מתוך medicontext.co.il
WESTPORT, CT (Reuters Health) – A simple risk index using age, systolic blood pressure and heart rate reliably predicts 30-day mortality in patients with ST-elevation myocardial infarction (MI), researchers report in the November 10th issue of The Lancet.
"There have been some very elegant models that have identified a number of important predictors for patients with ST-elevation MI," Dr. Morrow from Brigham and Women's Hospital in Boston told Reuters Health.
Those models contain up to 45 variables, he said. "Our goal was to develop an index that would be useful for everyone involved in the clinical care of these patients, and could be applied easily [and] very early after patient presentation."
Dr. Morrow and colleagues collected data on 13,253 patients who participated in the InTIME II trial. They used these data to develop a risk index that predicted mortality at 30 days: (heart rate x [age/10]² )/ systolic blood pressure. "Using just these three simple factors put together, we can reliably predict mortality," Dr. Morrow said.
Elderly patients with low blood pressure and elevated heart rate are the patients at highest risk, while younger patients with normal blood pressure and normal heart rate are those at lowest risk, Dr. Morrow explained. Risk index scores range from 12.5 or less for those with the lowest risk to more than 30 for patients at the highest risk.
The index was a strong independent predictor (p < 0.0001), the researchers note. It showed a more than 20-fold gradient of increasing mortality from 0.8% to 17.4%, when they categorized the index into quintiles (p < 0.0001). "The risk index was also a robust predictor of very early events, including death by 24 hours," Dr. Morrow's team notes.
When the investigators applied their index to 3659 patients from the TIMI 9A/B trial, they found that the risk index had a similar gradient of mortality as found in the InTIME II trial. "The risk index showed both a high discriminatory capacity and excellent concordance between the predictions based on InTIME II and the observed 30-day mortality rates in TIMI 9A/B," the researchers write.
Dr. Morrow believes this risk index can be used by paramedics in the field, as well as by emergency department personnel in the acute care of patients, to help make triage and treatment decisions. For example, using the index, high-risk patients can be identified and given prehospital thrombolysis or triaged to an institution for primary angioplasty.
In a journal editorial, Dr. W. Brian Gibler from the University of Cincinnati College of Medicine in Ohio comments on the study by Morrow, et al.
Protocols need to be developed before a risk score such as that suggested by the TIMI group can provide a "seamless fabric of care from the prehospital setting, through the emergency department, to the cardiac catheterization laboratory, and the coronary care unit," Dr. Gibler writes.
He recommends the next step "should be the study of whether prehospital use of this simple risk score for ST-elevated MI identifies critically ill patients and whether their transport to specialist emergency cardiac-care centers improves outcome for them."
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