Hubacek et al developed a model for predicting hospital mortality in a patient with an acute coronary syndrome undergoing percutaneous coronary intervention (PCI). This was based on the bedside score of Moscucci et al (above, original Michigan model). The authors are the APPROACH investigators from Canada.
Parameters:
(1) time interval from acute myocardial infarction (AMI) to PCI
(2) indication for PCI (see Table 1, page 309)
(3) cardiogenic shock
(4) serum creatinine
(5) cardiac arrest
(6) number of diseased vessels
(7) age of the patient in years
(8) left ventricular ejection fraction
(9) peripheral vascular disease
(10) gender
|
Parameter |
Finding |
Points |
|
interval from AMI to PCI |
<= 24 hours |
0.5 |
|
|
> 24 hours |
0 |
|
indication for PCI |
myocardial infarction (MI) |
2.0 |
|
|
non-MI |
0 |
|
cardiogenic shock |
absent |
0 |
|
|
present |
3.0 |
|
serum creatinine |
normal |
0 |
|
|
increased |
1.5 |
|
cardiac arrest |
none |
0 |
|
|
present |
2.5 |
|
number of diseased vessels |
1 |
0.5 |
|
|
2 |
1.0 |
|
|
3 |
1.5 |
|
age of the patient |
< 70 years |
0 |
|
|
70 - 79 years |
1.0 |
|
|
>= 80 years |
1.5 |
|
ejection fraction |
>= 50% |
0 |
|
|
< 50% |
1.0 |
|
|
missing |
1.5 |
|
|
unable to do |
1.5 |
|
peripheral vascular disease |
absent |
0 |
|
|
present |
1.0 |
|
gender |
male |
0 |
|
|
female |
0.5 |
total score =
= SUM(points for all 10 parameters)
Interpretation:
• minimum score: 0
• maximum score: 15.5
• The higher the score the greater the hospital mortality.
|
Score |
Predicted Mortality |
|
<= 4.0 |
0 |
|
4.5 |
0.3% |
|
5.0 |
0.6% |
|
5.5 |
1.0% |
|
6.0 |
1.6% |
|
6.5 |
2.7% |
|
7.0 |
6.4% |
|
7.5 |
10% |
|
8.0 |
15% |
|
8.5 |
23% |
|
9.0 |
34% |
|
9.5 |
45% |
|
10.0 |
56% |
|
10.5 |
67% |
|
11.0 |
75% |
|
11.5 |
84% |
|
12.0 |
89% |
|
12.5 |
93% |
|
13.0 |
98% |
|
13.5 |
98% |
|
14 - 15.5 |
> 98% |
from, Figure 2, page 310
To simplify this, the following table can be used based on the above data (this is not included in the citation).
|
Score |
Predicted Mortality |
|
0 to 4.0 |
none |
|
4.5 to 6.5 |
very low |
|
7.0 to 8.0 |
low |
|
8.5 to 9.5 |
moderate |
|
SpecialtyICD-10InfoSpecialty: Cardiology ICD-10: , |
