PREDICT: A Simple Risk Score for Clinical Severity and Long-Term Prognosis After Hospitalization for Acute Myocardial Infarction or Unstable Angina

Jacobs, David R.; Kroenke, Candyce H.; Crow, Richard S.; Deshpande, Mahesh C.; Gu, Dong Feng; Gatewood, Laël C.; Blackburn, Henry

doi:10.1161/01.cir.100.6.599

Cited by 183 publications

(101 citation statements)

References 27 publications

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“…1 It was reported to predict death, recurrent MI, or urgent revascularization at 14 days. 1,2 PREDICT, derived from a geographically defined cohort of acute coronary syndromes, 6 includes 7 clinical factors measured on the day of admission. It assigns integer points, added across components, leading to values ranging from 0 to 24.…”

Section: The Risk Scoresmentioning

confidence: 99%

“…and the Global Utilization of Streptokinase and t-PA for Occluded coronary arteries [GUSTO] score 5 ) or from registries and cohort studies (eg, the Predicting Risk of Death in Cardiac Disease Tool [PREDICT] 6 and the Cooperative Cardiovascular Project scores 7 ) ( Table 1). They differ with regard to their derivation population, which likely plays a role in the difference of the components retained in the final score 8 and their clinical applicability.…”

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confidence: 99%

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Scores for Post–Myocardial Infarction Risk Stratification in the Community

et al. 2002

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Background-Several scores, most of which were derived from clinical trials, have been proposed for stratifying risk after myocardial infarctions (MIs). Little is known about their generalizability to the community, their respective advantages, and whether the ejection fraction (EF) adds prognostic information to the scores. The purpose of this study is to evaluate the Thrombolysis in Myocardial Infarction (TIMI) and Predicting Risk of Death in Cardiac Disease Tool (PREDICT) scores in a geographically defined MI cohort and determine the incremental value of EF for risk stratification. Methods and Results-MIs occurring in Olmsted County were validated with the use of standardized criteria and stratified with the ECG into ST-segment elevation (STEMI) and non-ST-segment elevation (NSTEMI) MI. Logistic regression examined the discriminant accuracy of the TIMI and PREDICT scores to predict death and recurrent MI and assessed the incremental value of the EF. After 6.3Ϯ4.7 years, survival was similar for the 562 STEMIs and 717 NSTEMIs. The discriminant accuracy of the TIMI score was good in STEMI but only fair in NSTEMI. Across time and end points, irrespective of reperfusion therapy, the discriminant accuracy of the PREDICT score was consistently superior to that of the TIMI scores, largely because PREDICT includes comorbidity; EF provided incremental information over that provided by the scores and comorbidity. Conclusion-In the community, comorbidity and EF convey important prognostic information and should be included in approaches for stratifying risk after MI.

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Section: The Risk Scoresmentioning

confidence: 99%

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confidence: 99%

Scores for Post–Myocardial Infarction Risk Stratification in the Community

et al. 2002

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“…These clinical and demographic factors have been recognized as important risk factors among patients with MI in clinical guidelines 29. Moreover, these risk factors are incorporated in a number of risk prediction models for patients with MI 6, 7, 28, 30, 31, 32, 33, 34…”

Section: Discussionmentioning

confidence: 99%

“…Of importance, a large risk variation is recognized among patients with MI depending on demographics, comorbidities, and severity of MI 6, 7. Risk stratification is important because it may influence the selection of secondary preventive therapy, such as intensive antiplatelet therapy where benefit may only outweigh harm in higher risk patients but not among lower risk ones 8, 9, 10.…”

Section: Introductionmentioning

confidence: 99%

International Validation of the Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention in Post‐MI Patients: A Collaborative Analysis of the Chronic Kidney Disease Prognosis Consortium and the Risk Validation Scientific Committee

