CLINICAL STUDY: MYOCARDIAL INFARCTION
Predicting one-year mortality among elderly survivors of hospitalization for an acute myocardial infarction: results from the Cooperative Cardiovascular Project
Harlan M. Krumholz, MD, FACC,,*    ,
Jersey Chen, MD, MPH*,1,
Ya-Ting Chen, PhD*,2,
Yongfei Wang, MS* and
Martha J. Radford, MD, FACC*
* Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA
Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut, USA
Qualidigm®, Middletown, Connecticut, USA
Manuscript received August 2, 2000;
revised manuscript received March 12, 2001,
accepted April 24, 2001.
Reprint requests and correspondence: Dr. Harlan M. Krumholz, Yale University School of Medicine, 333 Cedar Street, PO Box 208025, New Haven, Connecticut 06520-8025
OBJECTIVES
We sought to develop a model based on information available from the medical record that would accurately stratify elderly patients who survive hospitalization with an acute myocardial infarction (AMI) according to their risk of one-year mortality.
BACKGROUND
Prediction of the risk of mortality among older survivors of an AMI has many uses, yet few studies have determined the prognostic importance of demographic, clinical and functional data that are available on discharge in a population-based sample.
METHODS
In a cohort of patients aged  65 years who survived hospitalization for a confirmed AMI from 1994 to 1995 at acute care, nongovernmental hospitals in the U.S., we developed a parsimonious model to stratify patients by their risk of one-year mortality.
RESULTS
The study sample of 103,164 patients, with a mean age of 76.8 years, had a one-year mortality of 22%. The factors with the strongest association with mortality were older age, urinary incontinence, assisted mobility, presence of heart failure or cardiomegaly any time before discharge, presence of peripheral vascular disease, body mass index <20 kg/m2, renal dysfunction (defined as creatinine >2.5 mg/dl or blood urea nitrogen >40 mg/dl) and left ventricular dysfunction (left ventricular ejection fraction <40%). On the basis of the coefficients in the model, patients were stratified into risk groups ranging from 7% to 49%.
CONCLUSIONS
We demonstrate that a simple risk model can stratify older patients well by their risk of death one year after discharge for AMI.
|
Abbreviations and Acronyms
| | AMI | = acute myocardial infarction | | AROC | = area under the receiver operating characteristic | | CCP | = Cooperative Cardiovascular Project | | GUSTO | = Global Utilization of Streptokinase and tPA for Occluded Coronary Arteries | | ICD-9-CM | = International Classification of Diseases, Ninth Revision, Clinical Modification | | LVEF | = left ventricular ejection fraction | | PREDICT | = Predicting Risk of Death in Cardiac Disease Tool | | ROC | = receiver operating characteristic |
|
This article has been cited by other articles:
|
|
|
|
 
M. J. Pletcher, L. Lazar, K. Bibbins-Domingo, A. Moran, N. Rodondi, P. Coxson, J. Lightwood, L. Williams, and L. Goldman
Comparing Impact and Cost-Effectiveness of Primary Prevention Strategies for Lipid-Lowering
Ann Intern Med,
February 17, 2009;
150(4):
243 - 254.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Spertus
Evolving Applications for Patient-Centered Health Status Measures
Circulation,
November 11, 2008;
118(20):
2103 - 2110.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M Singh, C S Rihal, V L Roger, R J Lennon, J Spertus, A Jahangir, and D R Holmes Jr
Comorbid conditions and outcomes after percutaneous coronary intervention
Heart,
November 1, 2008;
94(11):
1424 - 1428.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C P Gale, S O M Manda, P D Batin, C F Weston, J S Birkhead, and A S Hall
Predictors of in-hospital mortality for patients admitted with ST-elevation myocardial infarction: a real-world study using the Myocardial Infarction National Audit Project (MINAP) database
Heart,
November 1, 2008;
94(11):
1407 - 1412.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Singh, K. Alexander, V. L. Roger, C. S. Rihal, H. E. Whitson, A. Lerman, A. Jahangir, and K. S. Nair
Frailty and Its Potential Relevance to Cardiovascular Care
Mayo Clin. Proc.,
October 1, 2008;
83(10):
1146 - 1153.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. M. Albert and C. Lewis
Recognizing and Managing Asymptomatic Left Ventricular Dysfunction: After Myocardial Infarction
Crit. Care Nurse,
April 1, 2008;
28(2):
20 - 37.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Abdulla, L. Kober, S. Z. Abildstrom, E. Christensen, W. P. T. James, and C. Torp-Pedersen
Impact of obesity as a mortality predictor in high-risk patients with myocardial infarction or chronic heart failure: a pooled analysis of five registries
Eur. Heart J.,
March 1, 2008;
29(5):
594 - 601.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. L. Smith, F. A. Masoudi, M. G. Shlipak, H. M. Krumholz, and C. R. Parikh
Renal Impairment Predicts Long-Term Mortality Risk after Acute Myocardial Infarction
J. Am. Soc. Nephrol.,
January 1, 2008;
19(1):
141 - 150.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. L. Smith, M. G. Shlipak, E. P. Havranek, J. M. Foody, F. A. Masoudi, S. S. Rathore, and H. M. Krumholz
Serum urea nitrogen, creatinine, and estimators of renal function: mortality in older patients with cardiovascular disease.
