title: Ergometric score systems after myocardial infarction: prognostic performance of the Duke Treadmill Score, Veterans Administration Medical Center Score, and of a novel score system, GISSI-2 Index, in a cohort of survivors of acute myocardial infarction.
abstract: BACKGROUND
  The aims of the study were to evaluate the performance of the Duke Treadmill Score (DTS) and the Veteran Affairs Medical Center Score (VAMCS) in predicting 6-month death in GISSI-2 study survivors of acute myocardial infarction treated with thrombolytic agents, and to develop a simple predictive scoring system from the same database.
  
  
  METHODS
  Patients of the GISSI-2 study (n = 6251) performed a maximal symptom-limited exercise test 1 month after myocardial infarction. We calculated for each patient the DTS and the VAMCS. Based on the coefficients of a multivariate analysis of our database, we developed a simple predictive scoring system and performed an internal validation. The prognostic value of each scoring system was assessed by multivariate analysis.
  
  
  RESULTS
  Six-month mortality rates in the subgroups of each scoring system were as follows: DTS: low risk 0.6%, moderate risk 1.8%, high risk 3.4% (P < or =.0001); VAMCS: low risk 0.6%, moderate risk 1.9%, high risk 4.7% (P < or =.0001); GISSI-2 Index: low risk 0.5%, moderate risk 1.9%, high risk 6.1% (P < or =.0001). The results of multivariate analysis (relative risk [RR] and 95% CI) were as follows: DTS: moderate risk 2.50 (1.47-12.59), high risk 5.13 (3.61-15.55); VAMCS: moderate risk 2.65 (1.53-4.59), high risk 5.97 (3.10-11.49); GISSI-2 Index: moderate risk 3.16 (1.81-5.52), high risk 8.65 (4.36-17.18).
  
  
  CONCLUSIONS
  The use of ergometric-derived prognostic score systems in a population of survivors of acute myocardial infarction treated with thrombolytic drugs distinguishes subgroups at different risks of death and allows an appropriate recourse to more costly procedures.
authors.affiliation: Cardiology Department, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy. mvillella@tiscalinet.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Villella
authors.forename: Alessandro
authors.initials: A
authors.lastname: Villella
authors.forename: Luigi
authors.initials: L
authors.lastname: Santoro
authors.forename: Eugenio
authors.initials: E
authors.lastname: Santoro
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Franzosi
authors.forename: Aldo Pietro
authors.initials: AP
authors.lastname: Maggioni
mesh_terms: D000208:Acute Disease; D000368:Aged; D015331:Cohort Studies; D004562:Electrocardiography / Q000706:statistics & numerical data; D016552:Ergometry / Q000706:statistics & numerical data*; D005080:Exercise Test / Q000706:statistics & numerical data*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012306:Risk; D012307:Risk Factors; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data*
chemical_list: D005343:Fibrinolytic Agents