Predicting In-Hospital Mortality in Patients With Acute Myocardial Infarction

McNamara, Robert L.; Kennedy, Kevin F.; Cohen, David J.; Diercks, Deborah B.; Moscucci, Mauro; Ramee, Stephen R.; Wang, Tracy Y.; Connolly, Traci; Spertus, John A.

doi:10.1016/j.jacc.2016.05.049

Cited by 191 publications

(161 citation statements)

References 33 publications

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“…So, morphine could have been used as a symptomatic treatment, in combination with continuous positive airway pressure, for patients suffering from dyspnea or acute heart failure at first medical care. Initial heart failure and/or cardiogenic shock are strongly associated with a poorest prognosis 36. Despite this initial difference, the morphine group did not experience significantly more adverse events than the no‐morphine group.…”

Section: Discussionmentioning

confidence: 96%

Effect and Safety of Morphine Use in Acute Anterior ST‐Segment Elevation Myocardial Infarction

Bonin

Mewton

Roubille

et al. 2018

JAHA

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BackgroundMorphine is commonly used to treat chest pain during myocardial infarction, but its effect on cardiovascular outcome has never been directly evaluated. The aim of this study was to examine the effect and safety of morphine in patients with acute anterior ST‐segment elevation myocardial infarction followed up for 1 year.Methods and ResultsWe used the database of the CIRCUS (Does Cyclosporine Improve Outcome in ST Elevation Myocardial Infarction Patients) trial, which included 969 patients with anterior ST‐segment elevation myocardial infarction, admitted for primary percutaneous coronary intervention. Two groups were defined according to use of morphine preceding coronary angiography. The composite primary outcome was the combined incidence of major adverse cardiovascular events, including cardiovascular death, heart failure, cardiogenic shock, myocardial infarction, unstable angina, and stroke during 1 year. A total of 554 (57.1%) patients received morphine at first medical contact. Both groups, with and without morphine treatment, were comparable with respect to demographic and periprocedural characteristics. There was no significant difference in major adverse cardiovascular events between patients who received morphine compared with those who did not (26.2% versus 22.0%, respectively; P=0.15). The all‐cause mortality was 5.3% in the morphine group versus 5.8% in the no‐morphine group (P=0.89). There was no difference between groups in infarct size as assessed by the creatine kinase peak after primary percutaneous coronary intervention (4023±118 versus 3903±149 IU/L; P=0.52).ConclusionsIn anterior ST‐segment elevation myocardial infarction patients treated by primary percutaneous coronary intervention, morphine was used in half of patients during initial management and was not associated with a significant increase in major adverse cardiovascular events at 1 year.

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Section: Discussionmentioning

confidence: 96%

Effect and Safety of Morphine Use in Acute Anterior ST‐Segment Elevation Myocardial Infarction

Bonin

Mewton

Roubille

et al. 2018

JAHA

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“…The generalized estimating equation method with an exchangeable working correlation structure was used to account for within‐site clustering of patients (ie, within‐site correlation for response) 11. Multivariable logistic regression models were used to estimate the marginal effect of FI separately by MI type (NSTEMI and STEMI) after adjusting for age, sex, and covariates previously identified as significantly associated with in‐hospital mortality among patients with MI 12. These covariates include heart failure on presentation, cardiogenic shock, heart rate, systolic blood pressure, cardiac arrest, creatinine clearance, and initial troponin (as a ratio of the upper limit of normal).…”

