1999
DOI: 10.1161/01.cir.99.23.2986
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Comparing AMI Mortality Among Hospitals in Patients 65 Years of Age and Older

Abstract: Background-Interest in the reporting of risk-adjusted outcomes for patients with acute myocardial infarction is growing.A useful risk-adjustment model must balance parsimony and ease of data collection with predictive ability. Methods and Results-From our analysis of 82 359 patients Ն65 years of age admitted with acute myocardial infarction to 2401 hospitals, we derived a parsimonious model that predicts 30-day mortality. The model was validated on a similar group of 78 699 patients from 2386 hospitals. Of the… Show more

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Cited by 134 publications
(96 citation statements)
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“…9,10 In the GRACE registry, the risk increased for every 1 mg/dL increase in serum creatinine, while in our study, patients with an initial level > 1.4 mg/dL had a worse prognosis showing a trend towards statistical significance.…”
Section: Discussionmentioning
confidence: 41%
See 1 more Smart Citation
“…9,10 In the GRACE registry, the risk increased for every 1 mg/dL increase in serum creatinine, while in our study, patients with an initial level > 1.4 mg/dL had a worse prognosis showing a trend towards statistical significance.…”
Section: Discussionmentioning
confidence: 41%
“…The GRACE score incorporates newer prognostic variables like serum creatinine and cardiac arrest at presentation which have been shown to be most important in a Medicare database of patients with acute MI (AMI). 10 Moreover, the GRACE score has been developed from registry data and thus is more representative of the general population as compared to scores which have been developed from clinical databases. These clinical databases may suffer from selection bias due to exclusion of high-risk patients like those with coronary heart failure (CHF) or raised serum creatinine.…”
Section: Discussionmentioning
confidence: 99%
“…Two established riskadjustment indexes were tested and performed well in the patient sample (21,22). The algorithm proposed by Krumholz et al (21) showed areas under the receiver operating curve of 0.84 and 0.87 for 30-day and one-year mortality, respectively, with excellent goodness of fit.…”
Section: The Derivation Of Baseline Riskmentioning
confidence: 99%
“…With respect to the present sample, the second risk index also displayed excellent accuracy (areas under the receiver operating curves of 0.81 and 0.84 for 30-day and one-year mortality, respectively) and precision. The model of Morrow et al (22) had the virtue of excluding any of the pre-existing conditions whose effects on treatment behaviour served as one of the study's objectives and was therefore used to project baseline risk for each patient (a reanalysis with the index of Krumholz et al [21] did not meaningfully alter the results).…”
Section: The Derivation Of Baseline Riskmentioning
confidence: 99%
“…In order to account for potential differences in clinical characteristics between patients undergoing CABG and those not, we evaluated quality indicator rates by multivariate logistic regression analysis adjusting for patient clinical characteristics. Independent variables incorporated in the model included cardiac arrest or congestive heart failure on admission, myocardial infarction (MI) location, systolic blood pressure, white blood cell count, and serum creatinine levels-predictors of 30-day mortality in the Cooperative Cardiovascular Project identified by Krumholz et al 26 The software used for these analyses was SAS version 8.1 (SAS Institute, Inc., Cary, NC).…”
Section: Methodsmentioning
confidence: 99%