A predictive model to identify patients with suspected acute coronary syndromes at high risk of cardiac arrest or in-hospital mortality: An IMMEDIATE Trial sub-study

Abstract

BackgroundThe IMMEDIATE Trial of emergency medical service use of intravenous glucose–insulin–potassium (GIK) very early in acute coronary syndromes (ACS) showed benefit for the composite outcome of cardiac arrest or in-hospital mortality.ObjectivesThis analysis of IMMEDIATE Trial data sought to develop a predictive model to help clinicians identify patients at highest risk for this outcome and most likely to benefit from GIK.MethodsMultivariable logistic regression was used to develop a predictive model for the composite endpoint cardiac arrest or in-hospital mortality using the 460 participants in the placebo arm of the IMMEDIATE Trial.ResultsThe final model had four variables: advanced age, low systolic blood pressure, ST elevation in the presenting electrocardiogram, and duration of time since ischemic symptom onset. Predictive performance was good, with a C statistic of 0.75, as was its calibration. Stratifying patients into three risk categories based on the model's predictions, there was an absolute risk reduction of 8.6% with GIK in the high-risk tertile, corresponding to 12 patients needed to treat to prevent one bad outcome. The corresponding values for the low-risk tertile were 0.8% and 125, respectively.ConclusionsThe multivariable predictive model developed identified patients with very early ACS at high risk of cardiac arrest or death. Using this model could assist treating those with greatest potential benefit from GIK.

Characteristics of In-Hospital Mortality among Patients with Acute Coronary Syndrome: A Single-Center Study in West Java, Indonesia

“…Pulse rate and systolic blood pressure (BP) can be used to assess the hemodynamic state of the patient. 7 Vital signs measurements in this study reveal an average systolic BP of 106.8 mmHg (60-160 mmHg) and an average pulse rate of 87 beats/min (28-134 beats/ min). This finding was slightly lower than the results found the emergency department.…”

“…11 In this study, a history of hypertension occurs in more than half of the cases, while a history of smoking, diabetes mellitus (DM), dyslipidemia, and previous acute myocardial infarction (AMI) are only found in less than half of the cases, similar with several other studies. 7,12 The findings in this study are likely due to a high prevalence of chronic diseases among the elderly population. The most prevalent chronic disease found among the elderly is hypertension, followed by diabetes, heart disease, asthma, ulcer, and cancer.…”

“…This finding was slightly lower than the results found the emergency department. 7 This was likely due to the delayed presentation found among the subjects in this study.…”

“…8 However, other studies in Indonesia show different results which found predominantly male subjects with cardiac arrest or inhospital mortality. 6,7 Furthermore, a study on gender associated with hospitalization outcomes in ACS patients shows that women have significantly worse outcomes and higher in-hospital mortality. The majority of female ACS patients are in the older age group with more comorbidities and received less frequent acute treatments and medical therapy for secondary prevention compared to their male counterparts.…”