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Time-based risk assessment after myocardial infarction. Implications for timing of discharge and applications to medical decision-making.

Publication ,  Journal Article
Newby, LK; Hasselblad, V; Armstrong, PW; Van de Werf, F; Mark, DB; White, HD; Topol, EJ; Califf, RM
Published in: Eur Heart J
January 2003

AIMS: We evaluated timing of adverse cardiac events after thrombolysis to guide length of stay after ST-segment elevation myocardial infarction. METHODS AND RESULTS: Kaplan-Meier survival curves described timing of major postinfarction complications in 41021 fibrinolytic-treated patients in GUSTO-I. Using model-fitting, these data were best explained by a mixed-exponential survival model: an acute curve describing most adverse events and a chronic curve describing a lower background rate. We replicated this strategy in 15059 fibrinolytic-treated patients in GUSTO-III. From the relation between time and events described by the model's acute curve in GUSTO-III, we proposed times for hospital discharge. The acute curve explained 97% of deaths and 68%-96% of various event composites. Of complications within 10 days, 90% of deaths and 70% of acute curve death, stroke, shock, heart failure, or reinfarction occurred by 24 h. By 2.7 days, 95% of deaths, stroke, shock, heart failure, or reinfarction occurred. Most major ventricular arrhythmias occurred within 24 h, after which the hazard curve was flat. CONCLUSIONS: Mixed-exponential survival modelling describes timing of post-infarction complications and supports discharge 4 days after uncomplicated infarction. Such time-based risk assessment could guide decision-making in other settings in which randomized studies are impractical.

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Published In

Eur Heart J

DOI

ISSN

0195-668X

Publication Date

January 2003

Volume

24

Issue

2

Start / End Page

182 / 189

Location

England

Related Subject Headings

  • Time Factors
  • Thrombolytic Therapy
  • Survival Rate
  • Survival Analysis
  • Risk Factors
  • Risk Assessment
  • Proportional Hazards Models
  • Prognosis
  • Patient Discharge
  • Myocardial Infarction
 

Citation

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ICMJE
MLA
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Newby, L. K., Hasselblad, V., Armstrong, P. W., Van de Werf, F., Mark, D. B., White, H. D., … Califf, R. M. (2003). Time-based risk assessment after myocardial infarction. Implications for timing of discharge and applications to medical decision-making. Eur Heart J, 24(2), 182–189. https://doi.org/10.1016/s0195-668x(02)00301-9
Newby, L. K., V. Hasselblad, P. W. Armstrong, F. Van de Werf, D. B. Mark, H. D. White, E. J. Topol, and R. M. Califf. “Time-based risk assessment after myocardial infarction. Implications for timing of discharge and applications to medical decision-making.Eur Heart J 24, no. 2 (January 2003): 182–89. https://doi.org/10.1016/s0195-668x(02)00301-9.
Newby LK, Hasselblad V, Armstrong PW, Van de Werf F, Mark DB, White HD, et al. Time-based risk assessment after myocardial infarction. Implications for timing of discharge and applications to medical decision-making. Eur Heart J. 2003 Jan;24(2):182–9.
Newby, L. K., et al. “Time-based risk assessment after myocardial infarction. Implications for timing of discharge and applications to medical decision-making.Eur Heart J, vol. 24, no. 2, Jan. 2003, pp. 182–89. Pubmed, doi:10.1016/s0195-668x(02)00301-9.
Newby LK, Hasselblad V, Armstrong PW, Van de Werf F, Mark DB, White HD, Topol EJ, Califf RM. Time-based risk assessment after myocardial infarction. Implications for timing of discharge and applications to medical decision-making. Eur Heart J. 2003 Jan;24(2):182–189.
Journal cover image

Published In

Eur Heart J

DOI

ISSN

0195-668X

Publication Date

January 2003

Volume

24

Issue

2

Start / End Page

182 / 189

Location

England

Related Subject Headings

  • Time Factors
  • Thrombolytic Therapy
  • Survival Rate
  • Survival Analysis
  • Risk Factors
  • Risk Assessment
  • Proportional Hazards Models
  • Prognosis
  • Patient Discharge
  • Myocardial Infarction