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The evolving clinical status of patients after a myocardial infarction: the importance of post-hospital data for mortality prediction.

Abstract：

:Studies predicting mortality after myocardial infarction (MI) usually rely on in-hospital data, and combine patients admitted for the first MI with recurrent MI patients. Since treatment decisions are often made or modified at the first outpatient clinic visit, this study was designed to evaluate the importance of post-hospital data on mortality prediction after a first myocardial infarction (MI). An inception cohort of patients enrolled in the Beta-Blocker in Heart Attack Trial (n = 2830) was included. Forty-three variables (including in-hospital and post-hospital data) were evaluated using stepwise logistic regression. Ten variables were independently associated with 1-year mortality: five used in-hospital data (history of hypertension, hypercholesterolemia, congestive heart failure [CHF], ventricular tachycardia, and age); and five variables depended on post-hospital data collected at the first outpatient visit (CHF after discharge, New York Heart Association functional class, heart rate, pulmonary rates, and smoking). Two predictive systems were developed that partitioned patients into one of four classes with distinct mortality risks: a composite system using the 10 in- and post-hospital variables, and a system using only the 5 in-hospital variables. Mortality risk for the composite system classes ranged from 0.6 to 20.0% (I [n = 861], 0.6%; II [n = 1151], 2.3%; III [n =698], 4.3%; IV [n = 120], 20.0%). In contrast, the range of mortality risk using the in-hospital data only system was less (1 to 8.3%). Most importantly, a distinct gradient within each class of the in-hospital data only system was created by the addition of the post-hospital data. This study demonstrates that risk stratification after an acute first MI is improved by the addition of post-hospital data.

journal_name

J Clin Epidemiol

journal_title

Journal of clinical epidemiology

authors

Elmore JG,Viscoli CM,Horwitz RI

doi

10.1016/s0895-4356(96)00221-1

subject

Has Abstract

pub_date

1996-11-01 00:00:00

pages

1233-8

issue

eissn

0895-4356

issn

1878-5921

pii

S0895-4356(96)00221-1

journal_volume

pub_type

临床试验,杂志文章,多中心研究,随机对照试验

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The evolving clinical status of patients after a myocardial infarction: the importance of post-hospital data for mortality prediction.