A simple risk index for rapid initial triage of patients with STelevation myocardial infarction: an

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A simple risk index for rapid initial triage of
patients with ST-elevation myocardial infarction
an InTIME II substudy

• 91-01-02
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Introduction

• Rapid, effective triage for patients with STEMI
  and predicting mortality
• present directly to the ED/ immediate assessment
  of risk
• TIMI (thrombolysis in myocardial infarction) risk
  score
• age, heart rate and SBP at presentation of
  patients with STEMI
• assessed a risk index HRx(age/10)²/SBP

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Methods

• Derivation
• Basis on 13253 patients with STEMI from the
  InTIME II study, enrolled within 6 hours of
  symptom onset at a over 800 hospitals and
  randomly arranged with the bolus-fibrinolytic
  lanoteplase or alteplase.
• Exclusion criteria included history of
  cerebrovascular disease, SBP gt180 or lt110 mmHg,
  cardiogenic shock, and risk of severe bleeding.

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Methods (2)

• Statistical analysis
• the risk index HRx(age/10)²/SBP, for
  predicting mortality over 30 days
• a HR range between 50 to 150 beat/min
• age non-linear but uniform increasing relation
  with mortality
• predictive power
• prognostic discriminatory capacity
• the gradient in mortality across risk score
  groups

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Methods (3)

• Model validation
• assessed the risk index in an external data set
  of patients with STEMI, TIMI 9A and B
• discriminatory capacity
• 5 risk groups in TIMI 9, the observed mortality
  versus the expected mortality

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Results

• InTIME II mortality rates at 24 h, hospital
  discharge, and 30 days 2.1, 5.4, 6.0
• risk index strong predictor of mortality at 30
  days
• robust predictor within 24 h and hospital
  discharge
• new or worsening heart failure at 24 h and
  hospital discharge
• external validation from the TIMI 9A/B, high
  discriminatory capacity and excellent concordance
  between the observed and predicted value a
  strong predictor of early death and heart failure

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Discussion

• Assessment can be down at first contact with
  patient by the risk index early decision making
• Prehospital ECG and assessment of eligibility for
  reperfusion therapy
• future investigations
• patients ineligible for fibrinolysis, or
  excluded from clinical trials, even with severe
  bradycardia or tachycardia, could be at higher
  risk of adverse outcome- Unselected population.
• Additional data to update the risk assessment
• The development of protocols provide a
  seamless fabric of care from the prehospital
  setting, through the ED, to the cath lab and CCU.

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Thank you for your attention