Arch Intern Med,
May 22, 2006;
166(10):
1134 - 1142.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. D. Wiviott, D. A. Morrow, P. D. Frederick, E. M. Antman, and E. Braunwald
Application of the Thrombolysis In Myocardial Infarction Risk Index in Non-ST-Segment Elevation Myocardial Infarction: Evaluation of Patients in the National Registry of Myocardial Infarction
J. Am. Coll. Cardiol.,
April 18, 2006;
47(8):
1553 - 1558.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. J. Meine, M. R. Patel, V. DePuy, L. H. Curtis, S. V. Rao, B. J. Gersh, K. A. Schulman, and J. G. Jollis
Evidence-Based Therapies and Mortality in Patients Hospitalized in December with Acute Myocardial Infarction
Ann Intern Med,
October 4, 2005;
143(7):
481 - 485.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. C. Fonarow, K. F. Adams Jr, W. T. Abraham, C. W. Yancy, W. J. Boscardin, and for the ADHERE Scientific Advisory Committee, Stud
Risk Stratification for In-Hospital Mortality in Acutely Decompensated Heart Failure: Classification and Regression Tree Analysis
JAMA,
February 2, 2005;
293(5):
572 - 580.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Bursi, M. Enriquez-Sarano, V. T. Nkomo, S. J. Jacobsen, S. A. Weston, R. A. Meverden, and V. L. Roger
Heart Failure and Death After Myocardial Infarction in the Community: The Emerging Role of Mitral Regurgitation
Circulation,
January 25, 2005;
111(3):
295 - 301.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. D. Wiviott, D. A. Morrow, P. D. Frederick, R. P. Giugliano, C.M. Gibson, C. H. McCabe, C. P. Cannon, E. M. Antman, and E. Braunwald
Performance of the thrombolysis in myocardial infarction risk index in the National Registry of Myocardial Infarction-3 and -4: A simple index that predicts mortality in ST-segment elevation myocardial infarction
J. Am. Coll. Cardiol.,
August 18, 2004;
44(4):
783 - 789.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. V. Rao, K. A. Schulman, L. H. Curtis, B. J. Gersh, and J. G. Jollis
Socioeconomic Status and Outcome Following Acute Myocardial Infarction in Elderly Patients
Arch Intern Med,
May 24, 2004;
164(10):
1128 - 1133.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. R. Narins, W. Zareba, A. J. Moss, V. J. Marder, P. M. Ridker, R. J. Krone, and E. Lichstein
Relationship Between Intermittent Claudication, Inflammation, Thrombosis, and Recurrent Cardiac Events Among Survivors of Myocardial Infarction
Arch Intern Med,
February 23, 2004;
164(4):
440 - 446.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Lopez-Jimenez, T. Y. Goraya, J. P. Hellermann, S. J. Jacobsen, G. S. Reeder, S. A. Weston, and V. L. Roger
Measurement of Ejection Fraction After Myocardial Infarction in the Population
Chest,
February 1, 2004;
125(2):
397 - 403.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Torre-Amione, J. B. Young, W. S. Colucci, B. S. Lewis, C. Pratt, G. Cotter, K. Stangl, U. Elkayam, J. R. Teerlink, A. Frey, et al.
Hemodynamic and clinical effects of tezosentan, an intravenous dual endothelin receptor antagonist, in patients hospitalized for acute decompensated heart failure
J. Am. Coll. Cardiol.,
July 2, 2003;
42(1):
140 - 147.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M.A. Pfeffer
The intersection between acute coronary syndrome and heart failure
Eur. Heart J. Suppl.,
April 1, 2003;
5(suppl_C):
C19 - C23.
[Abstract]
[PDF]
|
|
|
|
|
|
|
P. A. James, A. J. Hartz, B. T. Levy, J. Z. Ayanian, M. B. Landrum, and P. Gaccione
Specialty of Ambulatory Care Physicians and Mortality after Myocardial Infarction
N. Engl. J. Med.,
March 27, 2003;
348(13):
1288 - 1289.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. M. Bravata, S.-Y. Ho, L. M. Brass, J. Concato, J. Scinto, and T. P. Meehan
Long-Term Mortality in Cerebrovascular Disease
Stroke,
March 1, 2003;
34(3):
699 - 704.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L.K Newby, M.V Bhapkar, H.D White, E.J Topol, F.C Dougherty, R.A Harrington, M.C Smith, L.F Asarch, R.M Califf, and for the SYMPHONY and 2nd SYMPHONY Investigators
Predictors of 90-day outcome in patients stabilized after acute coronary syndromes
Eur. Heart J.,
January 2, 2003;
24(2):
172 - 181.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. A. Geraci and C. K. Haan
Effect of beta blockers after coronary artery bypass in postinfarct patients: what can we learn from available literature?
Ann. Thorac. Surg.,
November 1, 2002;
74(5):
1727 - 1732.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. S. Weintraub
Prediction Scores After Myocardial Infarction: Value, Limitations, and Future Directions
Circulation,
October 29, 2002;
106(18):
2292 - 2293.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Singh, G. S. Reeder, S. J. Jacobsen, S. Weston, J. Killian, and V. L. Roger
Scores for Post-Myocardial Infarction Risk Stratification in the Community
Circulation,
October 29, 2002;
106(18):
2309 - 2314.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. K. Teo and D. J. Catellier
Risk prediction after myocardial infarction in the elderly
J. Am. Coll. Cardiol.,
August 1, 2001;
38(2):
460 - 463.
[Full Text]
[PDF]
|
|
|
|
