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Dynamic modeling of 90-day mortality in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

Publication ,  Journal Article
Westerhout, CM; Pieper, KS; James, SK; Mahaffey, KW; de Werf, FV; Califf, RM; Granger, CB; Armstrong, PW
Published in: Am Heart J
March 2013

AIMS: Dynamic risk models update the risk profile of ST-elevation myocardial infarction (STEMI) patients over the acute period following the event and have implications to clinical practice and research. METHODS AND RESULTS: Multivariable survival models were developed in 5,745 STEMI patients undergoing primary percutaneous coronary intervention (PCI) enrolled in the APEX-AMI trial to predict 90-day mortality from 4 clinically relevant times: baseline, 2 hours, 24 hours, and 96 hours. Culprit coronary thrombolysis in myocardial infarction flow grade, 30-minute post-PCI worst-lead ST-elevation residual, and in-hospital clinical events were considered in the models. The 90-day mortality was 4.7%; the cumulative proportion of mortality occurring within 2, 24, and 96 hours was 8%, 22%, and 40% respectively. Relative to the baseline risk factors, age and systolic blood pressure remained highly ranked in the post-baseline models. However, the relative importance of heart rate, Killip class, and creatinine declined, whereas markers of coronary reperfusion and in-hospital events (shock, congestive heart failure) became increasingly influential. The c-index increased from 0.819 at baseline to 0.847 at 96 hours. Over the forecasting periods, the proportion of "low-risk" (<1.1% 90-day mortality) patients increased from 20% to 49%. This approach derived from an unfolding series of models reveals the shifting levels of mortality risk from baseline to 96 hours. CONCLUSION: This novel approach in STEMI patients undergoing primary PCI demonstrates the dynamic nature of risk over time and may prove useful in understanding risk and in clinical decision making.

Duke Scholars

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

March 2013

Volume

165

Issue

3

Start / End Page

354 / 62.e2

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Single-Chain Antibodies
  • Risk Factors
  • Proportional Hazards Models
  • Percutaneous Coronary Intervention
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Westerhout, C. M., Pieper, K. S., James, S. K., Mahaffey, K. W., de Werf, F. V., Califf, R. M., … Armstrong, P. W. (2013). Dynamic modeling of 90-day mortality in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Am Heart J, 165(3), 354-62.e2. https://doi.org/10.1016/j.ahj.2012.12.001
Westerhout, Cynthia M., Karen S. Pieper, Stefan K. James, Kenneth W. Mahaffey, Frans Van de Werf, Robert M. Califf, Christopher B. Granger, and Paul W. Armstrong. “Dynamic modeling of 90-day mortality in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.Am Heart J 165, no. 3 (March 2013): 354-62.e2. https://doi.org/10.1016/j.ahj.2012.12.001.
Westerhout CM, Pieper KS, James SK, Mahaffey KW, de Werf FV, Califf RM, et al. Dynamic modeling of 90-day mortality in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Am Heart J. 2013 Mar;165(3):354-62.e2.
Westerhout, Cynthia M., et al. “Dynamic modeling of 90-day mortality in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.Am Heart J, vol. 165, no. 3, Mar. 2013, pp. 354-62.e2. Pubmed, doi:10.1016/j.ahj.2012.12.001.
Westerhout CM, Pieper KS, James SK, Mahaffey KW, de Werf FV, Califf RM, Granger CB, Armstrong PW. Dynamic modeling of 90-day mortality in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Am Heart J. 2013 Mar;165(3):354–62.e2.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

March 2013

Volume

165

Issue

3

Start / End Page

354 / 62.e2

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Single-Chain Antibodies
  • Risk Factors
  • Proportional Hazards Models
  • Percutaneous Coronary Intervention
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Female