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: Day 5 (baseline Day 0)
Outcome: 30-day mortality
Parameters on Day 5 shared with baseline, with some change in scoring:
(1) age in years
(2) systolic blood pressure in mm Hg
(3) total ST-segment deviation in mm from all 12 leads
|
Parameter |
Finding |
Points |
|
age in years |
< 65 years |
0 |
|
|
65 to 74 years |
1 |
|
|
>= 75 years |
3 |
|
systolic blood pressure |
< 120 mm Hg |
1 |
|
|
120 to 132 mm Hg |
1 |
|
|
> 132 mm Hg |
0 |
|
total ST segment deviation |
< 12 mm |
0 |
|
|
>= 12 mm |
1 |
The Killip class is not included in the Day 2 or Day 5 score. Heart rate is used in the Day 2 but not the Day 5 score.
Additional parameters shared with Day 2 but not shared with baseline:
(4) ST-segment resolution
(5) PCI status
(6) stroke status
(7) heart failure status
(8) electrical disorder
|
Parameter |
Finding |
Points |
|
ST segment resolution |
complete |
0 |
|
|
partial |
1 |
|
|
none |
2 |
|
|
ECG confounders or missing |
0 |
|
PCI status |
yes |
0 |
|
|
no |
2 |
|
stroke status |
absent |
0 |
|
|
present |
5 |
|
heart failure |
absent |
0 |
|
|
present |
4 |
|
electrical disorder |
absent |
0 |
|
|
present |
3 |
where:
• ECG confounders included left bundle branch block, paced rhythm, ventricular rhythm or poor quality ECG.
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 21 (Table 3 says 22)
• The higher the score the greater the 30-day mortality.
|
Total Score |
30-Day Mortality |
|
0 to 2 |
0.4% |
|
3 |
0.7% |
|
4 |
1.2% |
|
5 |
1.7% |
|
6 |
3.7% |
|
7 |
5.9% |
|
8 to 12 |
22.5% |
Performances:
• The area under the ROC curve was 0.81.
Specialty: Cardiology
