title: Prediction of 30-day mortality in older patients with a first acute myocardial infarction.
abstract: OBJECTIVE
  This study sought predictors of mortality in patients aged >or=75 years with a first ST-segment elevation myocardial infarction (STEMI) and evaluated the validity of the GUSTO-I and TIMI risk models.
  
  
  METHODS
  Clinical variables, treatment and mortality data from 433 consecutive patients were collected. Univariable and multivariable logistic regression analyses were applied to identify baseline factors associated with 30-day mortality. Subsequently a model predicting 30-day mortality was created and compared with the performance of the GUSTO-I and TIMI models.
  
  
  RESULTS
  After adjustment, a higher Killip class was the most important predictor (OR 16.1; 95% CI 5.7-45.6). Elevated heart rate, longer time delay to admission, hyperglycemia and older age were also associated with increased risk. Patients with hypercholesterolemia had a significantly lower risk (OR 0.46; 95% CI 0.24-0.86). Discrimination (c-statistic 0.79, 95% CI 0.75-0.84) and calibration (Hosmer-Lemeshow 6, p = 0.5) of our model were good. The GUSTO-I and TIMI risk scores produced adequate discrimination within our dataset (c-statistic 0.76, 95% CI 0.71-0.81, and c-statistic 0.77, 95% CI 0.72-0.82, respectively), but calibration was not satisfactory (HL 21.8, p = 0.005 for GUSTO-I, and HL 20.6, p = 0.008 for TIMI).
  
  
  CONCLUSIONS
  Short-term mortality in elderly patients with a first STEMI depends most importantly on initial clinical and hemodynamic status. The GUSTO-I and TIMI models are insufficiently adequate for providing an exact estimate of 30-day mortality risk.
authors.affiliation: Department of Cardiology, Atrium Medisch Centrum, Heerlen, The Netherlands.
authors.forename: Timo
authors.initials: T
authors.lastname: Lenderink
authors.forename: Adrián V
authors.initials: AV
authors.lastname: Hernández
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Manuel
authors.initials: M
authors.lastname: Martínez-Sellés
authors.forename: Miriam
authors.initials: M
authors.lastname: Juárez
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Sánchez
authors.forename: Maria T
authors.initials: MT
authors.lastname: Vidán
authors.forename: Maarten L
authors.initials: ML
authors.lastname: Simoons
authors.forename: Francisco
authors.initials: F
authors.lastname: Fernández-Avilés
authors.forename: Héctor
authors.initials: H
authors.lastname: Bueno
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D009203:Myocardial Infarction / Q000401:mortality*; D012306:Risk; D013030:Spain / Q000453:epidemiology