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Predicting long-term mortality in older patients after non-ST-segment elevation myocardial infarction: the CRUSADE
Matthew T Roe1, Anita Y Chen, Laine Thomas
1Duke Clinical Research Institute, Durham, NC, USA. matthew.roe@duke.edu
Insights
Older patients with non-ST-segment elevation myocardial infarction (NSTEMI) have high long-term mortality risks. A new risk score accurately predicts these outcomes using baseline characteristics, aiding treatment decisions.
Area of Science:
- Cardiology
- Geriatric Medicine
- Public Health
Background:
- Limited data exist on long-term mortality and risk predictors after myocardial infarction in current community practice.
- Understanding these factors is crucial for managing older adults post-NSTEMI.
Purpose of the Study:
- To develop a long-term mortality risk prediction model for older patients (≥65 years) with non-ST-segment elevation myocardial infarction (NSTEMI).
- To create a simplified risk score for clinical use in this patient population.
Main Methods:
- Utilized data from 43,239 NSTEMI patients (≥65 years) from the CRUSADE registry (2003-2006).
- Linked registry data with Medicare and Medicaid data for longitudinal mortality tracking (median 453 days follow-up).
- Employed Cox proportional hazard modeling to identify independent predictors of long-term mortality.
Main Results:
- Identified 22 variables associated with long-term mortality (full model c-statistic: 0.754).
- Developed the CRUSADE long-term mortality risk score using 13 key variables, achieving good discrimination (c-statistic: 0.734) and calibration.
- Observed 1, 2, and 3-year mortality rates of 24.4%, 33.2%, and 40.3% respectively in the study cohort (median age 77).
Conclusions:
- Older patients with NSTEMI experience significant long-term mortality.
- Baseline characteristics can accurately predict long-term mortality risk in these patients.
- The developed risk score can inform treatment decisions and facilitate provider outcome comparisons.
Objectives:
We sought to develop a long-term mortality risk prediction model and a simplified risk score for use in older patients with non-ST-segment elevation myocardial infarction (NSTEMI).
Background:
Limited data are available regarding long-term mortality rates and concomitant risk predictors after acute myocardial infarction in contemporary community practice.
Methods:
From the CRUSADE registry, a total of 43,239 (NSTEMI) patients aged ≥65 years treated at 448 hospitals in the United States from 2003 to 2006 were linked to Centers for Medicare and Medicaid Services data to track longitudinal all-cause mortality (median follow-up 453 days). Cox proportional hazard modeling was used to determine baseline independent demographic, clinical, and laboratory variables associated with long-term mortality. A simplified long-term mortality risk score was subsequently developed from these results.
Results:
The median age of this population was 77 years, and mortality rates at 1, 2, and 3 years were 24.4%, 33.2%, and 40.3%, respectively. We identified 22 variables independently associated with long-term mortality in a full model (c-statistic 0.754 in the derivation sample and 0.744 in the validation sample). The CRUSADE long-term mortality risk score was limited to the 13 most clinically and statistically significant variables from the full model yet retained comparable discrimination in the derivation and validation samples (c-statistics 0.734 and 0.727, respectively) and had good calibration across the risk spectra.
Conclusions:
Older patients face substantial long-term mortality risks after NSTEMI that can be accurately predicted from baseline characteristics. These prognostic estimates may support informed treatment decision-making and comparison of long-term provider outcomes.
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