This prognostic profile was developed in 1979 and is intended for predicting survival in patients with acute myocardial infarction by taking into account dynamic information during the course of hospitalization.
Four main categories of findings:
(1) patient history
(2) ECG findings
(3) biochemical results
(4) hemodynamic findings
Patient History
|
Factor |
Finding |
Prognostic Weight |
|---|---|---|
|
Sex |
male |
- 7 |
|
|
female |
+18 |
|
Age |
< 50 |
-30 |
|
|
51-60 |
-16 |
|
|
61-70 |
-2 |
|
|
71-80 |
+24 |
|
|
> 80 |
+48 |
|
Previous History |
unremarkable |
-46 |
|
|
anginal syndrome |
+7 |
|
|
hypertension |
+10 |
|
|
congestive heart failure |
+15 |
|
|
myocardial infarction |
+23 |
|
|
recurrent MI |
+56 |
ECG Findings
|
Factor |
Finding |
Prognostic Weight |
|---|---|---|
|
Location of Infarction |
anterior wall, not extensive |
-3 |
|
|
anterior wall, extensive |
+23 |
|
|
inferior wall |
-5 |
|
|
combined |
-8 |
|
ECG voltage |
normal |
-20 |
|
|
low |
+28 |
|
Rhythm Disturbances |
none |
-70 |
|
|
supraventricular arrhythmia |
-4 |
|
|
ventricular premature beat |
-16 |
|
|
ventricular tachyarrhythmias |
+30 |
|
|
fascicular blocks |
+15 |
|
|
1° or 2° AV block |
+12 |
|
|
3° AV block |
+24 |
|
|
combined |
+33 |
Biochemical Findings
|
Factor |
Finding |
Prognostic Weight |
|---|---|---|
|
SGOT (AST), maximum |
<= 120 |
-20 |
|
|
121-160 |
-12 |
|
|
161-200 |
+11 |
|
|
201-240 |
+18 |
|
|
> 240 |
+26 |
|
LDH, maximum |
<= 450 |
-21 |
|
|
451-600 |
+4 |
|
|
601-750 |
+7 |
|
|
> 750 |
+46 |
|
CPK, maximum |
<= 120 |
-16 |
|
|
121-160 |
-3 |
|
|
161-200 |
+18 |
|
|
> 200 |
+24 |
|
white blood cell count, maximum |
<= 10,000 per µL |
-24 |
|
|
> 10,000 per µL |
+25 |
|
arterial pO2 on room air (FIO2 0.21), maximum |
<= 70 |
+25 |
|
|
71-84 |
-25 |
|
|
>84 |
-20 |
Hemodynamic state
|
Factor |
Finding |
Prognostic Weight |
|---|---|---|
|
admission systolic blood pressure |
< 90 mm Hg |
+72 |
|
|
90-100 mm Hg |
+36 |
|
|
> 110 mm Hg |
-25 |
|
mean daily systolic blood pressure |
< 90 mm Hg |
+85 |
|
|
90-100 mm Hg |
+42 |
|
|
> 110 mm Hg |
-34 |
|
hemodynamic class |
no congestion |
-43 |
|
|
mild to moderate congestion |
-25 |
|
|
pulmonary edema |
+25 |
|
|
cardiogenic shock |
+162 |
prognostic profile =
= (points for sex) + (points for age) + (points for previous history) + (points for infarct location) + (points for ECG voltage) + (points for rhythm disturbances) + (points for SGOT) + (points for LDH) + (points for CPK) + (points for WBC count) + (points for arterial pO2) + (points for admission systolic blood pressure) + (points for mean daily systolic blood pressure) + (points for hemodynamic class)
Interpretation:
• minimum score is -384
• maximum score is +671
• prognosis decreases as score rises and improves as score falls
• scores at or above +120 are associated with death
• scores at or below -120 survived
• scores between -120 and +120 were indefinite and survival could not be predicted with certainty
Unfavorable prognosis associated with:
(1) advanced age
(2) previous history of MI, congestive heart failure, or both
(3) extensive anterior wall infarction
(4) ECG showing low voltage pattern
(5) third degree AV block
(6) increased enzyme levels, leukocytosis and hypoxemia
(7) low blood pressure on admission or during hospital course
(8) pump failure with pulmonary edema and/or cardiogenic failure
Limitations:
• The data for AST (SGOT), LDH and CPK does not give the units, method or reference ranges.
• The systolic blood pressure sections do not show data for 101-110 mm Hg; we have assumed "0" assigned.
• Some of the breakpoints for a finding along a spectrum are not clearly stated.
• The use of "combined" findings for rhythm disturbance and infarct location is confusing.
Specialty: Cardiology
ICD-10: ,