Mok

Ballew

Bash

et al. 2018

JAHA

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BackgroundThe Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS2°P), a 0‐to‐9‐point system based on the presence/absence of 9 clinical factors, was developed to classify the risk of major adverse cardiovascular events (MACE) (a composite of cardiovascular death, recurrent myocardial infarction, or ischemic stroke) among patients with a recent myocardial infarction. Its performance has not been examined internationally outside of a clinical trial setting.Methods and ResultsWe evaluated the performance of TRS2°P for predicting MACE in 53 599 patients with recent myocardial infarction in 5 international cohorts from New Zealand, South Korea, Sweden, and the United States participating in the Chronic Kidney Disease Prognosis Consortium. Overall, there were 19 444 cases of MACE across 5 cohorts over a mean follow‐up of 5 years, and the overall MACE rate ranged from 5.0 to 18.4 (per 100 person‐years). The TRS2°P showed modest calibration (Brier score ranged from 0.144 to 0.173) and discrimination (C‐statistics >0.61 in all studies except 1 from Korea with 0.55) across cohorts relative to its original Brier score of 0.098 and C‐statistic of 0.67 in the derived data set. Although there was some heterogeneity across cohorts, the 9 predictors in the TRS2°P were generally associated with higher MACE risk, with strongest associations observed (meta‐analyzed adjusted hazard ratio 1.6–1.7) for history of heart failure, age ≥75 years, and prior stroke, followed by peripheral artery disease, kidney dysfunction, diabetes mellitus, and hypertension (hazard ratio 1.3–1.4). Prior coronary bypass graft surgery and smoking did not reach statistical significance (hazard ratio ≈1.1).ConclusionsTRS2°P, a simple scoring system with 9 routine clinical factors, was modestly predictive of secondary events when applied in patients with recent myocardial infarction from diverse clinical and geographic settings.

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“…ST segment deviation predicts increased risks of major adverse cardiovascular events in ACS patients (12)(13)(14). Previous investigators have extensively validated the prognostic value of ECG abnormalities and/or troponin values (12)(13)(14)(15)(16)(17)(18)(19)(20)(21). However, no previous study has assessed the predictive value of combining the TIMI risk score and ECG deviation in non-ST elevation ACS, especially for more optimal risk stratification of patients with a low TIMI risk score of less than 5.…”

Section: Discussionmentioning

confidence: 99%

Complementary prognostic values of ST segment deviation and Thrombolysis In Myocardial Infarction (TIMI) risk score in non-ST elevation acute coronary syndromes: Insights from the Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) study

Huynh

Nasmith

Bernier

et al. 2009

Canadian Journal of Cardiology

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BACKGROUND: Although the Thrombolysis In Myocardial Infarction (TIMI) score incorporates ST deviation, it does not account for characteristics of the ST deviations. In the present study, it was hypothesized that the magnitude and characteristics of ST deviation may add to the prognostic values of the TIMI risk score in acute coronary syndrome (ACS) patients, particularly in lower-risk patients with a TIMI risk score of less than 5. OBJECTIVE: To evaluate the prognostic value of combining the TIMI risk score and characteristics of ST deviation in patients with non-ST elevation ACS and a TIMI risk score of less than 5. METHODS:The death/myocardial infarction (MI) rates of 1296 patients enrolled in the Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) angiographic substudy were examined. RESULTS: Patients without a TIMI risk score of 5 or greater, and without an ST deviation of 1 mm or greater had the lowest six-month rate of death/ MI (5%). In patients with a TIMI risk score of less than 5, the six-month death/MI rate was increased in those with ST depression of 2 mm or greater compared with patients with a similar TIMI risk score and without ST deviation of 1 mm or greater (24% versus 5%, P<0.001). The presence of ST deviation of 2 mm or greater identified an additional 15% of patients with an increased six-month death/MI rate in patients with a TIMI risk score of less than 5. CONCLUSION: ST segment deviation of 2 mm or greater confers additional prognostic information in non-ST elevation ACS patients with a TIMI risk score of less than 5. Patients with a TIMI risk score of less than 5 and ST deviation of 2 mm or less had the lowest risk of six-month death/MI.

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PREDICT: A Simple Risk Score for Clinical Severity and Long-Term Prognosis After Hospitalization for Acute Myocardial Infarction or Unstable Angina

Cited by 183 publications

References 27 publications

Scores for Post–Myocardial Infarction Risk Stratification in the Community

Scores for Post–Myocardial Infarction Risk Stratification in the Community

International Validation of the Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention in Post‐MI Patients: A Collaborative Analysis of the Chronic Kidney Disease Prognosis Consortium and the Risk Validation Scientific Committee

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