In addition to the simple score described in the previous section, Qureshi et al developed a model based on multivariate logistic regression to identify patients at risk for in-hospital mortality following a percutaneous coronary intervention (PCI). This can help identify patients who require closer monitoring and more aggressive therapy. The authors are from William Beaumont Hospital in Royal Oak, Michigan.
NOTE: The documentation and spreadsheet are based on the materials submitted by Dr Ana Paula Rodel from the Hospital Universitario de Santa Maria in Brazil.
Parameters:
(1) serum creatinine
(2) age
(3) history of AMI
(4) extent of coronary artery disease
(5) gender
(6) serum cholesterol
(7) peripheral vascular disease
(8) diabetes mellitus
|
Parameter |
Finding |
Points |
|
serum creatinine |
<= 1.5 mg/dL (normal) |
0 |
|
|
> 1.5 mg/dL (elevated) |
1 |
|
age of the patient in years |
<= 65 years |
0 |
|
|
> 65 years |
1 |
|
history of AMI |
none |
0 |
|
|
< 14 days |
1 |
|
|
>= 14 days |
0 |
|
extent of coronary artery disease |
single vessel |
0 |
|
|
multiple vessels |
1 |
|
gender |
male |
0 |
|
|
female |
1 |
|
serum cholesterol |
normal |
0 |
|
|
elevated |
1 |
|
peripheral vascular disease |
absent |
0 |
|
|
present |
1 |
|
diabetes mellitus |
absent |
0 |
|
|
present |
1 |
where:
• Multi-vessel disease was defined as >= 2 arteries with > 50% stenosis.
X =
= (0.7211 * (points for serum creatinine)) - (0.6694 * (points for age)) + (0.7621 * (points for AMI)) + (0.7866 * (points for extent of coronary artery disease)) + (1.2734 * (points for gender)) + (1.1891 * (points for serum cholesterol)) + (1.1675 * (points for peripheral vascular disease)) + (0.4338 * (points for diabetes)) - 7.1912
probability of in-hospital mortality =
= 1 / (1 + EXP((-1) * X))
where:
• An age > 65 lowers the mortality rate in this model as published. In the simple model age > 65 increased risk. It is possible that age <= 65 was intended. However, if the value is reversed the mortality rates become high relative to those reported in the paper.
Specialty: Cardiology
ICD-10: ,
