Wang et developed a score for predicting major cardiovascular events within 1 year of an acute myocardial infarction. This can help to identify a patient who may benefit from more aggressive management. The authors are from multiple institutions in the United States and China.
Patient selection: adult Chinese with acute myocardial infarction
Outcome: cardiovascular events within 1 year (recurrent AMI, angina, stroke, TIA, heart failure, revascularization, PCI)
Parameters:
(1) age in years
(2) college degree
(3) prearrival medical assistance
(4) history of prior angina
(5) history of prior acute myocardial infarction
(6) history of prior ventricular tachycardia or ventricular fibrillation
(7) hypertension
(8) time between symptom onset and admission
(9) renal dysfunction (BUN > 40 mg/dL OR creatinine > 2.5 mg/dL)
(10) left ventricular ejection fraction in percent
(11) white blood cell count per µL
(12) fasting blood glucose in mg/dL
(13) heart rate in beats per minute
(14) systolic blood pressure in mm Hg
(15) number of in-hospital complications (recurrent angina, recurant AMI, pericardial effusion, atrial fibrillation, cardiopulmonary resuscitation, ventricular tachycardia or fibrillation, new heart failure, infection, stroke, major bleeding)
|
Parameter |
Finding |
Points |
|
age in years |
< 65 years |
0 |
|
|
65 to 74 years |
6 |
|
|
75 to 84 years |
9 |
|
|
>= 85 years |
14 |
|
college degree |
no |
4 |
|
|
yes |
0 |
|
prearrival medical assistance |
no |
3 |
|
|
yes |
0 |
|
history of angina |
no |
0 |
|
|
yes |
5 |
|
history of prior AMI |
no |
0 |
|
|
yes |
4 |
|
history of ventricular tachycardia or fibrillation |
no |
0 |
|
|
yes |
6 |
|
hypertension |
no |
0 |
|
|
yes |
2 |
|
time between symptom onset and admission |
<= 4 hours |
0 |
|
|
> 4 hours |
3 |
|
renal dysfunction |
no |
0 |
|
|
yes |
4 |
|
LVEF |
>= 40% |
0 |
|
|
< 40% |
8 |
|
|
unknown |
6 |
|
WBC count |
< 6,000 per µL |
0 |
|
|
6,000 to 12,000 |
4 |
|
|
> 12,000 per µL |
7 |
|
fasting blood glucose |
<= 216 mg/dL |
0 |
|
|
> 216 mg/dL |
5 |
|
heart rate |
<= 90 beats per minute |
0 |
|
|
> 90 beats per minute |
5 |
|
systolic blood pressure |
>= 100 mm Hg |
0 |
|
|
< 100 mm Hg |
4 |
|
hospital complications |
|
|
total score =
= SUM(points for all 15 parameters)
Interpretation:
• minimum score: 0
• maximum score: around 84 (affected by the number of complications)
• The higher the score the greater the risk of complications within 1 year.
|
Total Score |
Risk Group |
Percentage |
|
<= 10 |
low |
1% |
|
11 to 30 |
average |
5% |
|
>= 31 |
high |
32% |
Performance:
• The area under the ROC curve was 0.69.
Specialty: Cardiology