Section: Methodsmentioning

confidence: 99%

Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry

Patel

Goodman

Yan

et al. 2018

JAHA

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BackgroundLittle is known about the prognostic implications of frailty, a state of susceptibility to stressors and poor recovery to homeostasis in older people, after myocardial infarction (MI).Methods and ResultsWe studied 3944 MI patients aged ≥65 years treated at 41 Australian hospitals from 2009 to 2016 in the CONCORDANCE (Australian Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events) registry. Frailty index (FI) was determined using the health deficit accumulation method. All‐cause and cardiac‐specific mortality at 6 months were compared between frail (FI >0.25) and nonfrail (FI ≤0.25) patients. Among 1275 patients with ST‐segment–elevation MI (STEMI), 192 (15%) were frail, and among 2669 non‐STEMI (NSTEMI) patients, 902 (34%) were frail. Compared with nonfrail counterparts, frail STEMI patients received 30% less reperfusion therapy and 22% less revascularization during index hospitalization; frail NSTEMI patients received 30% less diagnostic angiography and 39% less revascularization. Unadjusted 6‐month all‐cause mortality (STEMI: 13% versus 3%; NSTEMI: 13% versus 4%) and cardiac‐specific mortality (STEMI: 6% versus 1.4%, NSTEMI: 3.2% versus 1.2%) were higher among frail patients. After adjustment for known prognosticators, FI was significantly associated with higher 6‐month all‐cause (STEMI: odds ratio: 1.74 per 0.1 FI [95% confidence interval, 1.37–2.22], P<0.001; NSTEMI: odds ratio: 1.62 per 0.1 FI [95% confidence interval, 1.40–1.87], P<0.001) but not cardiac‐specific mortality (STEMI: P=0.99; NSTEMI: P=0.93).ConclusionsFrail patients receive lower rates of invasive cardiac care during MI hospitalization. Increased frailty was independently associated with increased postdischarge all‐cause mortality but not cardiac‐specific mortality. These findings inform identification of frailty during MI hospitalization as a potential opportunity to address competing risks for mortality in this high‐risk population.

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“…Third, our study population was derived from 6 hospitals diverse in payer status, age, race/ethnicity, and socioeconomic status, increasing the potential generalizability of our findings. Fourth, our models are less likely to be overfit to the idiosyncrasies of our data given that the predictors in our final AMI‐specific models have good clinical face validity, and have been associated with adverse outcomes, particularly mortality, in prior studies of this population 28, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39…”

Section: Discussionmentioning

confidence: 99%

Predicting 30‐Day Hospital Readmissions in Acute Myocardial Infarction: The AMI “READMITS” (Renal Function, Elevated Brain Natriuretic Peptide, Age, Diabetes Mellitus , Nonmale Sex , Intervention with Timely Percutaneous Coronary Intervention, and Low Systolic Blood Pressure) Score

Nguyen

Makam

Clark

et al. 2018

JAHA

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BackgroundReadmissions after hospitalization for acute myocardial infarction (AMI) are common. However, the few currently available AMI readmission risk prediction models have poor‐to‐modest predictive ability and are not readily actionable in real time. We sought to develop an actionable and accurate AMI readmission risk prediction model to identify high‐risk patients as early as possible during hospitalization.Methods and ResultsWe used electronic health record data from consecutive AMI hospitalizations from 6 hospitals in north Texas from 2009 to 2010 to derive and validate models predicting all‐cause nonelective 30‐day readmissions, using stepwise backward selection and 5‐fold cross‐validation. Of 826 patients hospitalized with AMI, 13% had a 30‐day readmission. The first‐day AMI model (the AMI “READMITS” score) included 7 predictors: renal function, elevated brain natriuretic peptide, age, diabetes mellitus, nonmale sex, intervention with timely percutaneous coronary intervention, and low systolic blood pressure, had an optimism‐corrected C‐statistic of 0.73 (95% confidence interval, 0.71–0.74) and was well calibrated. The full‐stay AMI model, which included 3 additional predictors (use of intravenous diuretics, anemia on discharge, and discharge to postacute care), had an optimism‐corrected C‐statistic of 0.75 (95% confidence interval, 0.74–0.76) with minimally improved net reclassification and calibration. Both AMI models outperformed corresponding multicondition readmission models.ConclusionsThe parsimonious AMI READMITS score enables early prospective identification of high‐risk AMI patients for targeted readmissions reduction interventions within the first 24 hours of hospitalization. A full‐stay AMI readmission model only modestly outperformed the AMI READMITS score in terms of discrimination, but surprisingly did not meaningfully improve reclassification.

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Predicting In-Hospital Mortality in Patients With Acute Myocardial Infarction

Cited by 191 publications

References 33 publications

Effect and Safety of Morphine Use in Acute Anterior ST‐Segment Elevation Myocardial Infarction

Effect and Safety of Morphine Use in Acute Anterior ST‐Segment Elevation Myocardial Infarction

Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry

Predicting 30‐Day Hospital Readmissions in Acute Myocardial Infarction: The AMI “READMITS” (Renal Function, Elevated Brain Natriuretic Peptide, Age, Diabetes Mellitus , Nonmale Sex , Intervention with Timely Percutaneous Coronary Intervention, and Low Systolic Blood Pressure) Score

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