Predictors of hospital mortality in the global registry of acute coronary events.

Journal Article (Journal Article)

BACKGROUND: Management of acute coronary syndromes (ACS) should be guided by an estimate of patient risk. OBJECTIVE: To develop a simple model to assess the risk for in-hospital mortality for the entire spectrum of ACS treated in general clinical practice. METHODS: A multivariable logistic regression model was developed using 11 389 patients (including 509 in-hospital deaths) with ACS with and without ST-segment elevation enrolled in the Global Registry of Acute Coronary Events (GRACE) from April 1, 1999, through March 31, 2001. Validation data sets included a subsequent cohort of 3972 patients enrolled in GRACE and 12 142 in the Global Use of Strategies to Open Occluded Coronary Arteries IIb (GUSTO-IIb) trial. RESULTS: The following 8 independent risk factors accounted for 89.9% of the prognostic information: age (odds ratio [OR], 1.7 per 10 years), Killip class (OR, 2.0 per class), systolic blood pressure (OR, 1.4 per 20-mm Hg decrease), ST-segment deviation (OR, 2.4), cardiac arrest during presentation (OR, 4.3), serum creatinine level (OR, 1.2 per 1-mg/dL [88.4- micro mol/L] increase), positive initial cardiac enzyme findings (OR, 1.6), and heart rate (OR, 1.3 per 30-beat/min increase). The discrimination ability of the simplified model was excellent with c statistics of 0.83 in the derived database, 0.84 in the confirmation GRACE data set, and 0.79 in the GUSTO-IIb database. CONCLUSIONS: Across the entire spectrum of ACS and in general clinical practice, this model provides excellent ability to assess the risk for death and can be used as a simple nomogram to estimate risk in individual patients.

Full Text

Duke Authors

Cited Authors

  • Granger, CB; Goldberg, RJ; Dabbous, O; Pieper, KS; Eagle, KA; Cannon, CP; Van De Werf, F; Avezum, A; Goodman, SG; Flather, MD; Fox, KAA; Global Registry of Acute Coronary Events Investigators,

Published Date

  • October 27, 2003

Published In

Volume / Issue

  • 163 / 19

Start / End Page

  • 2345 - 2353

PubMed ID

  • 14581255

International Standard Serial Number (ISSN)

  • 0003-9926

Digital Object Identifier (DOI)

  • 10.1001/archinte.163.19.2345


  • eng

Conference Location

  • United States