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 2 (baseline Day 0)
Outcome: 30-day mortality
Parameters on Day 2 shared with baseline:
(1) age in years
(2) heart rate in beats per minute
(3) systolic blood pressure in mm Hg
(4) total ST-segment deviation in mm from all 12 leads
|
Parameter |
Finding |
Points |
|
age in years |
< 65 years |
0 |
|
|
65 to 74 years |
2 |
|
|
>= 75 years |
3 |
|
heart rate |
< 63 beats per minute |
0 |
|
|
63 to 85 beats per minute |
1 |
|
|
> 85 beats per minute |
2 |
|
systolic blood pressure |
< 120 mm Hg |
2 |
|
|
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
Additional parameters on Day 2 not shared with baseline:
(5) ST-segment resolution
(6) PCI status
(7) stroke status
(8) heart failure status
(9) electrical disorder
|
Parameter |
Finding |
Points |
|
ST segment resolution |
Complete |
0 |
|
|
Partial |
1 |
|
|
None |
2 |
|
|
ECG confounders or missing |
1 |
|
PCI status |
Yes |
0 |
|
|
No |
2 |
|
stroke status |
Absent |
0 |
|
|
Present |
8 |
|
heart failure |
Absent |
0 |
|
|
Present |
5 |
|
electrical disorder |
Absent |
0 |
|
|
present |
5 |
where:
• ECG confounders included left bundle branch block, paced rhythm, ventricular rhythm or poor quality ECG.
total score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: 30 (Table 3 says 32)
• The higher the score the greater the 30-day mortality.
|
Total Score |
30-Day Mortality |
|
0 to 2 |
0.5% |
|
3 |
0.4% |
|
4 |
0.7% |
|
5 |
1.2% |
|
6 |
1.9% |
|
7 |
2.9% |
|
8 to 12 |
16% |
Performances:
• The area under the ROC curve was 0.86.
Specialty: Cardiology
