Chang et al several scores for predicting prognosis for a patient with ST-segment elevation myocardial infarction (STEMI). This can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Alberta, Duke University, University Hospital Uppsala Katholieke Universiteit Leuven and the ASSENT-3 PLUS Trial.
Patient selection: STEMI
Time for Assessment: 3 hours after starting therapy on Day 0
Outcome: 30-day mortality
Parameters at 3 hours (same as baseline with addition of ST segment resolution):
(1) age in years
(2) Killip class
(3) heart rate in beats per minute
(4) systolic blood pressure in mm Hg
(5) total ST-segment deviation in mm from all 12 leads
(6) ST segment resolution
|
Parameter |
Finding |
Points |
|
age in years |
< 65 years |
0 |
|
|
65 to 74 years |
2 |
|
|
>= 75 years |
4 |
|
Killip class |
I |
0 |
|
|
II |
1 |
|
|
III or IV |
3 |
|
heart rate |
< 63 beats per minute |
0 |
|
|
63 to 85 beats per minute |
1 |
|
|
> 85 beats per minute |
2 |
|
systolic blood pressure |
< 120 mm Hg |
2 |
|
|
120 to 132 mm Hg |
1 |
|
|
> 132 mm Hg |
0 |
|
total ST segment deviation |
< 12 mm |
0 |
|
|
>= 12 mm |
1 |
|
ST segment resolution |
complete |
0 |
|
|
partial |
0 |
|
|
none |
2 |
|
|
ECG confounders or missing |
2 |
where:
• ECG confounders included left bundle branch block, paced rhythm, ventricular rhythm or poor quality ECG.
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 14 (Table 3 says 13)
• The higher the score the greater the 30-day mortality.
|
Total Score |
30-Day Mortality |
|
0 to 2 |
0.9% |
|
3 |
1.8% |
|
4 |
3.8% |
|
5 |
4.3% |
|
6 |
6.6% |
|
7 |
14% |
|
8 to 12 |
26% |
Performances:
• The area under the ROC curve was 0.80.
Specialty: Cardiology
