Fanaroff et al reported the ACTION-ICU score for predicting the need for ICU care for a hemodynamically stable adult with a non-ST-segment elevated myocardial infarction (NSTEMI). The authors are from Duke University, Christiania Care Health System, University of Texas Southwestern, University of Missouri-Kansas City and University of California Davis.
ACTION = Acute Coronary Treatment and Intervention Outcomes Network
Patient selection: adult with NSTEMI who is hemodynamically stable
Outcome: deterioration with need for ICU admission
Parameters:
(1) age in years
(2) serum creatinine in mg/dL
(3) heart rate in beats per minute
(4) systolic blood pressure in mm Hg
(5) initial serum troponin as multiple of upper limit of normal (ULN)
(6) signs or symptoms of heart failure
(7) ST segment depression
(8) history of prior revascularization procedure
(9) chronic lung disease
|
Parameter
|
Finding
|
Points
|
|
age in years
|
< 70 years
|
0
|
|
|
>= 70 years
|
1
|
|
serum creatinine
|
< 1.1 mg/dL
|
0
|
|
|
>= 1.1 mg/dL
|
1
|
|
heart rate
|
< 85 mm Hg
|
0
|
|
|
85 to 100
|
1
|
|
|
>= 100
|
3
|
|
systolic blood pressure
|
< 125
|
3
|
|
|
125 to 145
|
1
|
|
|
>= 145 mm Hg
|
0
|
|
initial troponin
|
< 12 * ULN
|
0
|
|
|
>= 12 * ULN
|
2
|
|
signs of heart failure
|
no
|
0
|
|
|
yes
|
5
|
|
ST depression
|
no
|
0
|
|
|
yes
|
1
|
|
prior revascularization
|
no
|
1
|
|
|
yes
|
0
|
|
chronic lung disease
|
no
|
0
|
|
|
yes
|
2
|
total score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: 19
|
Total Score
|
Percent ICU
|
|
0 or 1
|
3.4%
|
|
2
|
4.5%
|
|
3
|
5.5%
|
|
4
|
6.9%
|
|
5
|
9.3%
|
|
6
|
12%
|
|
7
|
14.6%
|
|
8
|
17.4%
|
|
9
|
20.8%
|
|
10
|
23.3%
|
|
11
|
27.7%
|
|
12
|
31%
|
|
13
|
31.5%
|
|
>=14
|
39.3%
|
Performance:
• The area under the ROC curve is 0.72.
