Califf et al developed nomograms for predicting 1 year survival in patients with acute myocardial infarction treated by thrombolysis, heparin and beta-blockade. This can help identify patients who may benefit from more aggressive management. The authors participated in the Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries Trial.
Patient selection: A patient alive 30 days after thrombolysis for acute MI
Parameters:
(1) age of the patient
(2) history of previous myocardial infarction
(3) CHF or pulmonary embolus (PE) in hospital
(4) left ventricular ejection fraction (LVEF) in percent
(5) heart rate on the ECG in beats per minute
Model 1
|
Parameter |
Finding |
Points |
|---|---|---|
|
age |
30 years |
10 |
|
|
40 years |
15 |
|
|
50 years |
20 |
|
|
60 years |
32 |
|
|
70 years |
46 |
|
|
80 years |
60 |
|
|
90 years |
73 |
|
|
100 years |
86 |
|
history of previous MI |
no |
0 |
|
|
yes |
18 |
|
CHF or PE in hospital |
no |
0 |
|
|
yes |
25 |
points for age from 30 to 100 years =
= (0.007917 * ((age)^2)) + (0.1054 * (age)) - 1.827
total score =
= SUM(points for all 3 parameters)
Model 2
|
Parameter |
Finding |
Points |
|---|---|---|
|
age |
30 years |
1 |
|
|
40 years |
1 |
|
|
50 years |
2 |
|
|
60 years |
3 |
|
|
70 years |
5 |
|
|
80 years |
6 |
|
|
90 years |
8 |
|
history of previous MI |
no |
0 |
|
|
yes |
2 |
|
CHF or PE in hospital |
no |
0 |
|
|
yes |
2 |
|
LVEF |
80 |
92 |
|
|
70 |
93 |
|
|
60 |
94 |
|
|
50 |
95 |
|
|
40 |
96 |
|
|
30 |
97 |
|
|
20 |
98 |
|
|
10 |
99 |
|
ECG heart rate |
>= 120 |
4 |
|
|
100 |
3 |
|
|
80 |
2 |
|
|
60 |
1 |
|
|
40 |
0 |
where:
• 92 could have been subtracted from the points for LVEF to make a more concise score.
• The points for age are approximately ROUND for age points in Model 1 divided by 10.
• In the implementation the heart rate points are heart hard to assign because of the gaps in the numbers.
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score for Model 1: 10
• maximum score for Model 1: 129
• minimum score for Model 2: 100
• maximum score for Model 2: 115
|
Model 1 |
Model 2 |
Predicted Survival |
|---|---|---|
|
25 |
100 |
99% |
|
40 |
102 |
98% |
|
50 |
|
97% |
|
56 |
103 |
96% |
|
61 |
|
95% |
|
65 |
104 |
94% |
|
69 |
|
93% |
|
72 |
105 |
92% |
|
75 |
|
91% |
|
77 |
106 |
90% |
|
94 |
108 |
80% |
|
105 |
109 |
70% |
|
113 |
110 |
60% |
|
119 |
111 |
50% |
|
126 |
112 |
40% |
where:
• Above 77 points Model 1 changes rapidly. It may be helpful to have an equation rather than a lookup table over this range.
• Above 106 points Model 2 changes rapidly. It may be helpful to have an equation rather than a lookup table over this range.
Specialty: Cardiology
ICD-10: ,
