Paramedical and clinical staff could use a straightforward risk-assessment model to estimate the likely outcome of heart-attack patients outside the hospital environment and immediately after admission to emergency departments, conclude authors of a study in this week’s issue of THE LANCET.
Rapid and effective cardiac assessment is integral to emergency cardiac care of patients with a specific heart-attack profile called ST-elevation myocardial infarction (STEMI). Current models for predicting death in STEMI patients include up to 45 variables; advanced age, increased heart rate, and decreased blood pressure are among the strongest predictors.
Using data from over 13,000 STEMI patients from the InTIME II trial, David Morrow and colleagues from Brigham and Women’s Hospital, Boston, USA, developed and assessed a simple risk index using age, heart rate, and systolic blood pressure (SBP) for predicting death over 30 days. The risk index was a strong and independent predictor of mortality risk. When the risk index was categorised into quintiles for convenient clinical use, it revealed a more than 20-fold gradient of increasing mortality from 0.8 to 17.4%. The risk index was also a robust predictor of very early events, including death within 24 hours. The study was externally validated with similar prediction values from the TIMI 9 trials.
In an accompanying Commentary (p 1566), Brian Gibler from the University of Cincinatti College of Medicine, USA, concludes: “For a risk score such as that suggested by the TIMI group to be used to provide a seamless fabric of care from the prehospital setting, through the emergency department, to the cardiac catheterisation laboratory, and the coronary-care unit requires the development of protocols, some of which have to be local-eg, which hospitals are appropriate for which risk scores. However, the next steps should be the study of whether pre-hospital use of this simple risk score for STEMI identifies critically ill patients and whether their transport to specialist emergency cardiac-care centres improves outcome for them.”
Contact: Dr David A. Morrow, Cardiovascular Division, Department of Medicine, Brigham & Women’s Hospital, 75 Francis Street, Boston MA 02115, USA; T) +1 617 278-0145; F) +1 617 734-7329; E) damorrow@bics.bwh.harvard.edu
Dr W Brian Gibler, Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA; T) +1 513 558 8086; F) +1 513 558 4599; E) giblerwb@ucmail.uc.edu
Journal
The Lancet