selective patient enrolment and requiring data not readily available in the ED. These scores may not accurately represent the spectrum of patients in clinical practice and may lead to inappropriate decision making. Methods: This study cohort included 1212 consecutive patients with AMI who were admitted to the Mayo Clinic coronary care unit between 1988 and 2000. A risk score model was developed for predicting 30 day mortality using parameters available at initial hospital presentation in the ED. The model was developed on patients from the first era (training set-before 1997) and validated on patients in the second era (validation set-during or after 1997). Results: The risk score included age, sex, systolic blood pressure, admission serum creatinine, extent of ST segment depression, QRS duration, Killip class, and infarct location. The predictive ability of the model in the validation set was strong (c = 0.78). Conclusion: The Mayo risk score for 30 day mortality showed excellent predictive capacity in a population based cohort of patients with a wide range of risk profiles. The present results suggest that even amidst changing patient profiles, treatment, and disease definitions, the Mayo model is useful for 30 day risk assessment following AMI.

Atherosclerotic Renal Artery Stenosis: Association with Emerging Vascular Risk Factors

“…Elevated creatinine values (a surrogate for reduced glomerular filtration rate) predict a worse outcome (higher morbidity and mortality rates) following MI [105,106,107,108,109]. An elevated creatinine is also associated with an increased risk of ischemic stroke and transient ischemic attack episodes [110, 111], incidence of CHD [112] and all-cause cardiovascular mortality [109, 111, 112].…”

Prognostic value of blood pressure measured during hospitalization after acute myocardial infarction: an insight from survival trials

“…It has been postulated that the success of thrombolytic therapy is directly linked to systemic blood pressure, although this remains controversial [1]. Furthermore, some studies showed pulse pressure (PP) as being predictive of mortality in patients with heart failure or impaired left ventricular function after MI [2,3], whereas another study showed that low systolic blood pressure on admission predicted mortality at 30 days after acute MI instead [4]. The role of blood pressure in patients with acute MI is uncertain, especially on different modes of mortality.…”

Relationship Between Mean Blood Pressure at Admission and In-Hospital Outcome After Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction

“…[5][6][7] In addition to major blood pressure indexes, such as SBP and diastolic blood pressure (DBP), blood pressure is characterized by its pulsatile and steady components, which correspond to pulse pressure (PP) and mean blood pressure (MBP), respectively. We have already shown that admission SBP or PP in a certain interval between an extremely low subset and extremely high subset might be associated with a lower in-hospital mortality in Japanese AMI patients undergoing primary percutaneous coronary intervention (PCI), which followed a J-or U-shaped curve pattern.…”