CLINICAL STUDY: MYOCARDIAL INFARCTION
Development and validation of the ontario acute myocardial infarction mortality prediction rules
Jack V. Tu, MD, PhD, FRCPC* e,
Peter C. Austin, PhD* e,
Randy Walld, BSc ,
Leslie Roos, PhD,
Jean Agras, PhD and
Kathryn M. McDonald, MM
* Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
e Department of Medicine and Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
Manitoba Centre for Health Policy and Evaluation, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
National Bureau of Economic Research, Stanford, California, USA
Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University, Stanford, California, USA
Manuscript received March 31, 2000;
revised manuscript received August 2, 2000,
accepted December 14, 2000.
Reprint requests and correspondence: Dr. Jack V. Tu, Institute for Clinical Evaluative Sciences, G-106, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
tu{at}ices.on.ca
OBJECTIVES
To develop and validate simple statistical models that can be used with hospital discharge administrative databases to predict 30-day and one-year mortality after an acute myocardial infarction (AMI).
BACKGROUND
There is increasing interest in developing AMI "report cards" using population-based hospital discharge databases. However, there is a lack of simple statistical models that can be used to adjust for regional and interinstitutional differences in patient case-mix.
METHODS
We used linked administrative databases on 52,616 patients having an AMI in Ontario, Canada, between 1994 and 1997 to develop logistic regression statistical models to predict 30-day and one-year mortality after an AMI. These models were subsequently validated in two external cohorts of AMI patients derived from administrative datasets from Manitoba, Canada, and California, U.S.
RESULTS
The 11-variable Ontario AMI mortality prediction rules accurately predicted mortality with an area under the receiver operating characteristic (ROC) curve of 0.78 for 30-day mortality and 0.79 for one-year mortality in the Ontario dataset from which they were derived. In an independent validation dataset of 4,836 AMI patients from Manitoba, the ROC areas were 0.77 and 0.78, respectively. In a second validation dataset of 112,234 AMI patients from California, the ROC areas were 0.77 and 0.78 respectively.
CONCLUSIONS
The Ontario AMI mortality prediction rules predict quite accurately 30-day and one-year mortality after an AMI in linked hospital discharge databases of AMI patients from Ontario, Manitoba and California. These models may also be useful to outcomes and quality measurement researchers in other jurisdictions.
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Abbreviations and Acronyms
| | AMI | = acute myocardial infarction | | ICD | = International Classification of Diseases | | OMID | = Ontario Myocardial Infarction Database | | OR | = odds ratio | | ROC | = receiver operating characteristic | | TECH | = Technological Change in Health Care |
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