Predictors of 30-day Mortality in ST-Elevation Myocardial Infarction (STEMI) Patients
Eka Ginanjar1, Muhammad Yamin, Ika Prasetya Wijaya
1Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital. ekaginanjar@gmail.com.
Insights
This study identified Killip class and glomerulus filtration rate (GFR) as key predictors of 30-day mortality in ST-elevation myocardial infarction (STEMI) patients. The developed scoring system offers a reliable tool for risk stratification.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- Assessing 30-day mortality in ST-elevation myocardial infarction (STEMI) patients is crucial for effective treatment and resource allocation.
- Existing risk scores may not capture all relevant prognostic factors.
- The study aimed to identify novel predictors beyond traditional TIMI scores.
Purpose of the Study:
- To identify predictors of 30-day mortality in STEMI patients.
- To evaluate the role of left ventricle ejection fraction (LVEF) and glomerulus filtration rate (GFR) as prognostic factors.
- To develop and validate a new scoring system for 30-day mortality risk stratification.
Main Methods:
- A retrospective cohort study of 487 STEMI patients hospitalized between 2004 and 2013.
- Data analyzed using bivariate and multivariate Cox's Proportional Hazard Regression.
- A new scoring system was developed and its calibration and discrimination assessed using Hosmer-Lemeshow test and AUC.
Main Results:
- Killip class (II-IV) and GFR were significant predictors of 30-day mortality in STEMI.
- The new scoring system ranged from 0 to 4.6, with scores >3.5 indicating high risk (46.5% mortality).
- The model demonstrated satisfactory calibration and discrimination (AUC 0.816).
Conclusions:
- Killip class and GFR are valuable predictors for 30-day mortality in STEMI patients.
- The developed scoring system provides reliable risk stratification.
- Further research may refine this model for clinical application.
Background:
to identify other factors other than the TIMI scores that can be used as predictors of 30-day mortality in STEMI patients by including variables of left ventricle ejection fraction (LVEF) and glomerulus filtration rate (GFR) at Cipto Mangunkusumo National Central General Hospital.
Methods:
a retrospective cohort study was conducted in 487 STEMI patients who were hospitalized at RSUPN Cipto Mangunkusumo between 2004 and 2013. Sample size was calculated using the rule of thumbs formula. Data were obtained from medical records and analyzed with bivariate and multivariate method using Cox's Proportional Hazard Regression Model. Subsequently, a new scoring system was developed to predict 30-day mortality rate in STEMI patients. Calibration and discrimination features of the new model were assessed using Hosmer-Lemeshow test and area under receiver operating characteristic curve (AUC).
Results:
bivariate and multivariate analyses showed that only two variables in the new score system model were statistically significant, i.e. the Killip class II to IV and GFR with a range of total score between 0 and 4.6. Thirty-day mortality risk stratification for STEMI patient included high, moderate and low risks. The risk was considered high when the total score was >3.5 (46.5%). It was considered moderate if the total score was between 2.5 and 3.5 (23.2%) and low if the total score was <2.5 (5.95%). Both variables of the score had satisfactory calibration (p > 0.05) and discrimination (AUC 0.816 (0.756-0.875; CI 95%).
Conclusion:
There are two new score variables that can be used as predictors of 30-day mortality risks for STEMI patients, i.e. the Killip class and GFR with satisfactory calibration and discrimination rate.
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