Patient-specific predictions of outcomes in myocardial infarction for real-time emergency use: a thrombolytic predictive instrument.
Journal Article
Background
Thrombolytic therapy can be life-saving in patients with acute myocardial infarction. However, if given too late or insufficiently selectively, it may provide little benefit but still cause serious complications and incur substantial costs.Objective
To develop a thrombolytic predictive instrument for real-time use in emergency medical service settings that could 1) identify patients likely to benefit from thrombolysis and 2) facilitate the earliest possible use of this therapy.Design
Creation and validation of logistic regression-based predictive instruments based on secondary analysis of clinical data.Patients
4911 patients who had acute myocardial infarction and ST-segment elevation on electrocardiogram; 3483 received thrombolytic therapy.Measurements
Data were obtained from 13 major clinical trials and registries and directly from medical records, including electrocardiograms obtained at presentation. Input variables include presenting clinical and electrocardiography features; predictive models generate probabilities for acute (30-day) mortality if and if not treated with thrombolysis, 1-year mortality rates if and if not treated with thrombolysis, cardiac arrest if and if not treated with thrombolysis, thrombolysis-related intracranial hemorrhage, and thrombolysis-related major bleeding episode requiring transfusion. Together, these models constitute the thrombolytic predictive instrument.Results
The predictive models generated the following mean predictions for patients in the Thrombolytic Predictive instrument Database: 30-day mortality rate, 7.1%; 1-year mortality rate, 10.9%; rate of cardiac arrest, 3.7%; rate of thrombolysis-related intracranial hemorrhage. 0.6%; and rate of other thrombolysis-related major bleeding episodes, 5.0%. They discriminated with between persons having and those not having the predicted outcome; areas under the receiver-operating characteristic (ROC) curve were between 0.77 and 0.84 for the five outcomes. Calibration between each instrument's predicted and observed served rates was excellent. Validation of the predictive instruments of 30-day and 1-year mortality, done on a separate test dataset, yielded areas under the ROC curve of 0.76 for eachConclusions
After the basic features of a clinical presentation are entered into a computerized electrocardiograph, the predictions of the thrombolytic predictive instrument can be printed on the electrocardiogram report. This decision aid may facilitate earlier and more appropriate use of thrombolytic therapy in patients with acute myocardial infarction.Full Text
Duke Authors
Cited Authors
- Selker, HP; Griffith, JL; Beshansky, JR; Schmid, CH; Califf, RM; D'Agostino, RB; Laks, MM; Lee, KL; Maynard, C; Selvester, RH; Wagner, GS; Weaver, WD
Published Date
- October 1997
Published In
Volume / Issue
- 127 / 7
Start / End Page
- 538 - 556
PubMed ID
- 9313022
Pubmed Central ID
- 9313022
Electronic International Standard Serial Number (EISSN)
- 1539-3704
International Standard Serial Number (ISSN)
- 0003-4819
Digital Object Identifier (DOI)
- 10.7326/0003-4819-127-7-199710010-00006
Language
- eng