Predictors of 30-day Mortality in ST-Elevation Myocardial Infarction (STEMI) Patients
Keywords:
TIMI Score, Modified TIMI Score, 30-Day Mortality, GFR, LVEFAbstract
Background: to identify other factors other than the TIMI scores that can be used as predictors of 30-day mortality in STEMI patients by including variables of left ventricle ejection fraction (LVEF) and glomerulus filtration rate (GFR) at Cipto Mangunkusumo National Central General Hospital. Methods: a retrospective cohort study was conducted in 487 STEMI patients who were hospitalized at RSUPN Cipto Mangunkusumo between 2004 and 2013. Sample size was calculated using the rule of thumbs formula. Data were obtained from medical records and analyzed with bivariate and multivariate method using Cox’s Proportional Hazard Regression Model. Subsequently, a new scoring system was developed to predict 30-day mortality rate in STEMI patients. Calibration and discrimination features of the new model were assessed using Hosmer-Lemeshow test and area under receiver operating characteristic curve (AUC). Results: bivariate and multivariate analyses showed that only two variables in the new score system model were statistically significant, i.e. the Killip class II to IV and GFR with a range of total score between 0 and 4.6. Thirty-day mortality risk stratification for STEMI patient included high, moderate and low risks. The risk was considered high when the total score was >3.5 (46.5%). It was considered moderate if the total score was between 2.5 and 3.5 (23.2%) and low if the total score was <2.5 (5.95%). Both variables of the score had satisfactory calibration (p > 0.05) and discrimination (AUC 0.816 (0.756-0.875; CI 95%). Conclusion: There are two new score variables that can be used as predictors of 30-day mortality risks for STEMI patients, i.e. the Killip class and GFR with satisfactory calibration and discrimination rate.References
Cakar MA, Gunduz H, Vatan MB, Kocayigit I, Akdemir R. The effect of admission creatinine levels on one-year mortality in acute myocardial infarction. Sci World J. 2012;2012:1-5.
Muhadi, Antono D, Alwi I. Karakteristik sindrom koroner akut dengan edema paru kardiogenik di ICCU RS Cipto Mangunkusumo dan faktor-faktor yang berhubungan. Tesis. Jakarta: Universitas Indonesia; 2009.
Setyawan MP, Antono D, Dewiasty A. Validasi skor thrombolysis in myocardial infarction (TIMI) dalam memprediksi mortalitas pasien sindrom koroner akut di Indonesia. Tesis. Jakarta: Universitas Indonesia; 2011.
Morrow D, Antman E, Charlesworth A, et al. TIMI risk score for ST-elevation myocardial infarction: a convinient, bedside, clinical score for risk assessment at presentation: an intravenous nPA for treatment of infarcting myocardium early II trial substudy. Circulation. 2000;102:2031-7.
Abu Assi E, Ferreira-Gonzalez I, Ribera A, et al. Do GRACE (Global Registry of Acute Coronary events) risk scores still maintain their performance for predicting mortality in the era of contemporary management of acute coronary syndromes? Am Heart J. 2010;106(5):826-34.
Gibson CM, Pinto DS, Murphy SA, et al. Association of creatinine and creatinine clearance on presentation in acute myocardial infarction with subsequent mortality. J Am Coll Cardiol. 2003;42(9):1535-43.
Selvarajah S, Fong AY, Selvaraj G, Haniff J, Uiterwaal CS, Bots ML. An Asian validation of the TIMI risk score for ST-segment elevation myocardial infarction. PLoS One. 2012;7(7):e40249.
Vivian G Ng, Lansky AJ, Meller S, et al. The prognostic importance of left ventricular function in patients with ST-segment elevation myocardial infarction: The HORIZONS-AMI trial. Eur Heart J: Acute Cardiovascular Care. 2014;3(1):67-77.
Bradshaw PJ, Ko DT, Newman AM, Donovan LR, Tu JV. Validation of the thrombolysis in myocardial infarction (TIMI) risk index for predicting early mortality in a population-based cohort of STEMI and non-STEMI patients. Can J Cardiol. 2007;23(1):51-6.
Morrow DA, Antman EM, Parsons L, et al. Application of the TIMI risk score for ST-elevation MI in the National Registry of Myocardial Infarction 3. JAMA. 2001;286(11):1356-9.
Lee KL, Woodlief LH, Topol EJ, et al. Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction. Results from an international trial of 41,021 patients. GUSTO-I Investigators. Circulation. 1995;91(6):1659-68.
Kim JY, Jeong MH, Ahn YK, et al. Decreased Glomerular filtration rate is an independent predictor of in-hospital mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Korean Circ J. 2011;41(4):184-90.
Chan MY, Becker RC, Sim LL, et al. Reperfusion strategy and mortality in ST-elevation myocardial infarction among patients with and without impaired renal function. Ann Acad Med Singapore. 2010;39(3):179-84.
Sadeghi HM, Stone GW, Grines CL, et al. Impact of renal insufficiency in patients undergoing primary angioplasty for acute myocardial infarction. Circulation. 2003;108(22):2769-75.
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in renal disease study group. Ann Intern Med. 1999;130(6):461-70.
Bucholz EM, Rathore SS, Reid KJ, et al. Body mass index and mortality in acute myocardial infarction patients. Am J Med. 2012;125(8):796-803.
Downloads
Published
How to Cite
Issue
Section
License
CopyrightThe authors who publish this journal agree to the following requirements:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. (See The Effect of Open Access)
The names and email addresses entered in this journal site will be used exclusively for the stated purposes of this journal and will not be made available for any other purpose or to any other party.