title: A simple nomogram for early prediction of myocardial reperfusion after pre-hospital thrombolysis.
abstract: OBJECTIVE
  To discriminate early ST-segment elevation myocardial infarction (STEMI) presenters at a high probability of successful pre-hospital thrombolysis (PHT) using a simple nomogram based on independent predictors of complete ST resolution.
  
  
  RESULTS
  OPTIMAL was an observational, prospective study undertaken at 79 medical centres in France in patients with STEMI undergoing pre-hospital thrombolysis (PHT) within six hours of symptom onset and coronary angiography within six hours of thrombolysis. The baseline and pre-coronary angiography ECGs of 800 patients were analysed. The main outcome measure was ST segment resolution ≥ 70%. ST resolution was associated with a significant reduction in mortality (1.8% vs. 4.3%; p=0.05). After multivariable logistic regression analysis, five independent predictors of successful myocardial reperfusion were identified: ≤ 1 h between pain onset and thrombolysis (odds ratio [OR] 1.76, 95% confidence interval [CI] 1.18-2.62); body mass index (BMI) <30 kg/m2 (OR 1.74, CI 1.12-2.72); current/previous smoking (OR 1.71, CI 1.21-2.43); non-anterior infarct territory (OR 1.75, CI 1.27-2.41); and maximum amplitude of ST elevation <3 mm (OR 1.83, CI 1.32-2.54). The C-statistic of the model was 0.71 (95% CI 0.67-0.74). Using these five independent factors, a simple nomogram was developed to assess the probability of ST resolution after PHT. This nomogram allows discrimination of probabilities ranging from 13 to 72%.
  
  
  CONCLUSIONS
  This simple nomogram can predict the probability of successful myocardial reperfusion after thrombolysis. This may be useful in the triage of STEMI presenters.
authors.affiliation: Centre Hospitalier Universitaire Bichat Claude Bernard, Paris, France. j.rosencher@yahoo.fr
authors.forename: Julien
authors.initials: J
authors.lastname: Rosencher
authors.forename: Vanina
authors.initials: V
authors.lastname: Bongard
authors.forename: Karim
authors.initials: K
authors.lastname: Tazarourte
authors.forename: Louis
authors.initials: L
authors.lastname: Soulat
authors.forename: Dominique
authors.initials: D
authors.lastname: Savary
authors.forename: Meyer
authors.initials: M
authors.lastname: Elbaz
authors.forename: Darko
authors.initials: D
authors.lastname: Miljkovic
authors.forename: Yves
authors.initials: Y
authors.lastname: Cottin
authors.forename: Yves
authors.initials: Y
authors.lastname: Lambert
authors.forename: Ph Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Jacques
authors.initials: J
authors.lastname: Puel
authors.forename: Sandrine
authors.initials: S
authors.lastname: Charpentier
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology; D015425:Myocardial Reperfusion; D011446:Prospective Studies; D015912:Thrombolytic Therapy