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ACTION Risk Model Predicts In-Hospital Myocardial Infarction Death

The new ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry–GWTG (Get With the Guidelines) model for predicting in-hospital mortality in patients with acute myocardial infarction (MI) is effective for risk adjustment and risk stratification, according to a recent study.

The study aimed to develop and validate a parsimonious patient-level clinical risk model of in-hospital mortality for patients with acute MI. The study’s findings were published in the Journal of the American College of Cardiology.

Researchers focused on patient characteristics reported in the ACTION Registry–GWTG database from January 2012 through December 2013. The data were used to develop a multivariate, hierarchical logistic regression model to predict in-hospital mortality.
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Study participants included 243,440 patients across 655 hospitals. Patients were divided into a 60% sample for model derivation, and a 40% sample for model validation. Researchers created a simplified risk score to enable prospective risk stratification in clinical care.

Study results showed that the overall in-hospital mortality rate was 4.6%. Independent factors attributing to in-hospital mortality included age, heart rate, blood pressure, presentation after cardiac arrest, presentation in cardiogenic shock, presentation in heart failure, presentation with ST-segment elevation myocardial infarction, creatinine clearance, and troponin ratio.

Researchers reported that mortality rates varied substantially across risk groups, ranging from 0.4% in the lowest risk group (score <30) to 49.5% in the highest risk group (score >59).

The study received grants from the American College of Cardiology Foundation, Eli Lilly, Gilead, and Genentech and consulting for Novartis, Regeneron, Bayer and Amgen. -Julie Gould

 

Reference:

McNamara RL, Kennedy KF, Cohen DJ, et al. Predicting In-Hospital Mortality in Patients With Acute Myocardial Infarction [published online August 2016]. J Am Coll Cardiol. 2016;68(6):626-635. doi:10.1016/j.jacc.2016.05.049

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