Morrow et al developed a clinical score for risk assessment at presentation for a patient with ST-elevation myocardial infarction (STEMI). The authors are participants in the Treatment of Infarcting Myocardium Early II (TIME II) trial.
Patient selection: STEMI
Outcome: 30-day mortality rate
Parameters:
(1) age in years
(2) systolic blood pressure in mm Hg
(3) heart rate in beats per minute
(4) Killip class
(5) anterior infarct (ST elevation) or left bundle branch block (LBBB)
(6) risk factors (diabetes, hypertension, history of angina)
(7) body weight in kilograms
(8) time to treatment in hours
|
Parameter |
Finding |
Points |
|
age in years |
< 65 years |
0 |
|
|
65 to 74 years |
2 |
|
|
>= 75 years |
3 |
|
systolic blood pressure |
>= 100 mm Hg |
0 |
|
|
< 100 mm Hg |
3 |
|
heart rate |
<= 100 beats per minute |
0 |
|
|
> 100 beats per minute |
2 |
|
Killip class |
I |
0 |
|
|
II, III or IV |
2 |
|
anterior infarct or LBBB |
absent |
0 |
|
|
present |
1 |
|
risk factors |
none |
0 |
|
|
one or more of diabetes, hypertension or history of angina |
1 |
|
body weight |
>= 67 kig |
0 |
|
|
< 67 kg |
1 |
|
time to treatment |
<= 4 hours |
0 |
|
|
> 4 hours |
1 |
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 14
• The higher the score the greater the 30-day mortality rate.
|
Score |
30-Day Mortality |
|
0 |
0.8% |
|
1 |
1.6% |
|
2 |
2.2% |
|
3 |
4.4% |
|
4 |
7% |
|
5 |
12% |
|
6 |
16% |
|
7 |
23% |
|
8 |
27% |
|
9 to 14 |
36% |
Specialty: Cardiology
