Forecasting mortality: dynamic assessment of risk in ST-segment elevation acute myocardial infarction.
OBJECTIVE
To demonstrate the feasibility and clinical utility of developing dynamic risk assessment models for ST-segment elevation myocardial infarction (STEMI) patients.


RESULTS
In 6066 STEMI patients enrolled in the Assessment of the Safety and Efficacy of a New Thrombolytic-3 (ASSENT-3) trial with complete electrocardiographic data, we assessed the probability of 30-day mortality over the following forecasting periods beginning at day 0 (baseline), 3 h, day 2, and day 5 using multiple-logistic regression. These models were validated and simplified in independent samples of 1622 similar fibrinolytic-treated patients from the ASSENT-3 PLUS trial and in 814 STEMI patients undergoing primary percutaneous coronary intervention in the COMplement inhibition in Myocardial infarction treated with Angioplasty (COMMA) trial. The discriminatory power of these predictive models, from baseline to day 5, was excellent (c-statistics 0.80 to 0.87); and their predictive ability was supported by strong gradients in mortality outcomes as the risk score increased. Dynamic modelling also provided information on the change in prognosis over time which may be used to advise more appropriate therapeutic decisions, e.g. the identification of high-risk patients for possible co-interventions.


CONCLUSIONS
Dynamic modelling for STEMI patients enhances the risk assessment and stratification and should provide valuable ongoing guidance for their management.
Chang
Wei-Ching
WC
Department of Medicine, University of Alberta, 2-51 Medical Sciences Building, Edmonton, Alberta, Canada T6G 2H7.
Kaul
Padma
P
Fu
Yuling
Y
Westerhout
Cynthia M
CM
Granger
Christopher B
CB
Mahaffey
Kenneth W
KW
Wallentin
Lars
L
Van de Werf
Frans
F
Armstrong
Paul W
PW
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D018570:Risk Assessment / Q000379:methods / Q000592:standards; D015912:Thrombolytic Therapy / Q000379:methods